As a veteran healthcare management consultant with more than 30 years of practical experience, I am frequently engaged to help physicians plan, launch, change, or improve their medical practice operations. Lately the calls have been coming with increasing frequency to help recent graduates and hospitalists establish a new concierge private practice. In other instances, the calls are from frightened primary care and specialist physicians (and one veterinarian) who are unsure about the future of their business under healthcare reform and don’t want to continue down the same path they’ve been on for years.
Part 1
In consulting to concierge medicine startups, we typically encounter three types of callers. Each caller gets classified into one of three categories:
1) The go-getters: They’ve decided to take action. We sign an engagement agreement and take care of payment for the initial consultation over the phone with a credit card. As part of the initial consultation, I give them a comprehensive list of things that need to be accomplished.
2) The undecided: They’ve read articles upon articles. They are not sure “if” they want to make this decision, “when” and “which business model” they want to select. They’ve been deliberating for months, perhaps years. They watched others hire a consultant, and then successfully plan, launch and start to thrive, but they don’t want to commit just yet. It’s kinda like me and knee surgery. Yeah, it hurts, but not enough to take action…yet. Someday they will wake up and say, “Yup, today is the day”. Others will say “Nope, not gonna do it after all.” That’s okay, I can relate. I hope that when they decide to call me, I won’t be on the operating table having my knee replaced.
3) Shoppers: They call consultants as if they are shopping for tires at Costco. “Tell me about your services.” Chances are the shoppers that called me have called all my competitors and are still calling. They’ve taken no action. Some have actually called twice as if they forgot they already called. We use a customer relationship management system (CRM). We don’t forget.
The Agile Approach: No lengthy old-fashioned business plan
If no bank or lender will be involved, we really don’t need an old fashioned business plan. They cost money to develop, and by today’s startup practices, usually aren’t practical or viable long enough to open the doors.
Instead we develop work plans and a budget, based on the “To-do” list. As part of the first meeting, I will ask you to check off items in two columns: A) Stuff you’re going to do yourself, and B) Stuff you need us to do for you. This is completed right there in the first meeting. Start to finish. From this list, I assemble my team and we design the work plan (called “sprints”) into bite size nuggets of work deliverable (each with a budget estimate of the team member involvement and expenses involved). Each sprint is divided into achievable goals and tasks which make up discrete projects. Three to four months from the first meeting much of the work can be done – assuming you are ready to take action.
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Lots of startups fail, even when they do everything by the book. Maybe there’s something wrong with “the book”? Perhaps. To me, the single biggest cause of failure in concierge medicine is forecasting fallacy: it comes from taking action based on the belief that you have a good product fit when you don’t, or overestimating its appeal to consumers.
Next: Minimum Viable Product
