Speaker 1 00:00:00 Getting them to do what they need to do now is about, you know, this is what I know. This is what I need to do, and it's not necessarily going to get any better if I don't pay any attention to it. It's like not having your car serviced. It's going to come back to bite you.

Speaker 2 00:00:22 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 myself and Steven A. Dickens, vice president of medical practice services at SVMIC. We're talking about strategic planning and why it's so important in times of uncertainty. Stephen Dickens, thank you so much for joining me today.

Speaker 1 00:00:58 Oh, well, thanks for having me, Austin.

Speaker 2 00:01:00 So for context, we're recording this on April 9th and President Trump's tariffs have taken effect. Countermeasures from the EU and China. as somebody who's been involved in health care for a long time, just what's your take on all this?

Speaker 1 00:01:14 I think we are in a period of uncertainty and craziness.

Speaker 1 00:01:22 you know, I'm I'm sure the president has his reasons for what it is that he is doing, but I will be doggone if I can understand why. So. And I think a lot of people are scared, especially those who have checked their investments in 401 K statements.

Speaker 2 00:01:40 When you talk with practices about strategic planning. especially right now with things changing as rapidly as they are. I mean, what's the mindset that you encourage them to take? How should they be thinking when so much feels unpredictable?

Speaker 1 00:01:52 Well, you know, when when I am talking with them and we are talking about the future, you know, strategic planning has really evolved over the years. It is a. a much more fluid process, more dynamic. We don't really look at three year, five year, ten plans for the most part. There there are some things that'll still fall into that 3 to 4 year category. But, you know, so much of the future is unknown and where we're going to go. What I try to do is okay, you know, you can't control any of this.

Speaker 1 00:02:26 So let's not waste your time there. Know what's going on, understand what's going on and how it might impact you. But try to focus them back to what they do know and the mindset. You know, physicians went to school to take care of patients. The rest of this stuff is, you know, obviously the impacts them. But I try to get them to focus on let's let's talk about your patients, what you can do for them, where we can make a difference in their lives. And that's what brings them the most joy. And if they can find some happiness in that, then it can give them a little bit of relief in the other areas. You can't be miserable everywhere.

Speaker 2 00:03:06 Absolutely. Yeah. so again, there's been a lot of talk about tariffs, especially regarding their impact on medical devices, supplies and equipment. what kind of impact could something like that have on independent practices?

Speaker 1 00:03:20 I think the terrorists have the potential to have a very serious negative impact on all practices, not just independent practices.

Speaker 1 00:03:28 Independent practices will certainly feel any price shifts, more deeply than perhaps a, an integrated system, a hospital system, a national regional system that has deeper pockets. But even even they are going to have to figure out, well, where is this money going to come from? as as much as we like to wish perhaps that there was a finite amount of money, there's only so much. And when we talk about an independent practice, any penny that a physician spends is a penny that comes out of his or her practice. So, you know, I fully expect that we are going to see increased prices in all of these areas where there's, you know, medicines that come from another country, supplies or equipment. I think it probably will put a strain on local resources, that either we don't produce it here in the United States or we're not producing it at the volume that we need to. So companies are going to have to gear up for that. If if you'll think back to the pandemic when there was the run on hand sanitizer and, and, you know, sanitizing wipes and all that stuff, it took paper towels and everything.

Speaker 1 00:04:40 It took months for production to, if not year over year for production to get to the point to meet demand. So we're going to have those issues there. And even if we are able to, you know, get to the point that we meet those demands, are we going to be able to produce it and provide it here domestically? at a comparable price. So it's I. I think it has the potential impact to not only impact practices financially, but it also has the the potential to impact their patients. There may be things that physicians have to say, you know, they'll do the cost benefit analysis, and it's not worth the cost of what it is for us to do this versus what we're going to get reimbursed. And then that leads to patient care issues. So it is a chain reaction.

Speaker 2 00:05:29 If you're running a private practice and hearing about these potential tariffs and or just rising costs in general, what's something that you can do today to start your preparation?

Speaker 1 00:05:40 Yeah, for those for those groups that are worried about this are probably the most two most logical places to start are is there anywhere where we can begin to initiate any cost savings immediately.

Speaker 1 00:05:53 And that answers, for the most part, probably going to be no. I think most practices are running as efficiently as they possibly can, but it never hurts to take a fresh eye, a look at things to see if there are things that we can be doing better. I think it's also a really good time for them to take inventory of what they are using and where it's coming from. you know, as, as all practices are going to be scrounging for vendors, you know, it's going to be the first that establish those new relationships that are going to be able to get the product to, if indeed they can't get it, a product that they can afford. So I think that's important. And as we perhaps go further into this, I think they are going to have to really dig in financially. And okay. Is this is this a service that makes sense for us to continue doing it, what it's costing for us to do it. So, you know, figuring out where can we save, where can we replace the things we may not be able to get, and what are the things we need to continue doing?

Speaker 2 00:06:55 So these tariffs I mean they're often thought of as obviously a finance first issue.

Speaker 2 00:07:01 but do you see them affecting. I mean, I know you talked about patient care, but the daily operations in a practice and what are some ripple effects that, you know, doctors or practice managers might not even be thinking about yet?

Speaker 1 00:07:12 Yeah. Well, you know, as I said earlier, I definitely think this is going to ripple through patient care. the inability to get supplies that are needed to, to do the procedures or to provide the treatment, you know, the same again, we saw during the pandemic when we weren't able to get personal protective gear and practices were having to improvise with that. you know, necessity is the mother of invention, or so they say. So I think that's where we're going to see groups. Okay. Are there things that maybe are no longer in use that have been replaced with some new technology or new product, and we can revert back to some earlier version of something we used. I think that would be a really good thought there. You know what? What are we using now and what is an appropriate substitute? Who'd, You know, doctors do not want to put themselves in a position where they where they are doing something that is contrary to the, standard of care.

Speaker 1 00:08:12 But I really think that's where they need to look at their practice. And, and again, the assessment of what can we do differently that will still provide the same level of care.

Speaker 3 00:08:29 Say, Keith, this is all well and good, but what if someone is looking for more clinical information? Oh.

Speaker 4 00:08:36 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.

Speaker 2 00:08:49 So strategic planning I mean it can often sound like a big abstract idea. how do you help practices make strategic planning feel real and actionable? I mean, especially when they're facing these things like policy changes or staffing issues, Financial pressures.

Speaker 1 00:09:05 Yeah. You know, you raise a good point. you know, many, many groups do see strategic planning as some big hairy monster and something that is that is overwhelming. And strategic planning really is just a process. It it begins with, you know, collecting data. What are the internal and external factors affecting the organization? And as we're talking here today, policy changes and, you know, tariffs or those kinds of things or external changes as we talk about staffing changes, that's really more internal.

Speaker 1 00:09:39 I think the key players, whether that's the, the group's lead physicians, their board, or maybe all of the physicians, depending on the group size and their administrative team, need to sit down and, okay, what are the biggest issues facing us? And then prioritize. And that's where a lot of groups get lost. They come up with this big list of things that we need to do that we need to get done and they get lost because it's so overwhelming. You can't do everything all at once. It just is not realistic. So what I like for them to do is to prioritize, okay, what are the things that are going to make the biggest difference, and what are the resources we can allocate to those. And once they've done that, somebody has to be accountable. Somebody has to be in charge of keeping the process moving. And then from there, everyone has to understand why it is the group is doing what they're doing. And I really think at a time like this, to the issue of staffing changes, you know, there's staff there.

Speaker 1 00:10:42 They're watching the news as well. They're seeing all of this. They're all wondering, what does this mean for my job? And so be talking to the staff. they may have, you know, great ideas that would be helpful here. Oh, well, maybe we could do this differently. Well, we're doing this piece of this process, and it takes this extra amount of staff time or it takes these resources. Sources. Could we maybe do something different? Maybe it's time for an innovation taskforce or committee, whatever you want to call it, within the organization and when groups are doing something like that. I think that it's important to bring together people from all areas. Where can we cut pieces out of the process that do not impact quality of care, that do not create risk? so those kinds of things where people can see actionable results coming from the conversation and when they understand why they're doing it, that creates the buy in. I think that's what makes the strategic plan actionable and what makes it feel real to people.

Speaker 1 00:11:42 It's what brings it home to them.

Speaker 2 00:11:45 What are some signs the practices should be watching for? To tell them that their their strategy might need a reset?

Speaker 1 00:11:52 well, you know, if if they're not actively talking about the plan, then either we've not done a good job of communicating the why of it and what it is that we need to do. if people are just kind of like, oh, this isn't going to make a difference, they become lackluster about it. That's the time to push the reset button. If people no longer understand what we're doing or why we're doing it, then we've lost something there. And those are really essential elements. So I would I would encourage practices to watch for changes and attitude. canceled meetings where we're supposed to be talking about this. you know, we never really get around to it on the agenda. We don't put it on the agenda or the. Oh, well, it really doesn't make any difference. Anyway, so that lackadaisical lack of attention, is indicative that there's a problem.

Speaker 2 00:12:51 Yeah. Makes a lot of sense. the practice leaders, I mean, generally, we've talked about it with, you know, these burdens, they're they're swamped with these administrative tasks on top of clinical responsibilities. Yeah. How do you make the case? You know, for carving out time to think long term when the day to day feels so overwhelming. Well.

Speaker 1 00:13:11 It's one of those things that, you know, making the case is as simple as, do you want to continue to be in practice? do you want to continue to provide quality patient care? It's it's about understanding the necessary evils. You know, it's you know, we all have to do a lot of things that we don't like to do to get the result we want. And I think that's where it is about making the connection that, you know, I don't have time to not make the time. And the problem is not going to it's not going to go away. And whatever it is, whether it's we're talking about what's going on in the environment right now or whether it's something else.

Speaker 1 00:13:58 And, you know, we all have the exact same number of hours in the day. And it usually is about priorities and keeping your your practice open, keeping your patients cared for, keeping your staff engaged. Those all need attention. Those all need focus. And it's about the parties, about the leaders, the physician leaders, the administrative leaders understanding that just getting through the day doesn't deal with any of those things because time goes so quickly. You know, a day turns into a week, turns into a month, and you've let what might have been something you could have dealt with now snowballed into something that you can't deal with. So I really think it's about getting them to do what they need to do now is about, you know, this is what I know. This is what I need to do, and it's not necessarily going to get any better if I don't pay any attention to it. It's like not having your car serviced. It's going to come back to buy bite you.

Speaker 4 00:15:08 Oh, you say you're a practice leader or administrator? We've got just the thing.

Speaker 4 00:15:12 Our sister site, Physician's Practice. Your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physician's practice.

Speaker 2 00:15:26 From your experience working, you know, with practices over the years. Do you have a story of a specific example when strategic planning made a real difference?

Speaker 1 00:15:35 Oh, I do have a story. I don't know if I should tell it. I've, I've done a number of strategic planning, meetings over the years, and I always like to meet with the key players before the meeting. And that is, you know, the lead physician at a minimum, and the practice executive, you know, always at least those two. And I typically, depending on the size of the group, like to get a couple of other physicians. You know, I always want to know who they think is supportive of what they think. Always. Also want to know who they think doesn't agree with them so I can get the other side of it. I like to bring I like to go into it knowing what all of those different views are.

Speaker 1 00:16:16 And, you know, there are generally some some physician surveys or, you know, depending on the vibe I get, I'll do physician interviews as well, and I'll, I'll vary that number. And that's just a based on my gut and experience kind of thing. And I remember this one group and this has been a number of years ago. So maybe all the players are gone, that I went into and I met with the lead physician, I met with the practice executive and, and, you know, I could hear what they were saying, and it was it was a relatively small group. And but they did have several offices. And I talked to a couple of different positions, and we did the surveys and got the the data back. And what showed in the data was that there was one of the locations in the practice was really not very happy. And the staff comments and the physician comments and the administrative comments all seem to direct it toward a particular physician. Okay. And I see all that and think, okay, well, this ought to be interesting when we get into the meeting because I do share all the data.

Speaker 1 00:17:24 It's anonymous. redacted if it is identified. And so but I just throw it all out there. Let's attack the elephant in the room. So this particular doctor is is there because this doctor is the lead physician in that office. And we're going through all of this and we're having this conversation and it's, you know, feelings are getting hurt. And it's been getting, you know, little tents or whatever. And the moment was when we were having this discussion and we got the doctors to a place of comfort where they said what they thought. And we had the survey data here from everyone else, including the staff. This one doctor finally just kind of got this very, you know, pensive, reflective look on their face and, you know, kind of did the head down thing with their head in hand and then finally looked up and said, oh my gosh, I'm the problem. And it was just everything changed at that moment because they realized what was being said was true. And it wasn't that they were a horrible clinician, it was how they were coming across.

Speaker 1 00:18:37 And so it created an opportunity for this physician to embark on some leadership training. And everything that comes out of strategic planning doesn't have to be we're going to build a new building. We're going to buy a new electronic health record system. It can be about identifying the simplest of things that we have a process that doesn't work. People aren't happy with the compensation formula, i.e. we have a problem we haven't addressed. And I've always thought back to that moment that it changed that doctor's life and it changed that practice for the better. And it was a good day.

Speaker 2 00:19:16 Yeah. I mean, that's really great. those are all the questions that I have prepared for you. Is there anything that we didn't talk about that you think is important to share?

Speaker 5 00:19:24 You know.

Speaker 1 00:19:25 The only possible. Really ray of hope I can see in any of this is that, you know, we've had a real staffing issue in medical practices for the last several years, and there are a variety of reasons around why it's been difficult for practices to retain staff.

Speaker 1 00:19:44 you know, a lot of our frontline workers are lower paid. And, you know, it's really easy for them to jump industries or even jump work locations within healthcare and, you know, make another quarter $0.50 dollar an hour or whatever. So we saw a lot of that. But we also saw with a lot of those people who went through the pandemic that they realized that if they stayed home and cut out the expenses of daycare and eating out and gas and those kinds of things, and tighten their belt a little bit, that maybe they could make a go of it. Staying home. Certainly we saw a lot of people who chose to take retirement at that time. They said, oh, okay, I can do this. I'll be happy at home with the shifts, with the tariffs. And, you know, we're, you know, we're seeing some government employees being displaced and the concern about rising prices. We may suddenly see a group of people willing to come back into the workforce, or a group of people that, you know, have lost their job for whatever reason, that that that may open opportunities.

Speaker 1 00:20:49 I can't say that I'm terribly hopeful for any of that, but but that is the only thing that all of this may change the labor market yet again. And we'll see what impact that might have.

Speaker 2 00:21:02 All right. Well, Stephen Dickens, thank you so much again for taking the time today.

Speaker 1 00:21:06 Well, you're very welcome. Austin. Thank you for having me.

Speaker 2 00:21:12 Again, that was a conversation between myself, medical economics assistant editor Austin Littrell and Steven A. Dickens, vice president of medical practice services at SVMIC. 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 please, subscribe on Apple Podcasts, Spotify or wherever you get your podcasts so you don't miss the next episode. Also, if you'd like the best stories that Medical Economics and physicians practice publish delivered straight to your email six days of the week, subscribe to our newsletters at MedicalEconomics.com and PhysiciansPractice.com. Oh, 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.

Speaker 2 00:21:54 Off the chart, a business and 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.