In the movies, when Alice met the Cheshire cat in Wonderland, she asked which way to go from their spot in the woods. The cat replied, “That depends a good deal on where you want to get to.” Alice says, “Somewhere.” “Oh, you’re sure to do that … if you only walk long enough,” the cat responds.

As in Wonderland, so it is in business, said David Miller, managing partner at HSG, a Louisville, Kentucky-based physician advisory organization. Practices need a strategic plan, and this requires setting a target. Physicians should determine where their practice should head and create a path to get there.

Personal values matter

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Cameron Cox III, CEO of MSOC Health, a medical billing and consulting firm based in Chapel Hill, North Carolina, recently had an emergency room visit. During a casual conversation, a provider mentioned that she eventually wants to become a plastic surgeon treating children with cleft palates. “The provider doesn’t believe that any child should be made fun of because of the way they look,” Cox said. “If she goes on to run her own practice, that value will be core to what she does.”

Providers need to reflect on who they are and their purpose in work, Cox said. They often tell Cox they just want to practice medicine—period. But that is not an acceptable response, he said.  

“If you just want to practice, I can give you 50 different ways to do it,” Cox said. “You could be a telemedicine doctor working from home, or work in a hospital, or go to Doctors Without Borders. Why did you choose this profession? Whom do you want to help? Physicians at least know that they want to be independent or provide a certain kind of care to certain patients.”

Take a long view

Doctors need to step back and determine what they want their practice to look like in the next 3 to 5 years. Who refers patients to you now, and who do you want sending patients in the future? Doctors should establish a profile of preferred patients—their demographics, geography, and their insurance type—and try to grow the patient groups that are profitable, Miller said.

“Setting up measurable objectives is key,” Miller said. Physicians should think through their vision and what they need to do in the next few years and beyond.

“A lot of doctors say they don’t know what is going to happen 10 years down the road, but I disagree,” Miller said, adding that medical practices are going to have greater accountability for cost and quality. “When they are challenged to think a little further out, it changes their expectations of what the world is going to look like and how they will need to interact with it.”

SWOT Analysis

A practice can identify its internal and external challenges and opportunities by performing a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Health care providers tend not to understand that patients are consumers whose desires matter as much as the changing landscape and competition, Cox said. “If you haven’t walked through your waiting room in the last 5 years, you might have a strategy problem. You have no idea what your consumer is experiencing before they see you,” Cox said.

Strengths. Physicians need to know their practices’ strengths and use them to establish a solid brand. Those strengths might be ensuring quick access for new patients, providing speedy communication with referring physicians, or specializing in certain clinical areas or treatments.

Weaknesses. Practice weaknesses could be as something easily remedied, such as an aging office, which could be fixed with a fresh coat of paint and new furniture. Technology could be lagging. Physicians should bear in mind, for example, that many patients now prefer texts instead of phone calls to remind them of appointments, according to Cox.

Opportunities. Practices also need to look for opportunities. Providers may need to increase their number of referring physicians or consider strategic partnerships. Providers at one practice contacted Cox asking if they should join a health system in response to growing local competition. He advised them to figure out why they came to that conclusion and look at options. It is possible that they determined they could not survive solo, but failed to consider options like alignment with other partners or enlisting a management services organization. If they want to think way outside the box, they could consider switching to a concierge model. It may be valuable to bring in external help for this kind of practice.

Threats. Potential threats on the horizon are another important consideration. For example, major providers are using technology at an increasing rate to reach out to patients across the country. Patients could access Cleveland Clinic providers via telehealth rather than make appointments with a specialist in their community. “Providers have to understand the positives and negatives of the business as well as the forces at play in the market,” Cox said.

Practice managers need to know if they should shake things up, and if they do, what may come of it. “The purpose is to validate their position in the market and understand if what they are doing is working or if they should tweak or revamp their strategic plan,” Cox said.