GUEST POST from Arlen Meyers

It seems more and more people are becoming part of the gig economy, either part-time or full time, and 1099 docs are no exception.

Building a network has a lot of tangible and intangible benefits. The most obvious intangible one is you get to make more money and meet a lot of interesting people you can help, and , given the pervasiveness of social media, how many people are in your electronic Rolodex simply depends on how much time you want to spend clicking buttons. These days these kinds of people are called social media influencers.

The one thing you don’t want to do is be a yenta, a gossip or complainer that has a negative connotation. The correct term for a Jewish matchmaker is shadchanit for a woman, shadchan for a man.

However, in addition, to the intangibles, you can monetize your network either directly or indirectly. Here’s how:

1. Build network value and trust, not numbers. As noted, almost anyone can post big follower numbers, but, when it comes to asking for something or getting people to pay you, that depends on trust and the depth of the relationship

2. Find out what a your potential clients need. Like all products and services, the value of your network is user defined. For example, some will pay you to be an advisor because they think you can connect them to your network, open doors or make introductions to people who might want to use their products, help design them, finance them or provide strategic direction. Others want your help to find talent for their emerging company. Others want help finding a job. When they get it, they usually don’t forget to dance who brung ’em. Here are the 7Ms of being an advisor . Some might want you to be an innovation mercenary.

3. Don’t expect payment to come immediately Building your network should be a long term investment , not a way to sell something once someone joins your Linkedin network. For example, you never know who might be interested in investing in your startup venture or product 3 years from now.

4. Define your interests. Don’t expect payment to come to you directly in the form of cash. In exchange for your acting as a maven, connector, or salesperson,some will donate or give money to a charity, organization or third party you support or barter for products or services in exchange for your help.

5. Remember, charity begins at home. Being a compensated connector means asking for and negotiating the amount and terms of how and how much someone is willing to compensate you. Some will agree to success fees. Others might pay you in options or other forms of equity. A regularly scheduled cash payment is another option.

6. Be sure you disclose and make transparent conflicts of interest, particularly if you have a stable of clients in your network portfolio

7. Walk before you run. There are escalating levels of engagement. Use uncompensated ways to test and prove your value that might result in more compensated involvement e,g, agreeing to connect someone to another on social media with an introductory note. Advisory roles can be informal, where you look out for threats and opportunities and send a “heads up” to someone who should know, or more formal , i.e. serving on an Adviory Committee or Board, that would be compensated.

8. There are many ways to participate in the sick care gig economy. Don’t be surprised when one gig leads to the next since nothing succeeds like success.

9. You can do this any time during your career, from the first day of practice to your first day or rewire-ment.

10. Having Plan B should be part of your 10/20/30 plan

11.Another way to make money is to blog.

12. Here are some tips on how to be a coach or consultant either as part of your portfolio career or an encore career.

13. You will also need to determine your fee and you won’t make as much gross income as a freelancer as you probably work fewer, more flexible hours.There are two parts to your revenue model-how and how much you get paid.

14. When it comes to being an influencer, there is actually too much of a good thing. A microinfluencer is someone with 1,000-10,000 followers. Why? “People connect with microinfluencers because of their authenticity and honest perspective. They feel as if they are a person just like them. And with authenticity at the core of what brands desire, they’ve started looking more toward smaller influencers with higher engagement rates.”

Models include compensation in cash and/or equity, project based compensation, success fees for accomplishing certain benchmarks, and periodic payments for participating in meetings or events

Be sure to negotiate your compensation.

For a start, take your cash compensation and divide by 250(which is the number of billable days after factoring in vacations, sick time, and typical downtime) and then add 25%–50%. Then take that figure, compare it with the rates you’ve gotten from your network, and find a middle-ground number you can float as an experiment and then adjust based on feedback from potential clients.

In most instances, you will be paid in cash, equity or a combination of the two. Be sure you have some kind of advisory service agreement that defines the scope of work.

 Here are four things to keep in mind to become more comfortable charging what you’re worth.

14. Advisors can be informal or formal. Informal advisors are connectors or others in the community who offer themselves as pro bono resources. Formal advisors get paid to do specific things the role as an advisor to the CEO or the Board of Directors or as a member or leader of a more formal advisory board.

15. You might be offered a contingency, referral or success fee, depending on how much business you refer that results in a sale or contract for someone or the company. In addition, beware of illegal finder arrangements when it comes to raising money.

16. Be sure you get paid on time. Here are some tips on how.

17. Volunteer to work for a nonprofit that satisfies your interests. It is a fast way to get connected to another big community where you can offer and leverage your skills while you are giving back help you create more personal brand equity.

18. Here are some more tips on how to make a living being a solopreneur

19. When you consider speaking engagements, define your goals, the likelihood you will achieve them and whether the cost/benefit (travel and honorarium offered, or not) is worth your time and effort.

20. As you develop your personal brand, be sure to promote it.

21. Be sure there is a cultural fit

22. Write and speak about your area of expertise. Start doing it for free. Then, once you have developed your personal brand, start charging for your services. Here’s how much to charge.

23. You won’t need a lot of money to get, keep and grow customers. Here are some tips on how to get clients for your consulting or advisory services.

NB: These techniques do not include sending a blast email to 25000 Linkedin connections or Facebook ads asking them for business.

The value of your network depends on the end user perception of how you can help them and solve their problem. In some instances, scarcity creates value whereby connecting to key people or decision makers and filtering the gate keepers is the goal. For others, “wearing their sneekers” as a key opinion leader means the more people who see them on you the better. In other words, how and how much you get paid will correlate with your brand equity and your negotiating skills. As someone recently told me, you can’t buy genius by the hour. You should get compensated for results, not face time or clock punching.

Here is how some people have created single person million dollar businesses.

Social media increasingly is a part of everyday life. Why not make a few bucks doing it while you are sipping your latte reading this? Stop kvetching and start Merching.

 
Image Credit: Pixabay

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GUEST POST from Arlen Meyers

Take a look at the course catalog of the medical schools in the US or the ACGME (American Council on Graduate Medical Education) competencies following residency training and it is unlikely you will find a mandatory course or competency with the learning objective of teaching attendees physician entrepreneurship i.e. how to run a private practice profitably using a viable business model, how to add value as an employed physician intrapreneur, how to be a social entrepreneur or how to get an idea, invention or discovery to patients.

At best, those dwindling number of graduates interested in private practice are forced to take week -end “practice management” seminars or courses at their national specialty society meetings. Many focus on the IT- mandate- to- get- paid of the week by highly trained specialists, but, in many instances, they are offered by the blind leading the blind.

“Practice management” is an archaic, out-dated term that limits the scope of what 21st Century physicians need to know and know how to do to serve the needs of their communities of patients, while making a fair profit doing it. While operations management is important, instead, the future belongs to those who add user defined value through innovation. In other words, medical societies,medical schools and graduate resident education programs should offer mandatory courses, and require demonstrating competencies, in medical practice entrepreneurship, not practice management.

The purpose of these courses is to offer the knowledge, skills and attitudes necessary to thrive in the contemporary and rapidly changing medical landscape at a sustainable and scalable profit. At a minimum,courses should include:

1. Revenue Cycle Management including coding, billing and collecting

2. Human Resources

3. Digital Health

4. Innovation,Entrepreneurship and Intrapreneurship

5. Marketing

6. Personal Financial Planning

7. Basic Accounting and Financial Statements

8. Operations Management

9. The legal and regulatory environment of health

10. Comparative health care systems and alternative delivery channels

11. Value proposition design

12. Business model design

It is extremely unlikely that medical schools will offer these courses. Consequently, doing so will devolve to other independent or non-profits who embrace biomedical and health innovation and entrepreneurship education as part of their mission.

Here are some reasons why they should offer biomedical and clinical innovation and entrepreneurship education and training:

1. Employed physicians are expected to add more and more value as intrapreneurs
2. More and more doctors want side gigs but don’t have the knowledge, skills, abilities and competencies to add value.
3. There are many ways to create patient defined value other than starting a company or seeing 20 patients a day.
4. Innovation requires involving end users early to be successful
5. As we migrate from paying for volume to paying for value, we should teach doctors how to create it.
6. Doctors are interested in social enterprise and social entrepreneurship
7. Doctors are interested in alternative non-clinical career development
8. We need more leaderpreneurs
9. Every doctor has a great idea. Unfortunately, few have an entrepreneurial mindset, know what to do next with their idea and are unlikely to be taught what to do with it in medical school or residency.
10. It is a way to recruit new members and generate dues revenue.
11. Members need guidance when it comes to policies and procedures for working with biopharma, medtech and digital health companies
12. The demographics and psychographics of the medical workforce has changed and they are struggling to adapt to the new world of work
13. Both the American College of Cardiology and the American Gastroenterological Association are investing in startups.

Here are 10 reasons why practicing medicine using a viable business model should be an ACGME competency.

The sooner we move forward, the sooner doctors will have the ammunition they need to re-empower themselves, bend the private practice participation and cost curve, and add value to a system badly in need of it.

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GUEST POST from Arlen Meyers

If innovation starts with mindset and practicing entrepreneurial habits, it will fail without proper execution. By now you have probably heard these quotes about execution or have an aspirational poster of one in your employee lounge posted next to your company mission statement.

Turning an idea into an innovation is a hard, arduous journey whether you are an intrapreneur – an employee trying to act like an entrepreneur- or some other kind of entrepreneur e.g someone trying to get an idea to patients by creating a medical device or a digital health solution. The result is that the vast majority of ideas go down the drain during your morning shower and never see the light of day, perennial hostages of your mind.

Why is it so hard to execute? Generally, because there is a lack of :

1. Leaderpreneurship, i.e. those who lead innovators and not manage innovation systems
2. Followers with an entrepreneurial mindset. Here’s how to find GSC Club members.
3. Communication skills
4. Project management skills
5. A dog that will eat the food
6. People skills and emotional intelligence
7. A culture of innovation
8. Incentives to fail and persist
9. Acceptance of anything not invented here
10. Ways to track relevant key performance indicators, results, timelines and deliverables along the stages of development
11. Poor teamwork
12. Insufficient engagement of those who will be ultimately be affected by the proposed solution and have to use it and incorporate it into their workflow.
13. A VAST business model
14. A champion
15. Strategic and tactical alignment

Moving an idea to an invention to an improvement or innovation, or somewhere else on the novelty-value matrix, requires that you identify all the above barriers and figure how to fill the gaps to overcome them. Otherwise, you will be stuck in project purgatory, practicing innovation theater spewing innovaganda (innovation fake news) while your project dies a swift, merciful death on the executioner’s block.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

A recent report from Merritt Hawkins indicated that the average employed physician generates over $1.5M to their employer. Also, while there is a lot of noise about value based and bundled payment, the reality in the examining room is  “the healthcare environment remains solidly rooted in fee-for-service and other forms of volume-based reimbursement. According to a recent Health Affairs study, 94.7% of physician office visits were covered under fee-for-service arrangements, and just 5.3% under capitation payments.”In other words, docs have one foot in the boat and another on the dock.

In addition, entrepreneurs are creating new care delivery models, like urgent care clinics, new forms of primary care practices and retail based clinics and they are looking for ways to attract and compensate docs, particularly primary care docs, in ways that are both motivating and legal and not run afoul of Stark Laws.

Health systems leaders are trying to figure out how to manage clinical staffing and variation.As noted,  it is essential to address how the health system manages its clinicians, particularly physicians. This has been an area of explosive cost growth in the past 15 years as the number of physicians employed by hospitals has nearly doubled. In addition to paying physicians the salaries stipulated in their contracts, hospitals have been augmenting their compensation (e.g., by paying them extra for part-time administrative work and being on call after hours and by giving them dividends from joint ventures in areas such as imaging and outpatient surgery where the hospital bears most of the risk).

There is nothing simple about physician employment agreements when multiple federal agencies are watching over them. Here are 10 legal and regulatory landmines.

Furthermore, those doctors that generate the most don’t necessarily get paid the most, given that some specialists generate lots of downstream revenue in the form or tests, imaging studies and procedures, while other specialists generate less. In some instances, doctors generate almost 20x their salaries.

What to do with the doctor cash cows will continue to trouble sick care CFOs for the forseeable future. Revenue sharing, ESOPS ,delayed compensation and other forms of incentives, because of the nature of sickcare, rules and regulations or stock options will probably not be viable options.

Here are 10 reasons why it is so hard to kill fee for service (FFS) medicine:

1. Too many people make too much money doing it that way.
2. Politicians are afraid of enacting too much change too soon.
3. Entire industries, like EMR, CPT coding, and others have been built around optimizing the fee for service model.
4. Some would claim it would be like other “socialist” countries with more government power.
5. Many are wary of how the payment negotiations would play out and the end result.
6. Some want to get rid of third-party payment altogether and this is just making a bad system worse.
7. Many think “value” is a smoke screen and a ploy to pay providers less.
8. Pay for performance is not working.
9. Some stress that patients should decide what they want and how much they should pay for it and not be forced into a “panel” of patients.
10. There’s a presidential election campaign going on.

As we change more from sick care to health care and we see a gradual, real transition to bundled payments via MACRA, there will also be a MOO-vement to do something with the doctor cash cows.

 
Image Credit: Pixabay

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GUEST POST from Arlen Meyers

Knowledge technicians differ from physician managers who are different from physician leaders. In addition, not all physician leaders are entrepreneurs and few physician entrepreneurs are innovators.

The ” change impact funnel” looks something like this:

It starts at the top with a wide base of physician knowledge technicians. Most doctors are trained to do three things and to do them well: make decisions, perform technical procedures and communicate. In other words, they are expected to be a first class diagnostician and technician and have a pleasing bedside manner. Few are triple threats and many of these skills are being replaced or supplemented by deep learning, AI and robotic technologies. Consequently, we have redefined what it means to be a triple threat.

The second level of impact is the physician manager, someone who is expected to optimize the efficiency and effectiveness of business, marketing and clinical policies, procedures and processes. They are agents of the existing clinical care and business models. Their entire focus is on the now and not the new. They do the thing right, not necessarily the right thing.

Physician leaders occupy the next level and are expected to provide vision, direction and inspiration and drive the change process. Some see their role as incremental tweekers, leading the painful and difficult process of changing the existing model. Others see their role as making the model obsolete. They typically try to follow John Kotter’s 8 step change paradigm: unfreeze by creating a sense of urgency, changing behavior, and then refreezing the new behaviors to engraft them on to the culture and make them sustainable.

Physician entrepreneurs take it one step further, taking advantage of opportunity with scarce, uncontrolled resources with the goal of creating user defined value through the deployment of biomedical and clinical innovation. Often times, their outcomes will be in conflict with physician managers who are there to protect, not disrupt, the status quo, or leaders who don’t have the same vision.

Some physican entrepreneurs are innovators, occupying a space in the upper right hand corner of the novelty-value matrix

Where you sit on the matrix is dependent on how much time you are spending on the now (lower left), the next (right lower) or the new (upper right quadrant). The upper left quadrant is the place in hell reserved for shiny new objects at the apex of the hype cycle that create little or no user defined value at significant multiples when compared to the competition or the status quo.

Finally, there is that rare combination of physician innovator who leads and inspires other physician innovators, the leaderpreneur. They are hard to find, highly valued and difficult to retain.

Here is a recent list of healthcare entrepreneurs recognized by their peers. Some are physician entrepreneurs who span the change impact funnel. It remains to be seen whether they will make the cut next year.

Beatrice was Dante’s muse in the Inferno. Fortunately, we are seeing more and more physicians serve as role models for others who want to navigate the innovation inferno.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

Water and steam powered the first industrial revolution. Think water powered mills and the steam engine. Cyberintelligence is driving the fourth. However, many are qestioning the wisdom of so much emphasis on STEM (science, technology, engineering and math) to the exclusion of other disciplines that supposedly promise to get us to the promised land of equitable prosperity.

It’s time to recreate STEAM (social sciences, technology, english, arts and media) and here are the reasons why:

1. The most creative innovations of the digital age came from those who were able to connect the arts and sciences.
2. Technology industries, like most industries, cannot be fixed from inside. The next phase of the digital revolution will bring a true fusion of technology with the creative industries, such as media, fashion, music, entertainment, education, literature and the arts.
3. Artists are better at seeing around corners and separating the signal from the noise
4. Two key components of the innovator’s DNA are observing and associating
5. We need better story tellers, particularly those that know how to do it using cutting edge information and communications technologies
6. Customers buy emotionally and justify rationally. We need entrepreneurs who know how to appeal to the heart and soul, not the head, or hire someone who does
7. New ideas come from the collision of disparate industries at the edge
8. Mindset, creativity and imagination are the foundation of innovation
9. Stories matter. What people tell each other can have profound implications on markets — and the overall economy.
10. It is a myth that new STEAMers make less money or are unhappier than techies, engineers, or scientists. Just ask your molecular biologist daughter -in-law who is doing her 3rd postdoc. The MFA is the new MBA.

Here is how and what we need to teach students to win the 4th industrial revolution. We need to reinvent the STEAM economic engine.

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GUEST POST from Arlen Meyers

The purpose of doing the problem-solution, value proposition design exercise is to find the customer segment and identify the jobs they want you to do, the pains they are experiencing now doing it, and the expected gains they want from your product or service. Clayton Christensen described the “jobs to be done” credo in his lastest book, Competing Against Luck.

For example. here are the jobs to be done for college students.

One error is to focus exclusively on the technical job e.g. create a drug or device that treats or cures an illness or helps a surgeon do the job. But, in sick care, there are many other jobs customers, influencers, decision makers, payers,end users and sabateurs want you to do, or in the latter case, don’t want you to do. In addition to technical jobs there are:

1)Emotional jobs

2) Social jobs

3) Business model jobs

4.) Workflow simplification jobs

5) Regulatory approval jobs

6) Reimbursement and revenue jobs

7) Cost cutting jobs

8) Patient and doctor experience jobs

9) Compliance jobs

10) Time saving jobs

11) Service jobs

12) Convenience jobs

For the most part, doctors want you to create a QWILT SET. Patients value other things and want you to focus on different jobs, like making care affordable and convenient. The result are value gaps for different stakeholders.

Finding the right problem-solution fit, product-market fit and business model-environment fit are 3 key steps to creating products and services customers are willing to use and buy using a viable business model. Don’t stop at creating an app that takes your temperature and sends it your daughter in Cleveland.

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GUEST POST from Arlen Meyers

There are presently 141 accredited MD-granting institutions and 31 accredited DO-granting institutions in the United States. Here is a list of the programs that offer MD/MBAs. The list seems to be growing each year.

Like management MBAs and law degrees, the degrees have become commoditized and lack any real differentiation. Some argue the same holds true for medical degrees.

Applications to some of America’s most elite business schools fell at a steeper rate this year, as universities struggled to attract international students amid changes to immigration policies and political tensions between the U.S. and China.

There are other problems as well.

1. We don’t know how much value the graduates contribute to the sick care system.

2. The programs are usually not domain specific. Some think that’s a good thing, encouraging exposure to how other industries have solved generic problems Others feel sick care is so unique, that the lessons are not applicable.

3. Medical students are already up their waists in debt, most of which is taxpayer subsidized. Should additional debt be added to their student loans ?

4. Few of the programs address the needs of physician entrepreneurs.

5 There are many substitutes for physician entrepreneurs around the world and US schools are no longer the mecca.

6. Content has become generic and offered for free on the Internet.

7. Connections are easily to make using social media.

8. The MBA is losing credibility, given the large number of places that offer them, particularly those below the first tier schools.

9. Employers can see through the credentials

10. Costs continue to escalate and the programs do not accomodate the specific needs of busy clinician students.

Rather, if the purpose of graduate business and management education is to educate and train medical students to create value in the sick care system, we should be thinking differently by:

1. Offering MBEs not MBAs
2. Create entrepreneurial medical schools
3. Track and monitor MD/MBA outcomes
4. Rethink providing student loans to cover graduate business education
5. Require more work experience from medical graduates before admission.
6. Stop using the programs as cash cows for business schools who are feeding the needs of doctors who want to get off the clinical track rat race for an administrative job and be a “sick care influencer”
7. Do a better job of integrating STEM schools with business schools with arts and sciences during undergraduate and graduate education
8. Define medical practice entrepreneurship competencies as part of ACGME accreditation of residency training programs
9. Rewarding faculty with promotion and tenure credit for the scholarship of innovation
10. Stop deceiving ourselves that innovative medical schools are entrepreneurial medical schools

The MD/MBA bubble has burst and the degree no longer has legitimacy. They provide expensive connections, credentials, credibility and content, in that order of perceived worth. We need to redefine our learning objectives and create educational programs with a structure, content and price that meets market needs. We need to kill the MD/MBA cash cow recognizing that vested interests won’t sit idly by while we do it.

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