The E-Myth Physician: Why Most Medical Practices Don't Work and What to Do about It

Despite what most Doctors think, every business is a family business. To ignore this truth is to court disaster.

This is true whether or not family members actually work in the business. Whatever their relationship with the business, every member of a Doctor's family will be greatly affected by the decisions a Doctor makes about the business.

Unfortunately, Doctors tend to compartmentalize their lives unless some family members are actively involved in their practice. Doctors see their practice as separate from their family. They see their practice as a profession -- what they do -- and therefore none of their family's business.

"This doesn't concern you," says the Doctor to the spouse.

"I leave business at the office and my family at home," says the Doctor, with blind conviction.

And with equal conviction, I say, "Not true!"

In actuality, your family and practice are inextricably linked to one another. What's happening in your medical practice is also happening at home. Consider the following and ask yourself if each is true:

• If you're angry at work, you're also angry at home.
• If you're out of control in your medical practice, you're equally out of control at home.
• If you're having trouble with money in your medical practice, you're also having trouble with money at home.
• If you have communication problems in your practice, you're also having communication problems at home.
• Ifyou don't trust in your practice, you don't trust at home.
• If you're secretive in your practice, you're equally secretive at home.

And you're paying a huge price for it!

The truth is that your practice and your family are one -- and you're the link. Or you should be. Because if you try to keep your practice and your family apart, if you try to keep your practice and your family strangers, you will effectively create two worlds that can never wholeheartedly serve each other. Two worlds that split each other apart.

Let me tell you the story of Keith and Susan.

Keith Roberts and Susan Boga met in college. Participants in an anti-Vietnam sit-in in the chancellor's office, they sat next to each other and talked for hours. Though not a leader of the movement, Keith was one of its fiery orators. Susan thought he was the most dynamic man she had ever met, and soon they were living together.

Though Keith's father, now deceased, had been a doctor, Keith rejected everything his father stood for: rigid discipline, small-town thinking, and medicine. Instead, after graduation he became a landscaper. He loved getting his hands dirty and being his own boss. Still, Susan sensed that something was missing in Keith's life.

Every Christmas, Keith and Susan flew to Iowa to visit Keith's mother. Keith could hardly walk outside without someone approaching him with essentially the same message: "Your father was such a good man. He helped so many people. You must be so proud."

Keith and his father had never been close, so pride was not the first emotion that came to mind. Anger? His father rarely spoke to him except to criticize. Resentment? His father was rarely at home.

At his mother's house, Keith was drawn to a photo on the mantle. It was a picture of his father, black bag in one hand, bending over to kiss a little boy who was wearing a leg brace. Though that picture had been there for years, he had never really looked at it. Now he stared at it as though for the first time.

Two nights later, Keith announced that he wanted to go to medical school. Convinced that her husband was meant for great things, Susan readily agreed, promising her support. Through four years of medical school and two years of residency, she worked various jobs to keep them afloat.

Right out of school, Keith -- Dr. Roberts -- went to work for a medium-size medical practice near Sacramento, California. Soon afterward, Keith and Susan had a daughter. Those were good years. They dearly loved each other, were active members of their church, participated in community organizations, and spent quality time together. All in all, they considered themselves one of the most fortunate families they knew.

But work became troublesome. Dr. Roberts grew increasingly frustrated with the way the practice was run. "I want to go into business for myself," he announced one night. "I want to start my own practice."

Keith and Susan spent many nights talking about the move. Was it something they could afford? Did Keith really have the skills necessary to make a medical practice a success? Were there enough patients to go around? What impact would such a move have on their lifestyle, on their daughter, on their relationship? They asked all the questions they needed to answer before going into business for themselves.

Finally, tired of talking and confident that he could handle whatever he might face, Keith committed to starting his own practice. Because she loved Keith and did not want to stand in his way, Susan went along, offering her own commitment to help.

Thus began the practice of Dr. Roberts. He quit his job, took out a second mortgage on their home, and leased a small office.

In the beginning, it went well. A building boom had hit the town, and new families were pouring into the area. Dr. Roberts had no trouble getting new patients. His practice expanded, quickly outgrowing his waiting room.

Within a year, the practice employed an office manager, a receptionist, and a bookkeeper to take care of the money. Keith was ecstatic with the progress his young practice had made. He celebrated by buying a new Mercedes and joining a country club ...