David Finkel is the Founder and CEO of Maui Mastermind®, one of the world’s premier business coaching companies with thousands of clients worldwide. He is a Wall Street Journal bestselling author of eleven books, including SCALE (co-authored with Priceline.com Co-founder Jeff Hoffman) and The Freedom Formula: How to Succeed in Business Without Sacrificing Your Family, Health, or Life. 

David’s syndicated business articles can be seen on Inc.com, Fastcompany.com, and Forbes.com and have garnered millions of readers and his work has been featured in several prestigious media outlets including the Wall Street Journal, Bloomberg, Fox Business, MSNBC, and Inc. Magazine. 

He has helped hundreds of thousands of business leaders grow their companies and get their lives back. He lives in Jackson Hole, Wyoming with his wife and three sons and is the son of a physician.

To receive a FREE copy of David’s book: Grow Your Medical Practice and Get Your Life Back, Click Here



Tobin Arthur, David Finkel

Tobin Arthur  00:20

We have talked about getting to the point where you want the practice to work for you, not the other way around. So there’s a mental shift. And then we’ve talked about how that starts with time. And all of the techniques and tools to start to manage time and to start thinking in a system’s thinking. But one of the things and you’ve built an incredible organization around this is that it’s not a solo sport. All of us have gaps in our education and our experiences. And so you know, we have this language within AngelMD that “innovation is social”and I think similarly, this, there’s a social element to this process, which is what the Maui Mastermind community is all about. So let’s start talking just a little bit about business systems. Because again, that’s somewhat foreign to a lot of physicians in terms of thinking as a systems, what role in building these systems and you kind of indicated, does the doctor play? And how do they think about these things , and then we’ll talk about how your organization can supplement that and help that along.

David Finkel  01:29

First of all, we should step back and say why system so important. I mean, we would never think about going into an operating room without having a clear system for how we want our tools are implemented or instruments laid out on the tray. You know, we want a system for how we scrubbed to create an antiseptic environment, we know this, we need to have a good surgical field. All these are things that we know that we have checklists for either formal or informal and the best highest performing surgical teams and facilities, the ones that have the least unintended consequences of infection and other post surgical maladies. They have checklists they follow they have policies and procedures, best practices, we know that, well, the same is true in the business operation of a practice, the same thing is true. So the single most important thing that a physician owner can do is he or she can say, Hey, we are going to make this a priority in our practice. Because Tobin, here’s what happens. I have Mary who has run my practice for 15 years. And she just has everything in her head, or on her hard drive of her computer and kind of weird ways, or post it notes around her monitor when she gets sick, or she retires. And now we’re screwed. For lack of a better word, we, I don’t know how we do payroll. No one else knows how we do the compensation structure for figuring out the performance base pay the production base pay for some of our mid level people. We’re in a world of hurt, and it’s stressful. So we call this concept strategic depth. And every business we work with medical, dental, or manufacturing, right, we do the same thing, which is we make it a non negotiable that in our business in our practice, each quarter each year, we become a little bit better in terms of more strategic depth, which means we systematize, we cross train, and we build a culture that says we systematize and cross train, so that if Mary wants to take a vacation for two weeks wonderful, Sue in the office can cover some of her duties, Robin can cover some others. And still some others we note that aren’t getting done that will work on in the future. And the key is I don’t step away from the practice. And a month later come back with this like, manual. That’s my policies and procedures because that’s worthless. What matters is it as a discipline, that we create systems, we update systems, that discipline as a cultural commitment in our practice, that’s something that only the owner physician can emphasize both at the beginning of that and to check in at various points to make sure that they reinforce that the mechanics are easy. The will to do that is everything. And that’s the starting point.

Tobin Arthur  04:14

Well, that’s a it’s a great point there, which is I’m sitting there thinking that sounds great, but this sounds daunting, but what you’re saying is it’s really once you’ve made the mental shift, you’ve done the hard part. Talk just a little bit about the implementation in the digital age. And I imagine 10 years ago a lot of this was paper based and files and folders; give us an example of one specific type of type of system that you would work with or advocate for a practice to work on what does that look like to them to be efficient to find you know, the materials and to do all the follow up

David Finkel  04:48

Lets take the the thing that they do the most commonly right now – check a new patient in at the front office desk. In the past they probably have created some set of paperwork that’s done and some workflow for how that’s done. And that’s great. So one of the first steps might be to say, does all that paperwork exist in one place? So if we need to make an update, it’s not on three different people’s computer so that Mary uses the updated stuff. But when Sue or Jenny or Robin are there, they still use the old versions that don’t have the new HIPAA requirement, the changes of the language that that our attorney says we have to have in there protect ourselves from liability. So we create we call our UBS it stands for ultimate business system. It’s a centralized house cloud based, where we put all of our company systems, you know what, that could be Dropbox box, comm that could be Microsoft’s drive, that could be a Google Drive, somewhere that’s going to have good HIPAA compliant requirements. And all those do, we use a company called Ignite, it’s the same thing you know, anything different is the bells and whistles that come with it. But it’s where you house all the systems that don’t fit into your EMR. And so these are the, how we check a patient in and the paperwork that we use in a filled out example, that paperwork, a diagram of the workflow. Some of the signage we use right there that says, you know, please stop here to pay your copay. The scripting that we might use was someone who’s giving us a little bit of different difficulty that the insurances that require copay, the list and the ones that don’t, that are right there at the front desk, those are all saved in one place, named in a way that you can find it later on. And we have a methodology for doing that. And so what we do is we just pick one area to start with front desk. And we might just do the patient check in later on, we might do the patient checkout. Later on, we might work about what’s the system that our MAs use to take a patient to the exam room, prepare the exam room, do the initial getting of the medical details that we need to have, whatever it might be, we just take a little bit of a chunk, every quarter, we take another bite of the apple, and we don’t see the movement on this and one or two quarters. But within a year or two, we start thinking wow, it’s working better people are consistent with what they do, we start to as we systematize, find places that we can make obvious optimizations to make patients and staff more productive or happier respectively. And then we just keep doing this, again, as a cultural discipline, bit by bit by bit. And this is what allows a practice to eventually be less than less reliant on any one key person, which gives great peace of mind to the owner physician.

Tobin Arthur  07:30

Well, and bringing this full circle, it goes back to what you were saying to beginning with your father’s practice, which is these things actually also begin to make your practice more valuable. If somebody comes into acquire, and they see that you’ve got these systems in place, and they can, you know, just walk in and it’s cookie cutter. That’s worth a whole lot more to a potential buyer. I love reading great books, like you’ve written about new systems and tools and ideas of how to implement these. But it’s still always daunting, because you don’t know where to jump in. Or, again, you’ve got gaps in your education. So Maui Mastermind has built a whole series of solutions. Can you walk us through a little bit of everything from the workshops, how those fit into the equation, and then coaches and just how Maui Mastermind works?

David Finkel  08:20

So one thing that is different about a physician, owner and a medical practice. So generally, when we coach a client, we work directly with the business owner. And we do it on a quarterly flow. So every quarter, we step out of the business, and we do it at a workshop a day and a half workshop that we teach, and we create the next quarter’s action plan at that workshop topics are on hiring topics are on managing the financial pillar of your company, on increasing sales and marketing volume on operational systems, depending what it might be. And then for the balance of the quarter, we work with the client every two weeks one to one by phone and or zoom, to help them make sure they’re executing on their plan and improving the practice as they go at the end of the quarter we debrief and do the next. So the different thing that we do with a physician generally is they’re involved in a portion of that, but a portion of that one to one work is is the people that are doing in their practice. So it might be with a practice manager, it might be with the person who’s in charge of your billing team, it might depending on who and how the practice is set up. It might be a conversation with if there’s multiple partners, maybe once a quarter of the partners are involved in that conversation to set strategy or big picture decisions. But we know we have to manage that component of it. And the good part is that to weaken quarterly rhythm, the quarter is the perfect unit of time to make sure that I I’ve created enough of a block to get something accomplished not just started but actually get results. But it’s not so long that I can’t adjust or adapt and it feels like a sprint. And I can pause and take a breath afterwards and then do the next sprint. And then the two week period what we found is it’s the right unit of time for To get stuff done in the execution, but not so long, that if there’s a problem or something comes up, like, for example, one of the groups who work within Texas, hiring is a big challenge for them right now, what they were missing, though, was that for every three hires they made, they were losing one of their best people, because they were getting hired away by people recruiting way for more money or greener pastures. So they were focused on hiring, which we said, great, keep focusing on that. But let’s take this session and focus on what can we do, so that you can retain the best people in your practice with plugged the hole while you keep filling in more. And considering that there are a group that had over 100 openings across their system made a big deal. But the same thing applies even if I’ve got 12 people in one office with the retention side. So that’s an example that two week rhythm, it just works really well for execution.

Tobin Arthur  10:55

There’s another element there, which is it ties back to the time, which is it forces you to unplug and get you away from the practice, I was talking with the physician on the phone the other day, and he says, hang on second, I gotta take this call. He picked up the call, he says, I’m sorry, I gotta call you back, I’ve got to go in. I’m covering for this hospital. Turns out the hospital is two hours away. His whole day was now hijacked. But by forcing yourself and scheduling to unplug, and recharge the batteries for two days, I imagine that has the side benefit of getting rid of some of those distractions temporarily, even though it’s an investment of your time, because you know, your processing? How am I going to get all this stuff covered, and it’s lost revenue for one or two days. But this stuff requires an investment, not just some time, a little bit of money, but that ties into something pretty incredible. Talk a little bit about your commitment to their their practice and the cost of the program, because I’ve not heard of a guarantee like this.

David Finkel  11:55

So what we found and it’s pretty darn simple. It there is an initial cost for a practice that the owner physician and a staff are focusing on these things. But the ROI period is great. Generally, if I’m a physician, I’m thinking should I should I buy a piece of equipment, I have to ask myself, what is the real reasonable payback period, when when should I get my money back and be profitable. And usually, for a capital piece of equipment that might be $100,000 or or half a million dollars, your payback period is going to be I’m looking at this can pay back within 36 months or less, that’s a very sound investment, you know, the more expensive, I might need five or seven years, if it’s a building, I might need 10 years before I really start reaping the rich rewards. We feel that with coaching, you should have the results within the first 12 months. That’s an important one. And so what we do is we guarantee a client that they’re going to have at least twice their coaching feedback within the first year or it’s on us. Now we do put the caveat that they’re going to have to be a reasonably good client, they don’t need to be the a student, they were to get into medical school, we call it the B minus standard, they do 80% of their commitments, right 80%, that’s the minimum floor. Most clients do a lot more. But if they did just that, they’re going to get a great result. And it’s pretty darn easy. You know, generally for the depending on the client practice, it might be two to $3,000 a month. But they’re going to get that back quickly with that part. And the big part of it is it doesn’t take a lot like for example, if I most physicians have never done an audit of their payer contracts and said, like, for example, we have a vein specialist we were working with he said, David, how do I double my practice in the next 12 months? I said, Why don’t think we can do that. But I bet we could through better scheduling, get you a 25% lift? And he said well, how? And I went through with him, for example, in his practice, you know, people in his practice one of the surgical procedures the last quarter to use up their deductible of the year. Well, he had three main insurances, one of which paid a lot more than the other two. He was giving that last quarter of the year slots to all these different people equally. And I said, Well, what’s take half those slots that you gave to these other two only give it to your highest paying insurance folks, what would that do? And then use that as an excuse to push those other people back into August, September months, that historical, you’ve been fairly light and have extra capacity and do more procedures during that time, those simple changes meant about a 25% increase to the bottom line. That doesn’t take more work. It just takes more brainpower. You know, we do this in medicine, right, we have our differential diagnosis. If we don’t step that we don’t step start treating we start diagnosing and looking for what we’re going to treat. And that’s that quarterly process of stepping back to differentially diagnose what’s going on in the business, so that we can create the plan and execute it over the quarter. And that’s why from my perspective, it’s a pretty easy claim to make. We found that that’s we’re not going too far out on a branch right there. We’re pretty close to hugging the the trunk of a tree. We can’t help a medical group do that. There’s something wrong with us, I believe.

Tobin Arthur  14:59

I love it. You guys are putting your money where your mouth is, and I and I, you know, it’s, it’s a very, very strong system. You’ve made an offer, you’ve got this great book, I can’t recommend this highly enough to any physician who owns their practice, “Grow your medical practice and get your life back.” That’s a great starting point, you’ve offered to provide a copy of that book to anybody who’s interested. And we’ll make links available so that you can request that book, we’ll get it sent off to you. And so they read the book, they say, you know, this is exactly what he was talking about, this makes a lot of sense to me, the next step is, is what’s that look like?

David Finkel  15:39

You’re just gonna reach out to our office, you’re gonna either do it through our website, you know, grow my medical practice calm, or you’re gonna send an email over or pick up a phone, whichever is easier for you. And we’ll actually do a deep dive on your practice with spend, you know, 60 minutes, 75 minutes going through what would where are the leverage points in your practice? What would we want to do if we work together, here’s the the items and how we would sequence the item sequencing is actually more important many times and picking the items. Because again, we have the constraint of time. So we have to sequence intelligently. And if based on that, we think we have a mutual fit great, we work together based on that we don’t, then you leave the session having good value anyways, and no harm no foul.

Tobin Arthur  16:23

And from the examples you provided, it sounds like you guys have worked with everything from general practitioners, Family Medicine, to surgical specialists, and of course, dentists are in the in the mix there as well. There’s really no group in there that it probably doesn’t apply to.

David Finkel  16:40

Correct. And we’ve worked with the manufacturing of medical devices all the way through to the chiropractic and physical therapy offices as well.

Tobin Arthur  16:48

Well, David, this has been a really a great primer on all of the expertise that you have distilled into this practice into this book, I greatly appreciate your time. And and specifically, I appreciate it because having worked with physicians for almost 20 years, it there’s very few days that go by or I’m not hearing from a physician, the challenges and this constant reference to being on the hamster wheel. And it’s disappointing because these are some of the hardest working most important professionals in our society. They’re burning out at record rates. And you know, I always tell people there are the law of unintended consequences is if you sort of personalize this and your, God forbid, you know, one of your children gets sick, you don’t want your children being treated by the class clown, who was the C student, you want your children being treated by the person who is the A student who worked their butt off. And they’re super smart, and they’re going to make sure the kid gets back on track. And in order to incentivize smart kids, they have to be in an environment that’s thriving, not one that’s going the other direction. And you guys are doing a great job of counteracting some of the trends that are going against physicians. So I appreciate that. I thank you for this work and the wisdom that you’ve provided today.

David Finkel  18:06

Well, I appreciate that Tobin, it was a lot of fun. So thank you for having me on.