Shift Your Role from Employee to Entrepreneur

Physician's Money DigestSeptember15 2004
Volume 11
Issue 17

The E-Myth

Physician: Why Most Medical Practices

Don't Work and What to Do About It

Does this sound familiar: "Most physicianswho own their own practice don't own atrue business, but a job—doing it, doing it,doing it—hoping like hell to get some timeoff, but never figuring out how to get their practice torun without them"? Michael Gerber wrote thesewords in his new book, (HarperBusiness; 2003).

The E-Myth

The E-Myth


What is the E-myth? It's a conceptdeveloped by Gerber and explored in severalprevious books, including (HarperCollins; 1988) and (HarperBusiness; 1995). Essentially,E-myth stands for "the entrepreneurialmyth: the myth that most people who startsmall businesses are entrepreneurs."Expanded, it'salso defined as "the fatal assumption that an individualwho understands the technical work of abusiness can successfully run a business that doesthat technical work."

Collision Course

For many physicians, the scenario rings all tootrue. They are intelligent, high achievers wholearned to practice medicine and naturally assumedthey could go into business for themselves as a wayto have more control over their lives. Instead, theynow find they are working harder than ever—withless satisfaction than ever. "Physicians have hugeexpectations, and more and more, the reality ischanging and coming into collision with thoseexpectations,"Gerber says.

Medicine is certainly changing. But aremanaged care, insurance companies, nonappreciativepatients, and medical liabilityreally causing all the frustration? Gerbercontends that they aren't actually. "Mostpractices fail to fulfill their potential, notbecause of what's going on outside themedical practice,"he writes. "Rather, theyfail because doctors are simply unpreparedfor the business of medicine. Victims of an‘entrepreneurial seizure,'they believe that becausethey understand the technical work—the work of amedical doctor—they understand how to build a successfulbusiness that does that work."

Points to Ponder

Physician's Money Digest

So what does Gerber suggest? Here are just a fewkey points from his book and a recent interview with:

1. Change your role. Do you act like an employeeor an owner? Do you work in your practice or onyour practice? Have you created a job or a business?Gerber says that every enterprise must have a technician,manager, and entrepreneur. Unfortunately, toomany physicians only fill the role of the technician—the doer, the producer. "A technician-dependent practiceis an accident waiting to happen,"Gerber writes."If the practice is to flourish, the doctor must also fillthe roles of manager and entrepreneur."

2. Never be a sole practitioner. This sounds fairlyradical, but Gerber insists these practices simply don'twork—and physicians are failing to recognize thewriting on the wall. "I've never met a physician whois truly happy practicing on their own,"he says. Also,a one-physician practice makes it nearly impossiblefor the physician to break out of the technician role."It's going to get really boring—growth is where thevitality comes from,"Gerber explains.

3. Create a cash management system. Money hasbecome a huge issue in most practices—mostly due todelays in payment from health insurance companies.As a result, Gerber says you need to understand howto predict when money will come in and go out—notjust the amount you're receiving and spending. Mostphysicians, Gerber says, "are not interested in beingliterate about money."Some, he says, don't even lookat statements. "If you're going to manage your businessat all, you need to manage the money. Work tocreate an active dialogue in this area."

4. Recognize the advantages of a turnkey system.In other words, make yourself and your staffreplaceable by creating documented systems forhow things work. Why? Because it helps things runefficiently and effectively, while creating true equityin the practice. The physician can then take pleasurabletime off, open another location with the samesystem, or sell the practice for greater worth.

5. Take your practice to the next level. Gerbertalks a lot about the differences between a practice,a business, and an enterprise. A practice depends onthe doctor, a business depends on other people plusa system, and a business that has been replicated isan enterprise. As an example of achieving the enterpriselevel, Gerber writes about Dr. Jones, whooffers services that "demand her guidance, not herpresence"in many medical settings. He later writesin the book, "Because most doctors are controlfreaks, 99% of today's medical companies are practices,not businesses."Gerber says, "You can't go tothe enterprise level without being passionate aboutthe new role—it demands a new level of skills."

6. Change your attitude. Gerber is empathetic tothe situation in which many physicians find themselves.But he equally thinks "it's about getting outof your own way. Doctors are so unprepared tochange, they become the supreme victim."He says,"The thinking we have is what keeps us where weare."Instead, "Take ordinary subjects and deal withthem from a completely different perspective.Develop a completely new mindset—change the paradigm."He adds, "Bill Gates lives in the sameworld; [he] just sees it differently."

For more information and to purchase the book,call 800-221-0266 or visit

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