Zed Williamson 00:00:00 You know, burnout does not come from busyness, doesn't come from work. It doesn't come from working hard. It doesn't come from feeling like you ran out of time. It comes from feeling like you're paddling, but your oars not in the water.

Austin Littrell 00:00:19 Welcome to Off the Chart: A Business of Medicine Podcast, featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Austin Littrell. This episode features a conversation between Medical Economics Editorial Director Chris Mazzolini and Zed Williamson, founder and CEO of Physician Growth Accelerator. The two discuss the biggest challenges facing private practice physicians today, from burnout and administrative burdens to financial stability and the complexities of running your own practice.

Chris Mazzolini 00:01:01 Zed Williamson, thanks so much for joining me today.

Zed Williamson 00:01:03 Appreciate you having me.

Chris Mazzolini 00:01:05 Let's let's start off let's talk about physician growth accelerator. what is it and what's your mission?

Zed Williamson 00:01:12 Sure. I'll kind of give you a foundation of where it came from. I started my company in 2011, and the company was built on this idea that we could put ideal patients into private practices.

Zed Williamson 00:01:25 that helped with the functionality of the practice, the profitability of the practice that helped them build a healthier business side of the practice. The problem was we would have the same inputs going into multiple practices, but not the same outputs. One client would be so excited they're over the moon and someone else would go, I don't know. I don't know if I noticed anything, and that's an impossible outcome. Basically, the way I kind of view things from a system mindset is if we have the same inputs and we have different outputs, there's a reason beyond what the input for that. And that's where the idea of the Physician Growth Accelerator came from, because we found that there were so many internal constraints within the business side of a private practice, that it was holding the practice back from achieving what they really wanted to achieve. And so the Physician Growth Accelerator is a do it with you consulting for operations and coaching for leadership. And I say do it with you. Because first of all, consultants and coaches drive me nuts.

Zed Williamson 00:02:26 The idea that someone just comes into your business and say and says, hey, that's broken, you should fix it. Well, yeah. No kidding. I know what I'm looking for is how. So what we do is we work with the clients on how to fix these problems, and it's been incredible because we dig through the entire business. There's nine points of constraint, including the team, culture behaviors. And it's unbelievable what you can achieve. And our mission has been the same actually, since I started the company in 2011, is we are here to help people realize that they don't have to live the way they're living. And it it really kind of. This may sound a little cheesy, but it breaks my heart to think that there's someone who has an independent private practice and they're not excited going to sleep Sunday night. That drives me nuts. Everybody can be excited and going to sleep Sunday night. Looking forward to Monday.

Chris Mazzolini 00:03:22 Yeah, you know, that's one of the things we hear about from our physician audience all the time is just the struggle, the burnout.

Chris Mazzolini 00:03:29 You know, the, all of the challenges that the the lack of work life balance, you know, all the different ways you can kind of like, you know, get to the fact that they're unhappy with their job. Right? So, you know, let's go into some of what, you know, you guys are doing and talking about at Physician Growth Accelerator. in terms of practical strategies, what are what are some of the things that that practices and can do to, to both kind of, you know, keep their practice financially healthy while also, you know, the other important aspect is to keep it clinically excellent, to make sure the patients are being cared for the right way, at the right time and all of that stuff.

Zed Williamson 00:04:10 Sure. You know, so we're always going to assume clinical excellence like that has to be your focus. That has to be number one. Patients are trusting you. They're putting the most important thing in their life in your hands. And that's got to be number one.

Zed Williamson 00:04:23 And what happens is sometimes people think that focusing on that can only be the opposite of business health. And that is not the case whatsoever. What I would say is, and this is kind of a big idea, but don't treat your business like you treat your patients. Here's the problem. Physicians go to a lot of training. Physicians can learn to be extraordinary business people. They have to unlearn what they learned to be extraordinary physicians. And the reason is, is because you experience your patient In a glimpse of their lifespan, and you're dealing with what is the issue in that exact moment and trying to do your best to fix what is not fixed. Unfortunately, that's typically what happens when they think about business issues and they go, oh, this is the problem, let's fix it and then move on. That doesn't work in business. In business, you are in it the entire time. We have to think about the entire process. this last week, I was actually visiting some universities in Colorado with my younger son.

Zed Williamson 00:05:30 He's a junior in high school right now, and one of the schools we visited is a School of Mines. And he's he's got a science mind and is is going to go down the path somewhat. And just from conversations and some of the the cool projects they're doing, the idea of, of space travel came up. And it's interesting, if you were to build a rocket to enter space, someone might make the mistake saying, well, the most important thing is to have a, an engine and propellant that can get you out of the Earth's gravitational pull. That's a mistake. But that's how physicians typically treat their business. The reason it's a mistake is because there are so many other variables. What you need to do is you need to have a vessel that can withstand the pressure of the pounds of force needed to exit the Earth's atmosphere. And you have to think from the entire system, not just this one. Like, oh, I just need more patience. Or patient visits have to be shorter or we need to answer messages better.

Zed Williamson 00:06:33 That's what puts someone down the wrong path.

Speaker 4 00:06:40 Say, Keith, this is all well and good, but what if someone is looking for more clinical information? Oh.

Keith Reynolds 00:06:46 Then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again, that's patient care online.com.

Chris Mazzolini 00:07:01 Let's talk about practice culture. You know, among the physicians, the staff, front desk, back office. what are the what's the benefit? I mean, this is maybe an obvious question, but like, what's the benefit of a supportive, cohesive culture? And how do you get there is maybe the more difficult part of the question.

Zed Williamson 00:07:21 Sure. You know, I don't know that I would necessarily believe in what a in the definition of a supportive and cohesive culture. because you could have a supportive and cohesive culture and still be low performance. Right? So every practice has a culture. A culture is just a group of people, behaving in a way, culture is just, now what you can do is you can specifically drive a culture to be a certain way that supports what the goals are from the practice.

Zed Williamson 00:07:54 and this could be, you know, excellence in patient care. Patient experience. Business. Business. Health. These are all driven from culture. Now the importance of it is massive. It's kind of like, if you wanted to build a mansion, but you only had a $5,000 budget to build your foundation. You're not going to have a mansion because the foundation won't hold it. And that's what culture is. Culture is the foundation from which you can build the rest of your business from. Now, the way you create a culture on purpose is by driving behavioural values. And I always emphasize the word behavior because we are all in control of our behavior. Chris, I can't make you angry. You know, I might say something, and if you have a belief, you could choose to be angry, but I can't make you angry. You would not want to give that power to another human. And cultures generally turn into these defensive places where people are saying things are done unto them, and then it's allowed and it kind of stacks on top of each other, when in reality we are all completely in control of our own behavior.

Zed Williamson 00:09:02 And if you drive behavioral standards that support the goals of the practice, you attract the best employees. the worst employees go away and you have, you know, you're hitting your goals. Patients are happy. It is absolutely the foundation in which you can build everything on.

Chris Mazzolini 00:09:22 So being able to forecast revenue, have a stable revenue cycle, you know, obviously some of the key aspects of running a practice financially. So can you talk a bit about some of the approaches and tools that private practices can, can use to sort of better forecast and stabilize their their revenue cycle?

Zed Williamson 00:09:42 Yeah, absolutely. You know, one of the most important things that a lot of businesses and other industries do, that medical practices typically don't do is they understand the lifetime value of their customer. So one of the most important numbers to understand is what is the lifetime value of your patient. And then segmented by patient type. So you truly understand what is this inventory of time that you have and what is it worth to you. if I talk to five different practices and I ask them the question, are you busy? I'll get answered yes five different times.

Zed Williamson 00:10:20 If I ask them to define busy, I'll get five different answers. And what this is showing you is the variability within a practice that can be adjusted massively affects the potential of what that practice can achieve. And so the things that you measure, we categorize them as lead and lag measures. A lead measure is something that you have behavior over. For instance, if I wanted to get stronger, a lead measure might be I'm going to do ten pushups a day every day. A lag measure is maybe I want to measure how strong I am. So then I'm lifting a weight to see what is my strength. Well, the same thing can happen in business. There's lead measures that give you an idea of where you're tracking towards. So utilization of appointment slots, lifetime value of patients. how much time it takes per patient type, what the revenue associated with and then lag measure is what happened. Okay. You know, February is over. March is over. What happened in that time frame from a total patient's revenue, what was expected that didn't happen.

Zed Williamson 00:11:28 What was unexpected that did happen. And you when you consistently do those things, you can create a model that tells you what's going to happen. It's kind of like, if you put an address into your, you know, Waze or Apple Maps and it tells you you're going to arrive at 151 and let's say it's a 50 mile drive or whatever. And you're thinking to yourself, man, I really like to get there before 151 and so you are hauling. But on the interstate you're like, remember? And you still get there at 151. And it's because it knows the data of all the little points of constraint you're going to interact with. Yeah, maybe you hit 80 on the interstate, but you still had stoplights, you still had all these things. And when you measure all those things, you know, you can get to your destination exactly at 1:51 p.m..

Chris Mazzolini 00:12:17 So one of the things that our audience tells us repeatedly this has been, I think, you know, as long as I've been doing this and since it's been about 12, 13 years, I've been with medical economics, and they always tell us that their number one challenge is what I, what we call administrative burdens.

Chris Mazzolini 00:12:35 So we're talking about changing reimbursement models from payers. we're talking about prior authorizations, coding changes, regulatory requirements, you know, maybe to do with value based care or some other, sort of, new value based payment model. So like obviously each of those has different aspects and different ways of confronting it. But like in general, what are some strategies for practices, that you recommend to sort of help stay ahead of these changes, stay up to date without, you know, having business challenges, patient care challenges and those kinds of things.

Zed Williamson 00:13:16 Sure. You know, so it does come down to a process. you know, what is your current auditing process of what exists today? How can we simplify it? who owns it? This is typically where the issue comes from. People will say administrative burdens, but they're only burdens because they ignore them until they don't have to. Right. If if that's the only reason, it's a burden if we actually plan for it and there is a role in the organization, I don't mean hire a new person.

Zed Williamson 00:13:47 but here's what happens in roles is we hire someone and go, here's your tasks, here's what you should do. Oh, wait, you know, we have to do this every once in a while. But no one owns anything. No one's actually responsible for the specific outcome. And that that actually makes employees happier when you can give them responsibilities that they are, they own the outcome. They may not be doing the work specifically, but so what we like is assigning that ownership internally. Who is the hero related to which administrative burden understanding, and what are the what are the lead measures that we would be looking for to give us an idea that we need to make a shift? and like I said, it's it's typically a burden because it's reactive, not proactive.

Chris Mazzolini 00:14:32 So let's talk about technology. Technology has always been a double edged sword for physicians, where there's always been the promise that it can help streamline operations, improve things. You know, keep your medical records, digitize all of this stuff.

Chris Mazzolini 00:14:48 But, you know, each each new technology also often introduces its own set of challenges, anything from extra costs to things that don't work right. You know, contracts, it's hard to get out of all of those things. And so, you know, we're talking about things like EHRs, which are, you know, old hat at this point. But now we also have some newer stuff like generative AI that, you know, may have a role in a practice in terms of helping with correspondence, helping with claim denials, those kinds of things. So just in general, how how do you think, you know, private practices should approach technology as sort of a grab all term?

Zed Williamson 00:15:25 Yeah, it's we see it a lot where you get this kind of technology creep, meaning you sign up for something, it's not really what you expected, and then you sign up for something else and this and that and the other. And lo and behold, you have, you know, 14 subscriptions for 13 tools you don't use.

Zed Williamson 00:15:47 Right? And or you don't use them. Well. And this goes back to the foundation of how they're taught to treat patients as opposed to how you interact with business. The companies that are selling you, those tools, it is their job to help you uncover a pain that you have that their tool might be able to solve. The problem is they generally are Tylenol for a sore elbow. You know, you are not addressing root cause typically with technology. I love technology when you're using it to accelerate the foundation that you have actually created to be healthy. So an example I'll just use a car, you know, if you have a car and let's say it's a high performance car and you like to drive fast, we'll go back to driving 80 miles an hour on the interstate and someone tells you, hey, we've got these fancy new seats, and it's going to make your car drive faster, and you don't know enough about cars that. Well, you know, I do like those new seats. It doesn't help, but if you actually understand how the engine is structured and tuned and what actually gets more performance out of the car, and you do everything you can with the car you have now and then someone is able to say, hey, here is a bolt on turbo or whatever.

Zed Williamson 00:17:11 Now you can actually get more horsepower out of the car. It's the same with technology. it's easy to sign up for stuff when you're in pain and you're frustrated and you hear a complaint, you're like, it's ridiculous. This is broken. Just fix it. You know, find a service that handles the text message to patients or whatever. And that's where it comes in. So to me, root cause analysis, make that foundationally strong, then use technology to accelerate.

Keith Reynolds 00:17:40 Oh you say you're a practice leader or administrator. We've got just the thing. Our sister site Physicians practice.com your one stop shop for all the expert tips and tricks that will get your practice really humming. Again, that's physicians practice.com.

Chris Mazzolini 00:17:58 Earlier you mentioned, you know, this idea that physicians they obviously have their training mindset, right. Their, their years of medical training and the years in practice dealing with, you know, clinical challenges, what's in front of them, those kinds of things. So, and that obviously sometimes that's not different and that's a bit different of a thought process.

Chris Mazzolini 00:18:19 Then, you know, building a sustainable business. So what are some ways that physicians can, you know, when they need to shift, you know, shift their thinking, to, you know, kind of be able to do both of those roles?

Zed Williamson 00:18:33 Yeah, I think one of the easiest ways, and this may sound weird, is imagine that you lived with your patients. You know, if you spent 24 hours a day with your patient for years before they came in for their visit, what would be different in how you interact with that treatment? Because your business, you are with it 24 hours a day, whether you're in it or not. It's mentally there. And the key is setting up. Well, first let me just kind of squash something. It drives me nuts when I hear people say, doctors just don't make good business people. People say it and it drives me nuts. It is a ridiculous notion because this person has spent so much time learning. They can learn anything. If they can learn what they know, they can learn anything.

Zed Williamson 00:19:24 So first it's get that out of your brain, get that kind of self like, well, I'm just not good at business. That doesn't exist in you. You just haven't learned these different pieces yet, which, you know, you're good at learning. You can learn them. So I think that's number one. But number two, going back to my original statement, imagine if you lived with your patient, you know, kind of the guidance and what you'd be measuring so you wouldn't ever have to deal with what they showed up that day because they showed up too late. Right. That's the only reason they're they're typically seeing you is, is it's gone on a little long.

Chris Mazzolini 00:19:57 Now, I'm picturing, you know, a physician standing behind a patient at their cupboard being like, are you sure you want to eat those potato chips? So yeah, that's that's fun. in terms of, you know, where to get started, right? So if, if, if I'm a physician and I'm listening to this and, you know, I know, like, like you were saying, I know, like what some of the root causes are, I know it's some of the challenges I'm dealing with, either from like a staffing culture perspective or, you know, from a revenue side of things, you know, and I'm thinking like, how the heck, you know, I got to see 20 patients tomorrow and I got to do a bunch of charting and I got this and that.

Chris Mazzolini 00:20:36 You know, I want to like, I want some easy ways to get started. Like, so what are 1 or 2 things that a physician who's listening to this can, you know, get started this month. Right. Two changes that to kind of get you on like a better road.

Zed Williamson 00:20:53 Yeah. No, it's it's such a great question. you know, it's hard for us to get somewhere if we haven't identified the destination. So the number one thing I would say is start putting down what your destination is. The end of this month. What is the measurable destination? Maybe the end of six months, the end of this year. If you walk in, you know, to the office on December 31st, the end of this year, and you are witnessing this thing and that's the destination that you want to achieve. Simply doing that is going to put you ahead, because what happens is, like you said, I've got 20 patients to see. I'm charting, I'm doing this. Your head comes down, right.

Zed Williamson 00:21:42 But we are running a major race, owning a business. And I don't know about you, but I would not want to run many races staring at my feet. It's not going to end well. And simply deciding what that destination is. Lifts your chin a bit so that you can see where you're going. And your brain is really smart. We have a pretty, pretty awesome, computation device up in our skull, and if we understand where we're trying to get to, our brain will help us realize that we are going off track. if you know that you're going to achieve a specific destination and then your day to day work doesn't feel like you're getting there, you'll be aware of it. If you don't state the destination, you'll get lost in your day to day work, and five years will pass by and your five year goal is going to be the same as your last five year goal, because you never actually brought anything closer to your immediate time frame for you to act on. So I would think it's just one thing, and that is state your specific destination.

Chris Mazzolini 00:22:49 Before we wrap up, I, I wanted to go back to something you mentioned near the beginning, and that was, you know, this idea that like, it's it's a sad it's sad that, you know, so many physicians are going to bed Sunday night and being and dreading going to the practice. And I wanted to kind of, finish up by talking a little bit about some of those, those issues. And, you know, the fact that that doctors that there is a high burnout crisis with doctors, some doctors who are mid to late career are thinking about, you know, how can I get out early, you know, should I sell my practice and just, you know, unload this burden? so I guess what I'm asking is like, what are your thoughts about how we can create from a larger perspective, a better working situation, a better career situation for these private practice physicians, whether that's, you know, stuff they can do, you know, within their own practice or, you know, from a larger, you know, advocating for the profession sort of, sort of aspect, you know, what are your thoughts on how we can, you know, get rid of those Sunday Scaries for the for the doctors.

Zed Williamson 00:24:01 You know, burnout does not come from busyness, doesn't come from work, doesn't come from working hard. It doesn't come from feeling like you ran out of time. It comes from feeling like you're paddling, but your aura is not in the water. That's where burnout comes from. And when you talk to someone who's frustrated Sunday night about Monday, it's because they don't feel that they're affecting anything. That you could skip a week and nothing is the same. And we hear so often from practices, I know, I know what's broken. I just don't know how to fix it. And when you're paddling as hard as you're as hard as you can, but the ore is not in the water, that is mentally exhausting. And so the key is we have to understand what really matters to us. You know, what drives what we're doing because we can get lost in that. You know, there's you go down a path and you're working hard and bing, bang, boom. And three years, five years, ten years, 12 years goes by and you don't even really know why you're doing what you're doing anymore.

Zed Williamson 00:25:13 And so it's about rekindling what that passion is, what that Y is. So that Sunday night when you're going to sleep, the reason you're excited is because you're taking a step towards that, why you're creating what that powerful vision is for other people to witness and be a part of. and I think in this is a symptom of private practice, businesses being told that, you know, don't worry about it being a healthy business. You're you're not good at business. Just see patients. And I think this is a symptom of it, where you have a really powerful line. These patients lives are very important and you're affecting them. The team that works with you, you're affecting them. They're going home. They're affecting other people. If you can find where that passion is and what you do and the things you achieve, that's when that order starts to feel like it's in the water. And Sunday night becomes pretty exciting. And you can you start wearing your gym hat for Monday?

Chris Mazzolini 00:26:18 Zed Williamson, thanks so much for joining me today and sharing your insights with that audience, I appreciate it.

Zed Williamson 00:26:23 Thank you. Happy to be here.

Austin Littrell 00:26:35 Again, that was Medical Economics Editorial Director Chris Mazzolini and Zed Williamson, founder and CEO of Physician Growth Accelerator. Interested in hearing more from Zed and his team? Starting this Wednesday, March 19th, Medical Economics will be featuring new episodes from his Physician Growth Accelerator podcast on MedicalEconomics.com, so be sure to check them out! My name is Austin Littrell, and on behalf of the whole Medical Economics and Physicians Practice teams, I'd like to thank you for listening to the show, and ask you to please subscribe on Apple Podcasts and Spotify so you don't miss the next episode. Also, if you'd like the best stories that Medical Economics and Physicians Practice published delivered straight to your email six days of the week, subscribe to our newsletters at MedicalEconomics.com and PhysiciansPractice.com, and be sure to check out Medical Economics Pulse, a quick-hitting news podcast that offers concise updates on the most important developments affecting your practice, your bottom line, and the broader health care landscape delivered by the editorial team at Medical Economics.

Austin Littrell 00:27:30 Off the Chart: A Business of Medicine Podcast, is executive produced by Chris Mazzolini and produced by Keith Reynolds and Austin Littrell. Medical Economics, Physicians Practice, and Patient Care Online are all members of the MJH Life Sciences family. Thank you.