A Juggling Act

Image: ©2009 Image Zoo
Image: ©2009 Image Zoo

I remember, as a little boy at the age of 7 year-old, sitting in the back of my parents car and wondering what I‘d be doing and thinking in the year 2000, which seemed a lifetime away. Indeed it was to a boy of 7 years old, but here I am and it’s 2010 already.

I also wondered, as that little boy, what it would be like to have a wife and kids. I did a lot of wondering back then about what the future held. Now I find myself doing more reflecting than wondering, which I suppose is a natural thing to do as more and more years unwind and trail behind us and the road gets shorter and shorter. Right now I’m reflecting on the fact that I have a son due in about a week or so, meaning he will already have been born by the time you read this. My son will join my daughter Naya, now 2 and a half years old, in doing everything possible to prevent me from getting any work done, and yet will rely on me to do just that, keep my business alive and put food on the table.


It’s a juggling act that until you have kids you can’t truly appreciate, and it’s more than likely the most important act of your life. It’s also, without exception, the most difficult thing I have ever done. Yet I made a choice to be as much a stay-at-home dad as I could be so I didn’t have to wonder what it would be like to watch Naya learn to walk, or listen to her utter her first sentence or any of the other “little things” in life that we one day discover are not so little, that they are indeed those points of light in our life that stay with us forever, that mold and shape us just as they are molding and shaping our kids.

Sure I could have thrown it all on my wife and said, “I’m bringing home the money. You raise the kids,” but I’d only be cheating myself, and placing an undue burden on mom to carry. As I now know with conviction, working is a cakewalk compared to raising kids, and I say that with the understanding that my little girl is an angel as far as kids go. I can’t imagine what parents have to face with kids who are difficult to deal with or are going through tough times because of health or other issues.


So why am I mentioning this and how does it have anything to do with practice management? A lot as it turns out. As I stare out across the 2010 landscape, I recognize that in order to succeed both at home and in the field, I have to become more efficient and more clever in every way possible so that I can grow — not just maintain — my business while actively participating in — not just observing — my own family’s growth at home. And there’s the added struggle of trying to achieve all of this in a health care climate where the high-end, high-margin market potentially begins to contract, and the low-end, low-margin burden swells. In order to succeed in this dynamic and possibly catastrophic climate for small businesses, we have to differentiate, outsmart and outreach our competitors, delving into areas that previously may not have warranted our attention, all while reserving enough time for what we deem the more important things in life.


So while I struggle with the thought of having another mouth to feed and just as important another soul to nourish, I realize that this is what I was built for — to face challenges, surmount them and use the experience gained to prepare for the next one. No, believe me two kids are quite enough. What I’m talking about is our ability to prepare for any challenge that comes our way. To be able to take a shot across the jaw, get knocked down only to get up, dust ourselves off and say “thank you sir, may I have another” is a quality we should all learn to cultivate. The key is that we eventually learn to keep our hands up so we can block the punch, instead of taking it on the chin. In other words, foresight gained from familiarity or experience.


So what are the challenges ahead and what has our prior experience taught us about how to prepare for them? Finally, how do we free ourselves from the day-to-day grind sooner so we can focus on our families and ourselves — the stuff that really matters?

I see the biggest challenge facing our field is a radically altered health care system. There are many of you who don’t think it’s a big deal, and there are many of you who think it’s a great thing. Finally, there are many of you who think that a change to our health care system in the manner that’s being considered behind closed doors as we speak will never come to pass. I, for one, don’t fall into any of those camps and recognize that, in this case, preparing for the worst will still put me in a good position if I’m wrong about the outcome. Why? Because by preparing for the worst, I am putting up a strong defense that just happens to be a great offense, regardless of what transpires.

Allow me to explain. By fearing that I may have to take on more patients for less money and a greater administrative burden (when the government gets involved, have you ever seen your paperwork diminish?), I recognize that I have to increase my efficiencies, pure and simple. More numbers and lower dollars equal less time for my family, all other things being equal. Well, I refuse to let that happen, so what do I do?


Well, for one, we need to streamline everything.

One of the things we still have control of is our time, even if it often seems we don’t. Being more efficient in our patient intake process, our casting or imaging protocols, our shaping techniques, our fabrication methods (including the materials we use), and our delivery process will all yield rewards in the future, no matter what happens. This advice goes for staff clinicians and practitioners as well, not just business owners.

What I caution you all about is being careful not to simply take on more to fill the gaps. This is a little tough to accomplish as an employee. Your boss will most likely make this decision for you, but certainly the possibility exists that you produce the same and leave earlier than you have in the past, say only an hour or two after your official quitting time. as opposed to four or five hours. It’s always made me grimace to watch employees stay until 9 p.m. every night trying to impress their boss when by being more efficient they could achieve the same results and still have a life in the evening.

My recommendation: bank the time and use it for your own personal growth. It’s personal growth that tends to get left behind in the daily grind. I am not going to list all the methods I employ to be more efficient as there isn’t enough space left in this column, but I will say that I have learned from previous coaches — let the ball do the work. Take a look at the protocols you use and determine whether or not a little automation is possible. For example, if you’re hand-writing progress notes, could you benefit from dictation? If your letters requesting authorization and your coding process are all filled out long after the patient’s left the office, can they be created in the room as you work with your patient using intelligently created macros? There are many more ways to improve processes, but I’ll leave it for the moment and let your imagination take it from there.


In a changing competitive landscape, we need to engender loyalty over and above what we have achieved previously. This applies not only with our patients but with our payers and other health professionals along with a few other key individuals who might not at first glance be defined as our customers.

In other words, we need to reconsider who our customers really are. The truth is, everyone who sees, touches, speaks to or interacts in any way whatsoever with our patients are in fact our customers. The obvious ones are the referral sources we commonly work with but less obvious are neighbors down the street, the cashier in the local grocery store, the manager of the day care to which your patients bring their kids. We must consider everyone in our patients’ sphere of contact a potential referral source. They may not know anything about orthotics or prosthetics, but they don’t have to. They merely have to recognize that your patient wears their device proudly, uses it effectively and that maybe it looks better than anything they’ve seen before. This will stick in their mind and they most likely will know of someone in their own sphere they’d trust to send your way because you obviously care enough.

Market what you do in clever ways. Send a note of appreciation to your payers thanking them for joining you in helping to make their members’ lives better. The list of unique marketing techniques is endless. Be as creative as possible and you will reap the rewards of a referral network that grows and grows.

Finally, know when to call it a day and go home. A business person knows that without profits they can’t survive, but what they typically forget about is that without personal time they won’t survive either — at least not in a healthy way.

So here’s to 2010. Let’s hope it brings us all health, happiness, prosperity and personal development.

Randall Alley, BSc, CP, FAAOP, CFT

Randall Alley, BSc, CP, FAAOP, CFT is chief executive officer of biodesigns inc. He is chair of the CAD/CAM Society of the American Academy of Orthotists and Prosthetists, an international consultant and lecturer, and a member of the O&P Business News Practitioner Advisory Council. Alley can be e-mailed at ralley@biodesigns.com.

Leave a Reply

Your email address will not be published.