I was approached by an orthopedic client at a recent conference. Our firm had conducted a revenue cycle assessment for his solo practice. He told me we had issued a good report with lots of practical ideas for improvement. The problem was he couldn’t get the staff to implement any of them. They would not/could not/did not want to do anything differently and were unreceptive to his requests for new technologies and billing process changes. As the physician did not want to upset the staff, he didn’t push things, but he told me it was like being tethered to a ball and chain. Still, the staff wouldn’t budge. Ultimately, cash flow crumbled and managing the practice became too frustrating, so he took an employment offer from a large group and everyone in the practice lost their jobs.

Increasingly, we find ourselves coaching physicians to recognize staff are not shareholders in the business and do not get a vote on what is best for the business side of the practice. This orthopedic surgeon’s mistaken sense of loyalty to the staff resulted in all of them having to seek other jobs, which was not easy given their outdated skill sets. All of them had, in our assessment, below average reimbursement cycle and technology abilities.