Silkin Management on Handling Problems

In dealing with problems that can develop in a practice, there are six basic maxims:
1
What you don’t or can’t control loses income. To the degree you are in control of these seven key areas of your practice, you will have a lower-stress, higher-income practice. To the degree you are out of control of these seven key areas of your practice you will have a higher-stress, lower-income practice.
2
Even a poorly run practice can earn enough money to get by on. This is true, but unfortunately it is more of a curse than a blessing as “just getting by” often takes so much of your time and energy that doctors wind up on a “work-a-day” treadmill with problematic and stressful practices. This adversely affects their quality of life and personal relationships and often causes production plateaus well below what their actual production levels would be were they better organized.
3
The real and only reason a practice stops growing or becomes stressful is because the practice owner has reached his or her level of management skill. There is no other reason. Socioeconomic and demographic factors (income per capita, population, number of competing doctors, local economy, etc.) are not the real reasons a practice stops growing or becomes stressful. Though it is true that these factors do have an impact on a practice, it is equally true that there is little, if anything, that an individual practice owner can do to control these factors. The obvious conclusion is: One should invest one’s time, effort, and resources into those things which one can control or have an impact on.
4
How good a doctor you are has nothing to do with how successful your career will be. It is common in any area of the U.S. and Canada to find brilliant doctors struggling to make ends meet while less skilled doctors in the same geographical area are making their fortunes. How well you hire and train your staff, do case presentation, handle your finances, do internal and external marketing, monitor and correct your staff, and the accuracy of your decisions as an executive, will be the primary factors in determining your career satisfaction and financial success.
5
In lieu of executive leadership, accurate job descriptions, office policies, and a strategic program to get them implemented, the staff will invent their own, usually based on whatever is most comfortable or easily done, not necessarily what is best for the practice. Often the command structure in this type of practice is relegated to a “social pecking order,” in which the more predominant staff personalities “rule the roost.”
6
A practice will either sink to the skill level of your staff, or you will bring the skill level of your staff up to meet the challenge of the practice. In short, your problems won’t just go away by themselves. Philosophically you have two choices. Either you’ll be the effect of your environment, or you’ll be at cause over your environment. It’s that simple.

Silkin Management Group on Recruiting New Employees

Who, what, where, when and how.

In any practice or a business, it is a 100% certainty you will need new employees at some time or another, either to replace employees who leave or to help the practice grow. Where do you find the type of people you want to work with, people that you can trust and that will want to see your practice or business succeed? Read on.

NEWSPAPER:

The most obvious source to be used in recruiting new personnel is the newspaper. But before we discuss the ad itself, let’s take a look at some basics.

Never lower your standards when looking for a staff member. Keep your standards high and remember that you not only want a top quality person, but you deserve that person! Your practice and business growth depends upon people who are bright, energetic, sensitive, intelligent and outgoing. Be willing to compete for that type of person.

Also realize that possible candidates, the type of people you are looking for may not be “actively” looking for new jobs. Some of the most qualified individuals already have jobs, but may be looking for a change. These individuals may seem like “cold prospects”, but they actually do “skim” through the want-ads just to see what is out there. So it is very important to develop an advertisement that will attract the person you are looking for.

In your ads, use a larger 2-column ad rather than a standard one-column ad. A larger ad may be more costly, but it could very well pay off by gaining greater, faster and more qualified responses because what you are saying will stand out and be seen more easily by more people.

The Sunday paper is definitely the best time to run your ad. Sunday/Monday is a very successful combination for running an ad as people who are looking will look through Sunday’s paper and continue “looking” at least through Monday’s paper as well. Suburban weekly newspapers are also considered good places to advertise since they often remain in the home all week.

Do not waste your valuable ad dollars by advertising right before a major holiday, as people are less likely to read the classifieds. They are too involved with other matters, and will usually look after the holidays.

DEVELOPING YOUR AD:

Use an attention-grabbing headline to get peoples’ curiosity, such as “Are You Motivated?” or “Do You Have What It Takes To Be My Assistant?” or “Are You A People Person?”

Offer a competitive salary and benefits. Check around your area and learn what colleagues pay their staffs. You can do this by asking or by simply looking in the newspaper under the classifieds. List the salary range. Fewer people will respond if they do not have any idea of the pay involved.

List specific job duties and skills, e.g. “Must have good people skills and be able to handle a busy client and patient load while maintaining a good sense of humor,” or “Must be able to take initiative and think on your feet.”

Say who you are. This is optional but realize that “blind box” ads have a lower response rate than ads that reveal the employer. To avoid being deluged with phone calls and walk-ins, state in your ad that you will not accept applications in that manner. For example, “Resumes only. No phone calls or walk-ins please.”

End your ad with an invitation to action. Tell interested applicants how to apply and to whom, i.e. “Send resume and cover letter to (NAME) at (ADDRESS).

Keep a file of all the classified ads you run, along with a list of responses to each ad. This will help you determine what ads work the best. Also, when an applicant comes in, ask them which features of your ad drew them to the interview. This could come in very useful at a later date.

AGENCIES:

Employment agencies are another source of recruiting employees, but can sometimes be quite expensive. When dealing with an agency, ensure that you clearly understand their policies and arrangements. Have them put this in writing for you.

If you decide to use the services of an agency, be prepared to state the exact requirements for the position, or your time could be wasted by unqualified applicants phoning you.

For example,

TECHNICIAN:

ONE YEAR EXPERIENCE
GOOD COMMUNICATION SKILLS
X-RAY CERTIFIED

RECEPTIONIST:

COMPUTER LITERATE
EXCELLENT PR SKILLS
GOOD COMMUNICATION SKILLS
ONE YEAR PREVIOUS FULL-TIME EXPERIENCE

WORD-OF-MOUTH:

By letting friends, colleagues, and even patients know that you have a position to fill in the practice, you may find that just the right person comes your way. Never rule out the possibility that it might be easier than you think to find that new employee simply through communicating with your own connections.

NOTICE POSTED IN THE PRACTICE:

As mentioned above, one of your clients may prove to be just the person you are looking for to fill an open position. By posting an employment opportunity notice on your bulletin board, you may find an interested patient whom you already know, and who knows and respects you and would love to work for you. If you use this method, construct an attractive, professional and intriguing notice to be displayed. For any interested inquiries, schedule a formal interview.

TEST APPLICANTS:

If at all possible, test all applicants using a battery of personnel tests so that you can increase your odds of finding the best person. Silkin Management Group has a set of three tests that all of our clients use to help in this regard.

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INTERVIEWING AND SELECTING EMPLOYMENT APPLICANTS

The personal interview represents the basic process to use for selecting the best available person for a job. Relying on the interview process for finding the right person demands that the interviewer possesses the necessary expertise for planning and conducting an effective interview.

Great attention must be paid to the selection / interviewing process. By doing so, you will minimize staff problems such as troublesome employees or dissatisfied employees who seek employment elsewhere. While other factors in the working environment have a great influence on the employee’s performance and satisfaction, fewer problems will arise when the selection interview is regarded as the first critical step in hiring and keeping a qualified worker.

Interviewing and selecting employees can become a time-consuming responsibility for the office manager. However, if this process is regarded with high importance, the likelihood of hiring the right person who will enhance the practice increases greatly.

THE INTERVIEWER’S PURPOSE
The office manager must be careful not to enter the interview with any preconceived ideas about the applicant that can compromise an intelligent hiring decision. If, before or during the interview, the interviewer thinks in evaluative terms or reacts to statements from the candidate from a judgmental attitude, several results could negatively affect the hiring decision:

First, an evaluative attitude runs the risk of premature evaluation. If the interviewer reacts negatively to any particular applicant response and thereby decides that the applicant is not suitable, an otherwise valuable employee might be lost.
Second, an evaluative attitude increases the likelihood that important questions might not be asked because the interviewer’s mind is already made up.

While the office manager must maintain judgment concerning the applicant’s “fit” into the organization, the basic purpose guiding the interview must be to get in communication with the applicant and to collect information (facts, explanations, character traits, etc.). That will provide a basis for predicting an applicant’s potential success on the job. The office manager is a data gatherer.

The office manager must use his/her time wisely. Many interviewers tend to waste much and create negative impressions by asking questions about information already explained in a resume or application form. Oftentimes, the interviewer tends to talk too much. The interview should invite the applicant to do the majority of the talking; that is going to be far more revealing to the office manager as to who the applicant really is. The office manager is looking for things that otherwise could not be found on an application or resume such as:

How the applicant feels about past positions
How the applicant feels about types of management
Is the applicant interested in further training and professional growth
How does the applicant work as part of a team
How does the applicant appear to handle pressure

The interviewer is not only looking for the qualifications of the applicant, but also:

their communication abilities
depth regarding goals and motivation
the ability to think on their feet
the willingness of the applicant
the trainability of the applicant

Look for answers and attitudes that demonstrate a sincere interest in contributing, rather than simply what the applicant hopes to get from the business.

Be alert to comments and questions that indicate the applicant’s willingness to learn, to contribute, to be flexible, to take on new duties, and to help out when needed.

COMMON APPLICANT SELECTION CRITERIA

1.Communication Skills: Messages are clear, easily understood; candidate listens well, is articulate and concise.
2.Self-confidence: Seems poised and relaxed; attitude is not defensive or hostile; demonstrates ability to accept responsibility; seems to understand personal feelings and ideas.
3.Sociability: Demonstrates ability to work with others; has pleasant and supportive interpersonal style, able to relate to others with empathy, openness, non-defensive.
4.Ambition and Motivation: Shows understanding of personal goals and priorities; understands attraction of profession or job; capable of acting/working with minimal supervision or guidance.
5.Perseverance and Responsibility: Shows evidence of ability to start and follow through; can be counted on to produce and get results even under adverse conditions or stress.
6.Leadership: Demonstrates ability to influence others toward desired goals and provide appropriate direction and support along the way.
7.Adaptability: Demonstrates an ability to interact or communicate with a variety of different personality styles.
8.Appearance: Personal grooming and dress habits are adequate to the demands of the position.
9.Cooperativeness: Does not appear excessively competitive; possesses give and take attitude.

PLANNING AND PREPARATION
The essence of the hiring decision is to match an applicant’s qualifications with the requirements of the practice as a whole and the requirements of the job. The interviewer must have a thorough knowledge of the job. To evaluate the fit between the job, the practice, and the applicant, the job must be represented in all of its dimensions.

I. Have a thorough knowledge of the job, involving the following:

1.Duties and responsibilities
2.Competency requirements: What knowledge is needed to perform satisfactorily? What skills are required?
3.Enhancement skills: What job-related skills might increase the likelihood of above-average performance?
4.Performance standards: How is competency to be measured?
5.Selection criteria: What qualities would an acceptable applicant possess?

II. Prepare for the Interview:

1.Thoroughly read the resume, cover letter, application and references.
2.Prepare the questions you plan to ask, avoiding repetitious questions already answered on the paperwork; ask open-ended questions to get the applicant talking.
3.Confirm that none of your questions are illegal or discriminatory.
4.Plan the interview so as to avoid wasting valuable time. Failure to plan results in an unstructured interview which is less productive and could appear unprofessional.

FUNCTIONAL OPENING OF THE INTERVIEW:
Opening an interview is functional when it achieves several important purposes:

1.Explains what is going to happen.
2.Establishes rapport with the applicant in order to facilitate the flow of information during the next stage.
3.Actually begins the information-gathering process.

Although it is important to set your applicant at ease when welcoming them to the interview, it is not really necessary to engage in a lot of trivial, “rapport-building” techniques or ice-breakers such as chatting about sports, hobbies, the weather, etc. This can tend to waste valuable time and may even actually create more tension for the applicant who is eager to delve into how they are qualified for the opening.

Remember that this is a professional business meeting, and the beginning of this meeting is more than just to start talking. What is discussed demonstrates how well the interview will proceed later on.

1.Greet the applicant cordially and introduce yourself, along with your title, indicating (if appropriate) how you would like to be addressed.
2.Explain the purpose of the interview and how it will proceed.
3.Indicate why notes will be taken and ensure that the applicant understands that note taking is not indicative of negative impressions.
4.If appropriate, ask the applicant how they would prefer to be addressed.
5.Begin the “rapport-building” and the data-gathering itself by asking questions that are positive and that provide the applicant with an opportunity to begin letting you know who they are.

Example:

“What are some of your most significant accomplishments to date?”

“What personal qualities are represented in those accomplishments?”

QUESTIONING SKILLS
The questions that you ask and the manner in which you ask them determine the extent to which otherwise unavailable information about the candidate will be obtained.

There are some underlying categories that will guide the interviewer in planning specific questions to ask during the interview:

1.Competency: Is the candidate technically competent to perform the required duties and fulfill the required responsibilities?
2.Motivation and Willingness: Given that the candidate is competent, does the person demonstrate the motivation to contribute and the willingness your practice is looking for?
3.Adaptability or “Fit”: How well will the candidate interact in the practice’s interpersonal network? Depending on the specific requirements of a job, the fact that a person possesses a high degree of competency does not ensure that he/she will be able to work with others.
4.Personal Fulfillment: How well will the company satisfy the needs, goals and ambitions of the candidate? The apparent desirability of the applicant for the company does not insure a constructive fit. Both must be right for each other.

KEY QUESTIONS: DEVELOPING A QUESTIONING STRATEGY
One helpful way to prepare for an interview is the format listed below. For each of the key question areas, develop more specific questions you would ask. List two or three questions you would ask. Try to list two or three questions for each area. While these questions below are themselves not asked, they constitute the background from which the interviewer’s game plan or systematic questioning strategy is constructed.

1.Competency: What would you ask to determine the extent to which the applicant is technically qualified to perform the job?
2.Motivation: What questions would you ask to determine if the applicant is highly motivated, willing to utilize those skills that are technical in nature?
3.Adaptability / Chemistry: How will you determine the extent to which the applicant’s work style, ability to work and cooperate with team members, might justify hiring?
4.Satisfaction Potential: Regardless of qualifications, the job must be satisfying to the applicant or you will have a potential problem employee. What will you ask to determine if you are the right organization for the applicant?

Do not ask questions to simply fill time and avoid the discomfort of prolonged silence. To ask the right questions, one must know why the question is being asked and how it relates to hiring criteria. Prior to the interview, make two columns on a piece of paper:

1.On the left, list the qualities or criteria needed in a qualified applicant.
2.In the column on the right, list those questions which you believe will elicit responses from the applicant or which will provide insight about the candidate’s fit with the respective criteria.

OPEN-ENDED QUESTIONS
When developing your questions, use those that elicit information – open-ended questions rather than closed “yes” and “no” form of questioning. Open-ended questions minimize the possibility of an interviewer talking too much and dominating the interview. They also provide a basis for observing the applicant’s communication skills and ability to organize thoughts. They also give the applicant a chance to provide a more complete picture of his or her thoughts and feelings.

CLOSED QUESTIONS
Closed questions restrict the range of an applicant’s response by calling for a factual or yes/no answer. Closed questions are used to gain a clear position or opinion or to establish a point of fact. By their nature, closed questions do not encourage conversation.

The following examples demonstrate how to get at the same basic information with the two different types of questions. The difference will demonstrate why the open-ended question will keep the applicant talking more as well as call for a statement of position when required:

Closed: Do you mind working overtime?

Open: Since some positions may involve working overtime, could you describe the circumstances when you would or would not agree to work overtime?

Or

How do you feel about working overtime?

Closed: Would this position help you achieve any of your goals and ambitions?

Open: Could you describe the ways in which this position might be related to any of your goals and ambitions?

LEADING QUESTIONS
For the most part, these questions should not be asked. They encourage the applicant to misrepresent true feelings or intentions. The essence of a leading question is its implied pressure for a particular answer. The question implies what an appropriate answer should be.

Example: “Working overtime wouldn’t bother you, would it?”

“You wouldn’t mind transferring to _________, would you?”

SECONDARY QUESTIONS
As discussed earlier, your interview will be as successful as you are in engaging the applicant in real communication. Be willing to follow up to a previous response. In this way you are asking for clarification or enlargement of a response.

Examples: “Could you please explain what you meant by…”
“Could you tell me more about…”
“How did you feel about that?”

Secondary questions should be used to probe abstract or generalized responses.

Example: When in response to the question, “What is one of your greatest strengths?” an applicant responds by saying, “My ability to get along with people”. You, as the interviewer need to explore that response to achieve any meaningful understanding of what the applicant has said.

Example; In response to the question, “What are the qualities of an effective supervisor?” the applicant mentions “leadership”. You have no real understanding of the applicant’s concept of leadership. You might ask, “What are some of the qualities you believe leadership involves?”

You want to really know what the applicant is saying and get as clear an understanding of who they are as possible. Abstract or generalized answers must be broken down to more behavioral, specific dimensions for clarity.

COMMON AND IMPORTANT QUESTIONS
Listed below are some of the more common, yet important, questions that can provide valuable insight into an applicant’s job qualifications. They aim at technical and motivational data as well as provide a picture of the applicant’s self-knowledge and communication skills. Some questions may be more or less relevant, depending on the job’s scope of responsibility, complexity and difficulty.

1.What did you like best about your previous positions? What did you like the least?
2.What skills are required for getting along with and working cooperatively with others?
3.How do you expect to be treated by a supervisor or a manager?
4.Describe the qualities of a good boss.
5.Describe the qualities of a good employee.
6.What do you find most appealing about this position?
7.What are the strengths or assets you would bring to this practice?
8.What are your limitations that need further attention and development?
9.What is your definition of a “successful” practice?
10.What is required to succeed as an effective employee?
11.What should happen during an effective performance review?
12.We are looking for an employee that is ________________ (list the criteria). Convince me that you are that person.
13.What goals do you feel this position will help you attain?
14.What does “being motivated” mean to you?
15.(Describe a hypothetical pressured scenario, and ask) How would you handle that?
16.How would you feel about attending seminars to enhance job training?
17.What would you do if you saw another employee violating company policy?
18.We are all defensive about some things. What do you get defensive about?
19.What is the biggest mistake you have made on the job and what have you done about it?
20.We all have difficulty getting along with some types of people. What are the people like with whom you find some difficulty?
21.What are some things you have done that demonstrate initiative and creativity?
22.What do you know about our practice and what we do?
23.What have you learned about yourself from your previous job?
24.If we didn’t hire you, what would we be missing?
25.What are the greatest reservations you have about taking this position if it is offered to you?
26.How do you react to criticism?
27.What does an effective communicator do?
28.Employment is a mutual relationship. What makes you feel we are right for you?
29.In what ways would you be both an easy as well as a difficult person to work with?
30.When you have difficulty with someone, how do you handle the situation? How do you handle defensive people?
31.What do you hope to accomplish through this position that you were unable to achieve in you last one?

CLOSING
Unfortunately, some applicants who are later rejected are misled into believing that their chances for an offer are high. How an interviewer closes the interview not only generates positive feelings about the practice, but can sometimes prevent the filing of a lawsuit. If, because of an inappropriate closing, an applicant is mistakenly led into believing that the position will be offered and then it is not, the natural feeling of betrayal and hostility could lead to a charge of discrimination. To close on a positive note and minimize the possibility of a lawsuit, the following practices might be followed:

1.Indicate that you have pursued all of the issues on your agenda.
2.Ask the applicant if they have any questions or if they feel that there are any remaining issues that should be explored.
3.Avoid any general comments indicating approval or disapproval of the applicant’s responses; don’t build false hopes or unwarranted discouragement.
4.Thank the applicant for providing useful information.
5.Indicate what will happen with the information:

a. Who will evaluate it;

b. When the decision will be made;

c. How the applicant will be notified.

Stand first, indicating finality of the interview, and escort the applicant to the appropriate exit.

Search Engine Marketing for Doctors

By Lisa Thayer,

GoldfishNetwork.com

Surveys show that over 80% of internet users find new web sites by using search engines.

The question that seems to be on everyone’s minds today is “How do I get my website top placement on the search engines?” If you have a website, you may have found other websites above yours when you have looked for your site in Google. In order to answer the previous question, I need to give you a little background on the way search engines work.

There are two primary ways (out of many) that your website gets to the top of search engines: one is to pay for placement, the other is to market and design your website so that it rises up through the page ranks “organically” in search engine results.

Before I begin to discuss pay-for-placement online marketing, I have to get on my soap box and make a special announcement: If you glean nothing else from this article, remember this – having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. A baseline is the point at which you begin a marketing campaign so you can compare the effectiveness of the campaign.

Programs such as Google’s AdWords and AdSense or Yahoo’s Sponsored Search are good examples of paying for placement. Each search engine has their own individual fee structure. The price you pay to advertise in this manner depends on the “keywords” you choose and the competition for those placements. Keywords can be thought of as the words a person would type into the search box on search engines. They can consist of words, phrases, or alphanumerical terms. If you are spending your marketing budget on keyword ads, you need to choose your keywords carefully.

Using keywords that are overly broad such as “best dentist USA” can result in bringing more traffic to your website, but if you only have dental offices in California, that search probably won’t result in a new patient. Conversely, choosing keywords that are overly specific might bring in too little traffic, like “veterinarians who graduated from Purdue in 1983″. Keywords are so important in fact, that selecting keywords has become an industry all its own.

The two top search engines used by the general public are Google and Yahoo. Google and Yahoo also supply some of the smaller search engines such as AOL, My Space Search, Netscape, Alta Vista, etc. with their search results. In fact, if you added up the huge market share of Google it would account for almost 70% of all searches!

As previously mentioned, having a baseline BEFORE you start paying money for advertising is imperative as is tracking results of an online marketing program. You obtain a baseline by having your web designer add a tracking program/ code to your website. We set up Google Analytics on all of our client’s websites.

Google Analytics (GA) is a free service offered by Google that generates detailed statistics about the visitors to a website. Its main highlight is that a webmaster can optimize his/her marketing campaigns through the use of GA’s analysis of where the visitors came from, how long they stayed on the website and their geographical position. Users can define and track conversions, or goals. Goals might include sales, lead generation, viewing a specific page, or downloading a particular file. By using this tool, marketers can determine which ads are performing, and which are not, as well as find unexpected sources of quality visitors.
Many of my clients have asked, “Wait a minute…why is Google Analytics free?” The simple answer is that Google knows that if you have the information to make informed online advertising decisions, you will be more likely to advertise. And, since Google is the giant of the search engine world, chances are they will be able to earn your business.

Next time, I’ll discuss spiders and crawlers and bots…oh my!

Lisa Thayer is owner of
GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients across the U.S. Lisa can be reached at 503-783-0440 or by e-mail: Lisa@GoldfishNetwork.com

Search Engine Marketing – Why Does SEO Matter More In a “Down Economy?’

By Lisa Thayer, GoldfishNetwork.com

The question on many business owners’ minds today is “How should I market my company given the current state of the economy?” The short answer is by placing your marketing dollars in client specific, targeted advertising campaigns that have a built in accountability for measuring results.

In uncertain times, a business owner’s first reaction may be to reduce their overall marketing and advertising budget as part of a “batten down the hatches” mentality. That reaction is prevalent among companies that have experienced some reduction in business lately whether due to “the economy” or for a multitude of other reasons. While that response may give your CFO temporary anxiety reduction, before you know it she’ll be pestering you about declining sales figures.

Now is the time to step back, take a deep breath and make decisive, informed business decisions and steadfastly refuse to respond emotionally to the nightly news. Review both online and offline marketing endeavors looking for those that produce the best return on investment.

Search engine marketing can often produce a better ROI than many offline marketing endeavors due to the fact that spending can be controlled, results can be measured and you can easily make incremental changes to adapt to conditions as they continue to fluctuate. Online marketing also works for you 24/7 without accruing additional payroll expense.

If you stay the course, you may even be able to spot new opportunities and actually capture a larger segment of your market as others react instead of methodically planning a marketing strategy.

The best way to achieve optimal results online is to first have a qualified search engine professional review your website. It doesn’t do you any good to spend money to drive thousands of people to your website if once they arrive on your site the visitors don’t have a compelling reason to do business with you.

When it comes to search engine optimization and marketing “one size does not fit all”.
A good SEO review should advise you in creating “calls to action”, help to solidify your unique selling proposition, present solutions to rectify any design or usability issues, and even identify areas of weakness in your competition.

Once the SEO review is complete, you will be able target your specific customers and therefore be able to maximize your efforts and reduce your ad spend.

Lisa Thayer is owner of GoldfishNetwork.com, a website design and marketing company located just south of Portland, Oregon. GoldfishNetwork.com serves clients in 12 states across the United States. Lisa can be reached at (503) 783-0440 or by e-mail: Lisa@GoldfishNetwork.com

How to Survive Today’s Economic Times

By Shaw Millerman

Not a day goes by without more information coming to light regarding the economic situation we are all experiencing in this country and around the world. It is very clear that we are now seeing the very obvious signs of a national recession, despite whatever spin may be put on it by the politicians from both sides of the aisle. This crisis is not limited to the finance sectors or the housing market and is effecting many people and numerous businesses. It is likely to get worse before it gets any better, and as the economic problems go deep, it could possibly be as much as a decade before we’re able to fully recover.

That’s what’s happening today.

Silkin has worked with health care professionals for over 25 years and during that time, we’ve seen several periods of economic difficulty with different names attached to them. Some called them recessions, some called them “stagflation”, as well as a variety of other names. Whatever cute label one wants to attach to tough economic times, there is no fooling people with the fact that the economy in general, and their specific economic situation is far from ideal. And today, some economists are stating that this is the worst economic situation since the Great Depression of the 1930’s.

During a recessionary period such as this we oftentimes see practitioners “tightening up”, meaning they manage through fear, worry, and reduction. Promotional efforts are decreased and doctors often let go of staff. They may cut corners and consequently the quality of their service may begin to suffer. It’s a proven fact that doctors who act in this manner will begin to lose some portion of their patient base. This can make it a perfect time for doctors who don’t succumb to such thinking to capture more market share and increase their productivity.

Our clients generally thrive during recessions because they know what to do. They’ve learned how to manage their practices through objective means. They know how to effectively market without it costing an arm and a leg. We’ve been through three of these economic downturns/recessions and we’ve seen how our clients are able to take advantage of the situation rather than be the adverse effect of it. In fact, a recent survey of our clients showed that our clients who are trained and skilled in practice management have been increasing their productivity by 10% to 15% during those years the nation has been in recession. And this includes all socioeconomic areas of the country. This type of growth is generally not true for the average practice owner. In fact recent industry surveys have shown an average decrease of 10% to 15% for the average practice during the recessionary period we are now experiencing.

Our clients thrive because they are able to prepare for down economic periods. They make realistic plans based on objective data and systematically hire, train and monitor staff efforts in alignment with a business plan, marketing plan and financial plan. They know how to closely monitor all of the key areas of the practice and thus are in control of the practice. They know if they are understaffed or overstaffed, or if they have under utilized staff. They have efficient systems that keep “busy work” off their desks and don’t have a desk full of backlogged activities.

This is called running good control over your practice. And that doesn’t mean, as some people think, that it results in not having fun at work or not having relaxed staff people or having people obsess constantly over profit instead of paying attention to people and service. It simply means that you know what is going on in your practice, that your staff know their jobs and work well as a team together and, because of that, you and your staff enjoy the work environment much more.

Objective systems are the component that allow staff people to remain calm and competent. When they know their jobs inside and out, it allows them to respond creatively to unique and unanticipated situations. It allows them to be calm and composed even when work backs up or the amount of office traffic increases greatly. Staff become accountable and self motivated because their work is measured by objective statistics. They are productive rather than just busy.

Prior to the current economic situation, we have seen a large percentage of practices and businesses supported and inflated by the bullish economy. It normally does not take superior management skill to grow during such periods. Now that credit is less available and people have less disposal income, it becomes obvious which offices have the management skill and resulting infrastructure capable of handling the change. It isn’t enough to do the same old thing. Every income source must be maximized and must be maximized with the best interest of the patient in mind. Staff must be able to communicate the importance of delivering the highest quality of care without seeming to be solely motivated by profit. Everyday we work with practice owners to put together proper business, marketing and financial plans and help them properly implement those plans in a time frame that allows the creation of a stable infrastructure. We do this so practice owners are able to grow and thrive in a sane manner, during either good times or bad.

To survive any activity, you must be trained and knowledgeable in that activity. You wouldn’t be an effective doctor if you weren’t adequately trained in your profession. It is no different in terms of managing a practice. The business environment is very tough right now. The better you are trained in practice management, the better you will be able to not only survive this economic crisis, but to actually be able to expand during these difficult times. You can accomplish this if you approach management training with the same dedication as your professional training. Silkin Management Group can help!

We have been successfully training doctors in practice management for over 25 years. We offer a complimentary practice analysis for those who are interested in finding out the strengths and weaknesses of their practice and what steps they can take to improve any undesirable practice situations. Through this process you’ll be able to discover where and how improvements could be made that would result in more production, more profitability with less stress. Be sure to let us know if you are interested in scheduling an analysis and we’ll work with you to make the arrangements.

Research and patients…

Researchers Use A Patient’s Own Bone To Accelerate Orthodontics
Description

Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Newswise — Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.
Led by Hessam Nowzari DDS, PhD, Director of the USC School of Dentistry and Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient’s own bone material for the
grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.
Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth. Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as “Wilckodontics.”
USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory.
As the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.
Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed.
Nowzari says that his team believed they could improve the technique by using the patient’s own bone instead of the artificial or bovine graft.
“Given a choice for grafts, nothing is better than a patient’s own tissue,” Nowzari explains. “It encourages new, healthy bone formation in the grafted area. It’s very safe and eliminates the risk of any disease transmission.”

Contact Information
Angelica Urquijo (213) 740-6568 office (213) 271-4189 cell

The 6 basic rules….

In dealing with problems that can develop in a practice, there are six basic maxims:
1
What you don’t or can’t control loses income. To the degree you are in control of these seven key areas of your practice, you will have a lower-stress, higher-income practice. To the degree you are out of control of these seven key areas of your practice you will have a higher-stress, lower-income practice.
2
Even a poorly run practice can earn enough money to get by on. This is true, but unfortunately it is more of a curse than a blessing as “just getting by” often takes so much of your time and energy that doctors wind up on a “work-a-day” treadmill with problematic and stressful practices. This adversely affects their quality of life and personal relationships and often causes production plateaus well below what their actual production levels would be were they better organized.
3
The real and only reason a practice stops growing or becomes stressful is because the practice owner has reached his or her level of management skill. There is no other reason. Socioeconomic and demographic factors (income per capita, population, number of competing doctors, local economy, etc.) are not the real reasons a practice stops growing or becomes stressful. Though it is true that these factors do have an impact on a practice, it is equally true that there is little, if anything, that an individual practice owner can do to control these factors. The obvious conclusion is: One should invest one’s time, effort, and resources into those things which one can control or have an impact on.
4
How good a doctor you are has nothing to do with how successful your career will be. It is common in any area of the U.S. and Canada to find brilliant doctors struggling to make ends meet while less skilled doctors in the same geographical area are making their fortunes. How well you hire and train your staff, do case presentation, handle your finances, do internal and external marketing, monitor and correct your staff, and the accuracy of your decisions as an executive, will be the primary factors in determining your career satisfaction and financial success.
5
In lieu of executive leadership, accurate job descriptions, office policies, and a strategic program to get them implemented, the staff will invent their own, usually based on whatever is most comfortable or easily done, not necessarily what is best for the practice. Often the command structure in this type of practice is relegated to a “social pecking order,” in which the more predominant staff personalities “rule the roost.”
6
A practice will either sink to the skill level of your staff, or you will bring the skill level of your staff up to meet the challenge of the practice. In short, your problems won’t just go away by themselves. Philosophically you have two choices. Either you’ll be the effect of your environment, or you’ll be at cause over your environment. It’s that simple.

You can’t control the economy….

You can’t control the economy…

You can’t control the economy, but you can control your practice.

By: Ken DeRouchie



I have recently been interviewing doctors around the country regarding how the economy has been affecting their practice and what they have been doing to keep their practice financially viable. I have found that many of the doctors I’ve spoken to have simply shrugged their shoulders and accepted the down-turn in the economy. Many say there’s nothing they can do about the economy and, because of that, are producing less and making much less money. At the same time, most of them who feel this way have done little to nothing in terms of making any changes in the management of their practice to combat the exterior forces that are impeding the growth and solvency of their business.

This brings to mind an old saying: “If you always do what you’ve always done, you’ll always get what you’ve always gotten”. Simply put, if everything is changing around you and you don’t change and adapt with it, you will be unable to combat the external forces – very real forces – that are slowing or stopping your practice growth. It is imperative that if you want to continue growing in the economic environment that we are all experiencing, you must be able to adapt the management of your practice to the current state of your area, your local economy, the changing demographics of your area, etc. Most practice owners can grow in a booming economy. We’ve seen that during good economic times. But only those who are have management skills, either inherently or through training, can adapt successfully to difficult times.

In August of 2007 I conducted a user poll on the Solutions Magazine web site in which 169 practice owners participated. The survey question was “The economy of the past 6 years has negatively affected my practice?”. 51% of the doctors answered :yes”.

I decided to follow this up with another user poll in November of 2007. 171 practice owners participated.

The topic of this was “When there are slow periods of the year, I …”.

46% of the doctors replied that [they] “live with it until it picks up again”

24% of the doctors replied that [they] “do extra marketing/promotion to make sure we don’t lose money”

16% of the doctors replied that [they] “schedule vacations at that time”

4% of the doctors replied that [they] “have a hard time making payroll”

11% of the doctors replied that [they] “wish there was something I could do to counter this”

You can see that only 24% of the doctors surveyed were actually doing something proactive to handle the slow periods! Obviously, you aren’t in a position to change the country’s economy, but you can , if you know how, make effective changes in your practice to combat slow periods.

Realize that the above surveys’ were conducted prior to the recent economic collapse. I therefore conducted a third survey in the last few months in which 71 practice owners took part. Since effective marketing of a practice is essential during poor economic periods, I decided to ask the question “On your new patient/client forms, when you ask the question “How did you find out about our practice”, what do you do with the answers?”

65% said [they] “Do Nothing”
1% said [they] “Enter it into a data base then nothing”
20% said [they] “Send a thank you card”
2% said [they] “Too busy to do anything with it.”
11% said [they] “Use this info for future marketing campaigns”

As you can see, only 11% were doing something useful with this vital data!

From these 3 surveys I conclude that:

Many practices across the country are hurting from the effects of the economy.
Most of them aren’t doing anything about it.
When they are getting new patients in they don’t even bother to strengthen or further the actions that got those new patients in.

The ultimate result of all of this is most practice owners that are completely the effect of the economic environment and not in control of their practice.



If this in any way sounds somewhat or a lot like what you are going through, read on. .

Things that you CAN control:

The following list includes links to articles written about specific areas in your practice that YOU DO have control over. If you are feeling a negative impact from the economy, I highly recommend that you hunker down and dig in. There’s a lot of ground to cover here but you will find this time well spent.. You do NOT just have to shrug your shoulders and “live with it”, you CAN take back control of your practice! These articles and others in this issue of Solutions can help you.

- Your appointment schedule – Cancellations/No-shows-rescheduled appointments

www.silkinmanagementgroup.com

Silkin Management Group Rescues Veterinary Practices As Many Hit Bottom

LAKE OSWEGO, OR, December 09, 2008 /24-7PressRelease/ — Silkin Management Group http://www.silkinmanagementgroup.com),
a 25 year old health care practice management firm, rescue Veterinary practices in the what is being called the worse economic times in 50 years with recommendations most faltering practices neglect. The great majority of veterinarians are held in the highest esteem by their clients, whether a small pet owner, equestrian professional or farmer, due to their medical expertise. Yet, many make poor business decisions and are losing their practice.

“In economic turn downs, such as the ones we are experiencing now, we see veterinary practices tighten their belts in unhealthy ways. By this we mean that they get very worried and reduce their promotion,” reports Fred King, CEO of Silkin Management Group. “They may start letting go of staff and making do with fewer personnel.”

Current economic conditions seem to demand that veterinarians cut corners but this causes lower standards of service and patient care. When the quality of service goes down clients become unhappy with their pet or animal’s care and start looking for another vet. That clients demand good animal health care is demonstrated by a 2006 survey of 50,000 pet owners that revealed almost all pet owners feel a strong human-animal bond. About 49.7 percent of survey respondents consider pets to be family, and 48.2 percent consider pets to be companions.

“This situation makes it an excellent time for veterinarians making the correct management decisions to capture more market share and increase their productivity,” explains King. “We help veterinary practices know exactly what to do to in each economic cycle so they are making correct management decisions that continually grow their practice.”

For those veterinarians wanting to take advantage of these tough economic times but who don’t want to start with any financial investment, Silkin Management Group offers a 2 hour practice analysis at no-charge. All the veterinarians’ questions are answered by a veteran senior analyst. Silkin analysts have worked with veterinary practices in every part of the country. They have a wealth of experience and an understanding of the issues veterinary practices face on a daily basis. For more information about Silkin Management Group visit http://www.silkinmanagementgroup.com/offers/analysis.html or call toll free: 800-695-0257.

Silkin Management Group was established in Portland, Oregon in 1983. Since that time the company has focused on delivering consulting and training services to doctors in private practice. Now an international leader in practice management, Silkin has a long standing track record of providing assistance to its clientele that consistently exceeds their expectations. For more information about Silkin Management Group visit http://www.silkinmanagementgroup.com/offers/analysis.html or call toll free: 800-695-0257.

Silkin Management Group
18010 SW McEwan Road
Lake Oswego, OR 97035
Phone: 503-726-1810
Toll Free: 800-695-0257
Fax: 503-726-1719

About Silkin Management Group

Silkin Management Group was established in Portland, Oregon in 1983. Since that time the company has focused on delivering consulting and training services to doctors in private practice. Now an international leader in practice management, Silkin has a long standing track record of providing assistance to its clientele that consistently exceeds their expectations.