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What Game Are You Playing? by Jay Geier

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Categories: Practice Management, HR and Accounting; Practice Transitions;
What Game Are You Playing? 

Pinpoint your place to ensure you win at your game as an independent practice owner

Part 1 of 2

by Jay Geier

In this series, I’ll be talking about the three types of doctors who own private practices. I like to think of it as three different games that are going on throughout the industry. Unfortunately, doctors rarely recognize the game they’re playing, much less understand the rules or how score is being kept. So it’s not surprising that many independent practice owners aren’t winning at their own game and don’t even realize it.

Based on the descriptions here, you should be able to recognize which game you’re playing—if you’re honest with yourself. Once you understand the ramifications of playing one game versus another, you can decide if you need and want to play a different game to ensure you end up with the winning score.

 Game #1: Working doctor

Almost every orthodontist starts out playing this game. You worked hard to earn your degree so you could enjoy the privilege and satisfaction of caring for patients. You may have worked for another practice for some time, and at some point decided to buy or start your own practice. So, then you started treating more patients … and more patients … and more patients.

Caring for patients is all you do, day in and day out. All you think about is how to better care for patients with the latest technology, latest equipment, and latest procedures. Especially if you’re a single-doctor practice, your clinical work will begin to consume you. You’ve got your head down, working as hard as you can, because you think those are the rules of the game and that’s what drives up your score.

Years go by, and eventually you become almost mummified by the role—in fact, you view yourself as only a doctor, not as a business owner. You introduce yourself as the thing that you do and not as the owner of a practice and the leader of an organization. You’re almost oblivious to what’s going on at the front desk, how your employees are performing as a team, whether your patient numbers are growing, the state of your cash flow and why it’s not what it should be, and your long-term financial trajectory. You stay focused on working with patients because the game you’re playing is one of being only a working doctor.

Game #2: Doctor who just wants out

Unfortunately, Game #1 usually transforms into this next game without the doctor realizing it. Suddenly you’re burned out and just want to be done working. You feel old and tired and crotchety, and are no longer enjoying your profession. You fi nd the practice management aspects exhausting. You bought into the adage that if you just kept your head down and worked hard, it would lead to the best avenue of success. But that’s a fallacy when it comes to owning a business: You can’t just be a full-time clinical worker bee and ignore all the other aspects of running a practice.

Whether you’ve been in business for 10 or 25 years, if you’ve been playing Game #1 all that time, you’re likely to be on the verge of being thrown into Game #2—if you’re not already there. The pandemic drove many doctors to decide they just wanted out, even though they weren’t in a financial position to do that wisely. In fact, groups that specialize in buy-and-sell practice transactions report that across the board (not just in orthodontics), 90% of sellers aren’t ready: They sold for the wrong reasons, such as personal crisis, debt or being overleveraged, which significantly affected the sale price.

You cannot win at this game! Emotions override sensible, profitable decision-making. You’ll have no long-term perspective about anything because you just want out as quickly and conveniently as possible. This hasty choice will lead to the worst decision you’ll ever make concerning your largest financial asset—one that guarantees a lousy ending score for you and a spectacular win for someone else.

 GAME #3: Business owner growing business value

Taking the CEO role

1. Create strategy and vision, share with:
• Team
• Patients
• Investors

2. Build your team.
 • Human capital selections
• Motivations

3. Execute plan, coach team, finance growth.
 • Explain motivation and strategy
• Set clear goals
• Hold people accountable
• Have a selling vision and track progress

Private-practice owners playing this game have decided to treat their practice like a business. They’ve stepped into the CEO role of their company and are focused on growing the value of their business.

Virtually every doctor says they will sell their practice at some point. So the question really isn’t one of keeping versus selling—it’s a question of how many years before you think you will be ready to sell. Then, what do you need to do to be prepared to sell for top dollar? Regardless of your timeline, growing the business is of paramount importance.

Those who start playing this game learn that the strategies worth keeping build a thriving business that is also prepared for maximum sale. At right is a clear visual of the work required for someone to grow a business.

Doctors don’t become good CEOs overnight. They evolve into the role by building the necessary skill sets with effective training and coaching and then gaining experience over time. The biggest struggle every practitioner faces is having to stop seeing patients full-time. And if you’re a sole proprietor, to cut your work back, you need to bring on an associate for the first time, which is a game-changer in itself.

Everyone goes through the transition process. Most doctors start in the role part-time, but they come to accept that continuing to treat patients is very time consuming. It requires a lot of energy and effort and headspace, and they become torn between priorities. To be a great CEO, you can’t do the job part-time. That’s why we work with clients on a plan to transition completely away from seeing patients, typically over a five-year period.

No matter how many years you’ve been in business, or how long before you might want to sell, this is the role you need to be in, and the game you need to be playing. Only then can you prepare your business for the most successful sale when you decide you’re ready—one in which you end up with the winning score because you’re selling for the right reasons and at a time that’s right for you. You may even decide to keep a highly profitable business as part of a multigenerational wealth strategy instead of selling it after all.

 Know the rules

Now that you’ve identified the game you’re playing, you’re in a better position to decide if you’re headed for a win or a loss, whether you’re planning to sell soon or not. (Hint: If you’re not playing the business owner game, you’re not headed for a win—at least not one as big as it could and should be.)

Next in this series, I’ll talk more about the rules of each game, the rules that your opponent knows and will use against you. That way, you can at least try to protect yourself against the plays being made by others to ensure you win, and they lose.

Next month: Part 2

In our January/February issue, Jay Geier will discuss more rules of the practice ownership game and how orthodontists can protect themselves against plays being made by potential buyers to ensure you win, and they lose.



Author Bio
Author Jay Geier is a world-renowned authority on growing independent practices. His passion is in turning practices into businesses, doctors into CEOs, and employees into high-performing individuals and teams. He is the founder and CEO of Scheduling Institute, a firm that specializes in training and development, and coaching doctors how to transform a private practice into a thriving business that they can keep for a lifetime of revenue or sell for maximum profit. The phenomenal growth of Scheduling Institute is a result of Jay practicing what he preaches and helping those around him live up to their full potential. To hear more from Geier, subscribe to his Private Practice Playbook podcast at podcastfordoctors.com/townie.
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