Morning Coffee and Reality Check with Dr. Muroff

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Another day of RBMA-ing has begun, and I’m starting it off right with “A Half-Dozen Tips for Improving Your Practice,” the presentation from Lawrence Muroff, MD, president and CEO of Florida’s Imaging Consultants Inc. Muroff can always be counted on to tell it straight, even when the news is hard to hear, so I’m interested to see what kind of reality check he’ll be serving up this morning. From the looks of this packed ballroom, I’m not the only one.

“Things are nasty out there, and radiologists are in a profound sense of denial,” he began. “There are going to be winners and losers, and the winners are going to be led by the business executives in their practices. You hold the future as to whether your practices will be successful.”

So what differentiates great practices from the rest? Muroff said it’s two things: effective governance structure, which very few radiology practices have, and strong business infrastructure. But there are other nuances as well, and Muroff’s presentation focused on six of these:

Great practices make decisions based on a group-developed and -approved mission statement and business plan. Muroff explained that too many practices have a mission statement like “We want to be the best radiologists EVER,” when in fact it should closely define who you are, what you want to do, and where you want to practice. “It should be a statement that only the members of your practice see,” he said. “If you know who you are, what you want to do and how you want to do it, you can set specific goals that fit your mission and assign responsibilities and provide timelines for completion.” (Hmmm . . . sounds familiar, no?)

Why is this important? “It provides focus,” Muroff said. “And it gives leadership a blueprint, including timelines, for action.” He added that most groups fail because of inaction, with the lack of a mission statement/business plan to blame.

Great practices pursue strategic planning and adopt strategic thinking. Muroff noted that radiology practices are “pathologically addicted to democracy”—“everybody believes that he or she has a right to say something about everything, and decision-making is often based on insufficient information or emotion.” He added that the interests of individuals can impede the progress of the group when no strategic plan is in place. Further, Muroff said, radiologists tend to mistrust their partners. “Radiologists just don’t trust each other, and it’s a true impediment to getting things done,” he said.

To implement strategic planning, partners and senior partner-track physicians should outline the practice’s priorities at a group retreat—not one where people sing “Kumbaya” around a fire, Muroff stressed, but one focused on improving the business and facilitated by an outside professional. “Remember the concept of sub-specialization,” he said. “Pick the consultant best suited to deal with the issues facing your practice. Match the skillsets of what your problems are with the person you bring in to help you, and make sure the person is knowledgeable about the culture of radiology.”

Ideally, every partner would agree to the plan, the projects and the priorities, Muroff said—and if there are a few outlying objections, they should be thoroughly discussed. “You can’t get radiologists to agree on anything, so you’re not going to get unanimity,” he noted. “But once decisions have been made, the group must stand behind the decisions and present a united front. Failure to do this has destroyed more radiology practices than anything else I could name. Once your doors open, be perceived as powerful and united.”

Great groups demand that everyone in the practice contribute to practice-building activities. “A nine-to-five mentality is for shift workers, not owners of the business,” Muroff noted. “Someone cannot work and act like a shift worker but be paid like an owner. That’s not sustainable—or tolerable.” Instead, practices should foster a culture of participation and mutual expectation. Every member of the practice should contribute to practice-building in addition to reading films.

In most practices, Muroff said, 90% of the business-building is done by 10% of the practice members—who are often not compensated for the additional work. “We’re not in the pre-2005 era anymore. We in radiology have this perverse belief that non-clinical stuff doesn’t count,” Muroff said. “But non-clinical activities are crucial to building and protecting a practice.”