Revolutionize Your Practice: Dr. David Norris Shares Insights on Financial Management for Physicians

Well, hi everybody. Thanks for joining me, Kevin Stephenson on. I don't care with, of course, me, Kevin Stephenson. Appreciate you, joining me today. Today's guest is doctor David Norris. And doctor Norris has written a couple of books that are, will be a great help for, any physician or any healthcare professional But, first, I wanna welcome you, doctor Norris. Welcome to Idaho Care. Thank you, sir. It's good to be here. Good. Good to have you. Hey, tell my tell my audience a little bit about yourself, you know, what, what type of practice you have, what got you started in, in writing these these books for physicians and others, just a little bit about you. Sure. I'm, I've been practicing anesthesia for a little over almost twenty years now. Did residency and fellowship at Banderbilt went to med school at KU. And then then when I got out of residency and fellowship, joined a practice and then was eventually elected into positions of leadership in that practice. And then was beginning to get handed and become responsible for certain reports and decisions within the group. And with twenty six physicians and probably thirty eight forty CRNA. So those are families. So over seventy families, eighty families, depending on good solid decisions, I realized I was ill prepared to make, to run a private practice. So I went back and got my MBA. While working full time, so I I had to go back to class, and sit in a real classroom every Saturday for two years. Okay. And that was quite a shock to the system initially. I'm sure. And and, you know, I'm I'm finding so many more physicians going back and getting their MBA And so, you know, I think that's incredibly admirable because, I mean, as you and I both know, you guys don't get a lot of business training in medical school. Nope. Get none. And so when I asked about these things in residency or medical school, med school, I was told you'll get it in residency, residency, I was still there. You learn it when you get out. And by the time I got out, it was just too late. Sure. So one of what really prompted me to do this two things. I did a research pay project for my, in one of my classes in med school or in my MBA program, and I sent out a survey to every physician in my county. And, I got about a thirty five, forty percent response rate in a one time nail mail with self addressed stamped envelope. And in that survey, I asked a bunch of questions. Do you know what it what it costs to see a patient? Do you know how you make per patient. Do you know what your expenses are? Do you know how to budget? What areas do you have problems with in terms of leadership, negotiations, patient satisfaction process improvement, financial reporting, accounting, And then I ask those same questions related to their personal lives. Do you know how much you have in checking? Do you balance your checking account? And, I wanted to see if there's a correlation between, I don't know what's going on in my business, and I don't know what's going on in my private life. Data came back. There wasn't a statistically significant correlation, but there was a strong correlation with those physicians who knew the answers to their business. They also knew the answers to their personal life. And those that did not really know have any idea how much they had in checking. Pretty much didn't have any idea how much they made per patient. And I remember after I sent that survey out, one of the surgeons I work with to me, looked over the drapes in one case. He said, you know, I'm not happy with you. You're sir and I'm like, what? I was like, your survey made me feel stupid. I'm like, no, no, no survey. I didn't make you feel anything. I was just asking questions. She's like, well, I didn't like the answers to my your questions. I'm like, well, sorry. And that just prompted a discussion. You know, well, there's no real good way place to get this sort of stuff without you know, enrolling in a class. And then I had a mentor that popped into my life about the same time, and he really encouraged me to start writing, and doing speaking and consulting work, and those two, events led me to start with the manuscript. That was the first book, financial intelligence physician. And, the second book is just more about patient satisfaction and how do we design systems that improve patient satisfaction. So That's how I got started and, still working down that path every day. That's great. Well, let's talk first about the financially intelligent physician. Yeah. What what topics did you did you focus on? Did you and was it was it a pretty basic book? I mean, did you What kind of assumptions did you make based upon your survey, of your audience for the book? Yeah. So, the survey results number one, the issue they felt they had, they didn't really end no well. We're financial, you know, financial reporting, accounting. That was the reason why I chose that book first. The second the second and the third were really kind of negotiations and process improvement how do we make something better, smoother, faster, easier for everyone? And at the bottom of the list oddly enough was leadership, which I've always found curious in that I've known a lot of physicians who think they're good leaders when they're not, but that's a topic for another day. So in the book, I assume that you basically don't have any fund of knowledge. And I pretty much try to walk you through what shows up on these reports. So we start out very basic. We go over, I discuss what's on each report, why it's on that report, and what you can expect or should expect to get from an accountant. I cover the P and L or the profit loss or income statement. I also then cover balance sheet and then the cash flow statement. And then the the next part of this section of the book is really determining the financial health of the product or financial analysis. So we take numbers off those reports, and there are a bunch of different metrics we can use to kind of determine the overall financial health of the practice. Much like we do in clinical medicine, where, you know, with hemoglobin a1cs or PTINR, same thing, with these reports. And then I kind of walk you through all the different ones. I don't cover all the report or all the metrics, but they're because they're a lot out there. I'd cover the ones that I think you might find useful. And then I kind of suggest pick one and, go from there. And then the last part of the book, I talk a little bit about, time value of money and how to determine costs. If you don't already know that. Well, interesting. You know, I've got a lot of friends, obviously, that are that are practice administrators. Yeah. And they all say the same thing that they're that they're incredibly surprised by the overall, lack of financial knowledge by by their physicians. And and so they spend a great deal of time much as you've done educating them on, you know, the opportunities within the practice and and really, you know, shining a light on on things like, expense control and contracting with managed care providers or what and and whatever. And so I think a lot of that really is, you know, helps the physicians not only be better stewards of their practice funds and their personal funds as you said, but also helps them you know, understand how we as hospital administrators have to think about various, you know, procedures and things like that, in the decisions that we make, on a day to day basis. Yeah. My the conversations I had with the hospital CFO after got through those classes and began to understand, they became much more effective and shorter because we were talking the same language. And whenever he might say something, I'm like, that's no. That's that's not what you mean. Or is that really what you mean? You're trying to pull a fast one on me. And so, yeah. And, you know, if you don't understand those reports, or even look at these reports, people will steal from you. Absolutely. And, so it's a it's a I also say it's a great way to make certain nobody steals from you. Because I've we've had a couple practices here where, the office managers have stolen millions of dollars. In fact, one just went to jail. She didn't wanna say. I'm sorry. So the judge gave her time and she's seventy something. Oh, my gosh. Yeah. Going to jail. Was gonna say it's not only not only in the office, but certainly, you know, on a personal level because again, somebody physicians utilize, you know, financial advisors or whatever that they just don't understand, you know, maybe the investments that are being made or whatever And and I don't wanna I don't want it to sound like I think all physicians are are are stupid, but but, you know, they just you guys just aren't trained in this way. You know, and so, you know, unfortunately, I've had a lot of physician friends who have really been brought into some pretty bad investment deals that have cost them you know, years of of income. And so, you know, I think, you know, you as a physician and someone who did go back to get their their MBA. You know, you have a little bit better credibility than than most others in speaking with physicians about their financial health. And so I think that's Right. So anything else, around the financial intelligent physician that you wanna you wanna hit on before we go to your second book? Oh, well, I think it's it of the two by that one first because that one's gonna make the most impactful thing. Not only in your professional life or personal life. These these principles applied both ways. You know, you know, we we don't change glasses when we go from when we switch half you know, I might have a doctor hat and a dad hat, a husband hat, but I usually leave the same glasses on. And how we view the problem is how we view the problem all we need to do is change that prescription a little bit. And I think you'll have, a happier life, because you actually stand where the money's going to and coming from. And that's really the most important thing. And, I find it really frustrating when physicians, I don't care. I just wanna at the bottom line. Like, that's that's not how to that's not how you run a business. Do you think that's how Fortune five hundred companies do it? I mean, you might as well act like that, even though you might not be, you can still have, good performance if you do. Yeah. Absolutely. Well, and and so so let's let's go to your next book. Great care. Every patient. Tell me about that. So that book I wrote, because I really wanted to, talk a little bit about process improvement. And I didn't really used to be kind of an interest or passion of mine because as an anesthesiologist, I'm not I don't really own a lot of those processes. You know, the hospital owns those processes, you know, or the surgery center for the patient from, you know, registration, check-in, I pick it up when they hit the pre op and I, you know, I'm done when they're leaving recovery. But it wasn't until my parents became consumers of health care. I really began to appreciate and understand everything the patient goes through. And so I started to try in preparation for that because I think a lot of physicians think they do good stuff, but they don't realize that it's not It's not your perception of your care. It's the patient's perception of your care, the matters. And I really wanted to kinda bring that, argument to bear and then give them some tools and things to think about as they develop the care. Those processes, you know. Because we I don't wanna say we wanna manipulate the patient, but we definitely wanna design systems and process these touch points that reinforce the emotions we want that patient to experience when they go through our clinic. Because they'll remember the emotions more than they will, what you tell them. Right? You know, you can tell them you have cancer and but if or you have a bad disease or we can manage this, they're not necessarily always gonna remember everything you say, but they're definitely gonna remember how they feel when they left, whether or not you, the physician took time and really cared about them, whether your office staff was pleasant. And it it even goes from the beginning, like, how easy it is to get in you know, do your is it do they call back to schedule that appointment like they're supposed to, or can they even get the billing right? You know, my dad, you know, he has, metastatic prostate cancer and, you know, he he likes his, oncologist. But he when he first started going to him, you know, he wasn't concerned that the oncologist didn't know what he was talking about. But they never could get the bill right. And that said, I I don't even know, you know, if you can't get the bill right, how's is he really giving me good care? Is he really treating me the way you know, giving me the proper care? And for clinicians, we say, well, those are two teva two totally different things. But for the patient or the consumer, it's all one continuum. And it's that last stop, that last piece of touch point that really solidifies that. You know, if you make a great first impression, you can overcome that, but still, you know, you can still hurt yourself by not making certain that you can get all those pieces in in line. So in that book, I just try and give you some ways think about how to design and really get down on paper the processes because in the service industry, we have steps that other people own, and it can kinda be hard to conceptualize to get your brain around all the steps that go on and to getting a patient in the clinic until you get it down on paper. And then and then we start to assign roles. Who's responsible for this? Are they responsible? And do they have the ability to change if they see and need to change? Do we give that or empower them with that authority? And then we review that and, like, what emotions do we want the patient to feel? And then, you know, go through it as yourself and make certain as a physician and health care providers, a lot of us walk in the back door and we never see the front door. And I've walked through a number of front doors and been like, wow. Do they really know what this feels like when they walk in here? You know? And it kind of leaves you scratching your head like, well, I wonder what your satisfaction scores are like. So, you know, those are things that, you know, we just don't really think about because we think about, well, I'm gonna get the diagnosis. I'm gonna get the treatment boom, that's great care. And it is, but it's not the whole thing. And that's really what that book is trying to illustrate or trying to drive home is it's more than your ability to treat the patient. And you have to, if you're gonna be in private practice or even in, in a big organization, you really gotta think about every touch point and what you can do to drive the emotional response of that patient to reinforce that we're here for you. We care for you. We want you to know that, and we're, you know, every step of the way. We wanna we want you to be aware that we're attentive to you. No. I totally agree. And I love I love how you put that. That you know, we as health care professionals walk in the back door, but rarely through the front door. And I think, you know, that perspective of walking through the front door, whether it be through the ED or actually the physical front door of the clinic or the hospital, you do get a different view of the entire experience. And and I talked to some other folks about about physician customer service and all that. Let me throw something out. I'm interested to hear your perspective on it. You know, I think from a primary care standpoint, you know, I want somebody that is very attuned to me trying to develop that relationship and and really make sure that that clinic visit goes well. But the higher up I go in in medical sub specialties. You know, I'm really looking for that physician who is clinically, you know, excellent. You know, case in point, I had a procedure done many years ago. Not in my current not in my current city, but somewhere else. And the physician had a terrible bedside manner. But he was a phenomenal surgeon. And so I overlooked that. What do you think about that? Well, Yes. Because you went to him with a certain expectation, certain demands. However, I don't think I don't want to excuse that poor bedside behavior. And, so part of what I I teach disc, which is a personality style or it's for me, it's down and dirty. It's quick. It's easy. But more importantly, after you get to know a patient, you begin to understand their disc personality. You can begin to talk their language, right? And you can begin to address the patient how they want in their personality style. So I am not what we call high d. So I'm very task driven and and and outgoing or or energy. Let's get it done. Now that could come across very differently in the ten minute window. I have to interview a patient before anesthesia, depending on your other styles. Now, if you're the style that's complete opposite of me, which is very people oriented and very reserved, you know, my I can come across as overbearing. And if I don't understand that or I don't actually take the time to try and figure out what you might be, based on, you know, behaviors and and other things. I might shut you down. I might not get all information, or I might not really you might walk away thinking they might walk away thinking. He doesn't really care about me. He's just here to do the job. When, in fact, I do want to do a good job and I want to make certain you get through your surgery. Whereas other patients, you know, in a high eye, they're going to come to me and they're going to talk talk, talk, talk, they may not even, they may take five minutes to answer a yes, no question. Okay. And if I'm in a hurry and I, and I'm not aware of what I'm thinking and feeling, I may shut that down and say, just answer the question. I don't need to hear about, you know, your gallbladder variance at your sister's wedding in California, I know if you've had surgery before. If I don't if I don't tactfully do that because I recognize that they are a big talker, and I just gotta let them do it for a minute, acknowledge it, and then move on and redirect. That interview and how they feel when I walk out of that room are gonna be completely different. And, you know, there are some patients, you know, like, or a high c which is very task oriented and reserved. Those people that come in with their EMR already preprinted. They have their entire EMR. Right? You know, those people I know as soon as I hear it, I see it. I say, alright. They're not gonna be they're not here for the touchy feely. That's fine. They wanna know that I'm gonna do a great job and they're they wanna know exactly what I'm gonna do. So then I kinda shift that talk a little bit to address those concerns And so you kind of tailor it for each patient. And I've just discovered that over the years, I've been using this for about fifteen years. And pick a model that works for you and then begin to work on and apply. It takes a lot of effort, but as soon as you begin to really incorporate that you can address your patients a little differently and, you can still do a good job. I think just because you're a good surgeon doesn't mean that you are licensed to be a jerk on the bedside. And I think, and I honestly, a lot of surgeons that I know one on one in the or or, you know, outside the operating room, they are good people and they wanna do a good job. They just they just they just haven't developed or been taught those soft skills. And I think if you'd by really thinking about patient status faction and what all the tools that we can use to improve that, I think they could probably even up their game even more. But, no. I mean, you're right. A lot of patients do that. They'll they'll overlook bad behavior, because, you know, of the expert they are. And I think those days are beginning to wean. I mean, you know, we see hospital administration and nurses and other folks not tolerating outbursts and other such stuff in the o or even if you are a good surgeon. Absolutely. And something some things that pendulum is like, you know, you're not we're not gonna tolerate that. And I think, you know, the same thing, should be proactively done on the physician side. No. I totally agree. So so you mentioned it sounds like you're you're already prepping for that third book on leadership. What what what direction are you gonna take that in? Well, it's really gonna be, what I'm what I'm doing is I'm taking, all of my podcasts, articles that I've written over the course of the last eight years. And I'm kind of re tooling those, recondensing those, to, hit high points or teaching points. With with a number of questions at the end of each section to really, you know, make it sure that you absorb and apply the information. The leadership really is more about, you know, I think, you know, being a good leader goes beyond the title, you actually have to care about the people you work with. And you actually have to realize that, other people, have lives and, that's not just about you, as a, you know, particularly as a specialist I've realized that that, the hospital is there for the patients. I'm just helping the hospital take care of patients sometimes. So Okay. That's a I look forward to that one too. Yeah. So that's that's kinda what the man you know, I got the the manuscript almost done. It's still being tweaked and stuff. But, yeah, that's that's what I've been working on for the last couple of months now is taking all those materials and repurposing them to make them, one big one big book to, help residents or new newbie physicians or anybody really. That sounds great. So, in our last few minutes, any final words, How can my audience if they wanna, you know, pick up pick up one of your books or or maybe engage you in some consulting? How can they contact you? Yeah. They can reach me at my website david norris m d m b a dot com, or they can shoot me an email at david at david norris m d m b a dot com, or they can, just, give me a call. Numbers, three one six two zero zero two seven eight five. And that's them. And if they wanna buy the book, and it's on Amazon and Barnes and Noble, the books are there, they can buy them. I don't I don't sell them myself. I just use the retailer, to do that. I found that, it was a lot easier. Because I know that they have time to ship the book and sometimes Sure. I totally understand. I don't. So I just let Amazon and Barnes and Noble handle it, but they can go online and find that as well. That's great. Well, doctor David Norris, anesthesiologist author of two fantastic books so far, the financially intelligent physician and great care every patient David, thanks again for joining me on I don't care today. Oh, thank you, Kevin. I enjoyed it. It was good to talk to you. Thanks. Nice to see you. I look forward to having you on and, after this leadership book comes out. Yeah. Absolutely. Sounds great. Well, folks, we've just put another episode of I don't care in the can. Thanks for joining me, and we will see you next week. Take care.