A Holistic Approach to Healthcare Compensation

Intentionate’s Stu Schaff was interviewed on a recent episode of the Practice Freedom podcast.

In the interview, Stu unravels the complexities of financial rewards, organizational values, and the personal aspirations that drive our healthcare heroes. This isn’t just a discussion about the numbers on a paycheck; it’s an exploration into what motivates the people dedicated to healing others and how practices can cultivate an environment where everyone flourishes, from providers to patients.

You can listen to the podcast or read a transcript of the interview below. If you have any questions or would like to discuss how Intentionate can help your organization with provider compensation and setting clear work expectations, please contact us.

Interview Transcript

Mark Henderson Leary, Practice Freedom:

Welcome to Practice Freedom. What if you can hang out with owners and founders from all sorts of healthcare private practices, having rich conversations about their successes and their failures, and then take an insight or two to inspire your own growth. Each week on Practice Freedom, we take an in-depth look at how to get the most out of both the clinical side and the business side of the practice, to get the most out of your people. And most of all, how to live the healthy life that you deserve. I’m Mark Henderson Leary. I’m a business coach and an entrepreneurial operating system implementer. I have a passion that everyone should feel in control of their life, and so what I do is I help you get control of your business. Part of how I do that is by letting you listen in on these conversations in order to make the biggest impact in your practice, and ultimately, live your best life. Let’s get started.

Mark Henderson Leary:

 Welcome back to Practice Freedom. Happy to have your back. Today’s conversation, Stu Schaff, a really, really great conversation I think. If you think a lot about physician and provider compensation, we dig into all kinds of aspects of this. He and I talked in advance, and I wanted to make this as tangible as possible.  I think we both agree that a lot of this is pretty conceptual though. So, hopefully you will get the right mindset and listen to an immersive conversation that goes a little longer than average. I just felt like we were talking about important things with regard to the mindset associated with provider of compensation, and how that fits in.  I think the conversation goes deeper than just compensation is just a means to an end, but the interface between the compensation and the culture, and your objectives. So, we talk a lot about that. We talked about objectives.

Mark Henderson Leary:

You know, Stu, I should have started there, Stu is a principal consultant in an organization called Intentionate Healthcare Advisors. And really his passion is getting this right. Letting the people who are healing people now and in the future be seen, compensated, hired, and pulled into organizations where they’re the right fit, and making a great impact and fairly compensated. And the flip side is organizations who want these people. How do we have these conversations? What do we say and do to attract and set expectations well for performance. We talk a lot about the goals and outcomes that you’re after. This is the terminology of doctors and physicians. It’s really all about the difficult providers licensed or otherwise, that you’re trying to attract. We talked about comp models. We talked about culture. We talked about the impact to the organization, and just a lot of different things that hopefully, if you’re struggling with this idea of how to compensate, and what needs to be considered and what the conversation needs to involve; hopefully, this is going to be helpful to you. So, before we let you jump in there, please don’t forget that I’m here to help. This community is an amazing community. But if you’re stuck, and you don’t know how you’re going to get your organization to become that vibrant, healthy, evangelical, happy to get to work, privilege to heal people type of culture, please don’t stay stuck, please reach out. I believe the first step in that process is to implement a business operating system, and if you want to know more about whether that’s the right first step for you or not, please get some time with me. Reach out at practicefreedom.com/schedule and we can talk that through. In the meantime, please check out Stu Schaff and the compensating principles, those providers in your organization. Have a listen. Give us some feedback. Have fun.

Mark Henderson Leary 

Well Stu, it is so good to finally get this conversation going. We’ve kind of checked in before this but let’s kind of warm the conversation up. How are you?

Stu Schaff, Intentionate Healthcare Advisors:

I’m doing good.

Mark Henderson Leary:

It’s holiday time.

Stu Schaff:

I can’t say a sunny day.

Mark Henderson Leary:

No, I was going to say it’s holiday time. It’s cool outside, not cold. Managing the transition between Hanukkah and Christmas in my family, which is a double whammy of stress. Because yeah, I mean, that’s the holidays.

Stu Schaff:

 Yeah, this time of year is always fun.

Mark Henderson Leary:

Happy holidays.

Stu Schaff:

Same to you. Same to all our listeners.

Mark Henderson Leary:

So, I’m really excited to have this conversation because for no other reason you care a lot about this subject. You have an infectious passion for this subject of, I was going to say compensation. It’s not compensating is the passion. That’s part of the language.  What is it that drives the passion for you?

Stu Schaff:

Compensation is definitely part of it. I mean, that’s the SEO term. That’s what people are looking for. That’s what kind of perks their ears when I’m talking to them.  But really, what we work on is anything related to the way that physicians and other health care providers work and how they’re paid for it. It’s really the exchange of their effort for, well, whatever it’s exchanged for. But the passion that you’re talking about is a human one. I care about the folks who care for others. Our business, I think, is a little bit more mission-focused in that way than a lot of the other consulting firms that I’ve worked for in the past.

Mark Henderson Leary:

Isn’t it weird that that’s a just cause to fight for?

Stu Schaff:

Caring for others?

Mark Henderson Leary:

Yes, that hopefully is intuitive. Maybe I’m making assumptions because I’ve thought about this a bunch. I find myself having to advocate for doctors and physicians in an organization. A lot of it is inspired by you. You’ve really given me a new lens to look through on that. There aren’t a lot of people who feel sorry for the plight of physicians.

Stu Schaff:

Yeah. Well, first of all, thank you for the compliment. But second, it’s very interesting, in the times that we’re living in, that that’s the case. How quickly we went from healthcare heroes everywhere, and people banging on pots and pans during the pandemic to recognize health care workers, to the fact that we’re finding more and more health care providers are being physically abused in their jobs. It’s astounding. I don’t know what the cause of that is and it’s probably way outside the scope of what we’re here to talk about today. I think part of what we see here, this kind of strange situation, could have to do with the fact that health care providers relative to other professions, are pretty well paid. Generally speaking, right? When you look at absolute numbers. But it’s not just about absolute numbers, right? There’s an exchange happening here. Society puts a value on the effort that that person is putting in [versus] the outcomes that they get. The fact that they’re keeping people healthy, specifically, is what I mean, are helping them come back from the brink. All the training and the risks that they’re taking, and on and on and on. It’s a whole economics course. Right? But I think for some people, it’s just difficult to get past that number. And they say, oh, woe is me, your life is so hard. But look at you, you’re making hundreds of thousands of dollars a year, but it’s more than that.

Mark Henderson Leary:

Yeah, I think that’s exactly right. And it’s, I think there’s like so many things. The typical patient, the typical person who’s working a nine to five, you know. I guess it’s totally reasonable. They would be like; doctors live the best lives. They live in the best neighborhoods. They drive a Mercedes. And you know what, that has nothing to do with me. And I think you can make the case that there’s some truth to that. But I think where this gets interesting, is the people who are closer; the people leading the organizations who have a real vested interest in getting the best outcomes, making it possible so that these people who ostensibly have the capability, capacity, and passion to heal people, and all the obstacles that make it very difficult for them to do that. Systemically, I mean, really, mostly systemically, in many capacities, but very tactically, I’m sure these are things that you’re talking about in terms of having a conversation. I’m going to hire a physician. That’s to me is not systemically problematic … The whole system is insurance and there’s complexity in EMR and managing the information through the supply chain is very, very difficult. That’s the systemic stuff I’m thinking about. But like where you kind of get mostly involved [is] I need a doctor for this organization, and all the obstacles that go into setting expectations about that; it’s amazing to me how hard it is. How hard it is to set expectations and to make it possible for these people to make a difference.

Stu Schaff:

Yeah, I want to go back to what you just said there. You know, the systemic issues that we have in healthcare is the background that everything else, you know, is against. So, you’re trying to hire a new physician. You have all the challenges of the fact that there are only so many physicians who are coming out new into the industry every year because of the way that the medical education system works. You have licensure issues, where you know, someone may only be licensed in a particular state and maybe they’re not immediately available to you; just as two quick examples.

Mark Henderson Leary 

Yeah.

Stu Schaff:

But there’s also the fact that, you know, our physician owners, the folks that you and I serve, they are also burned out by the system, and it makes every additional complex decision like hiring a new physician, to use your example, even more challenging, right?  To the point where maybe the distance that they go, to the point where they throw up their hands and say, “you know what, this is just not worth it to me?”

Mark Henderson Leary: 

Well, I mean, I want to make this understandable. And I would talk to you before we started recording, I want to make sure this isn’t too conceptual. And I’m going to dive into concepts a little bit. But I can imagine the combination of the frustration of the systems, the systematic nature of it all, the licensure…Combined with this rugged, individualistic mindset that I think is built into healthcare, like, it was really tough for me, and it will therefore be really tough for you and that’s the way it’s supposed to be. And then there’s frustration that comes from, I’m just going to force this. I’m just going to get really angry, and …I’m just going to push harder, and no one wants to work anymore. And back in my day, we, you know, it was like this, and we were walking uphill in the snow both ways. That kind of mindset. And you’ve got to get in there and say, all right. You’re making this really hard on yourself, in addition to the stuff you’re complaining about the that’s external.

Stu Schaff:

Yeah. And the work that we do. The best tool that we find is, what are you trying to accomplish? Let’s go back to the basics here. Because yeah. There’s a messy web in your way and there’s always going to be a messy web in your way. So, let’s really focus on what’s important and let’s figure out how to accomplish that goal in the most, you know, meaningful way that works specifically for you.

Mark Henderson Leary 

So, what do you do?

Stu Schaff:

 Great question. Thanks. So, you know, we focus on physician compensation [and] physician engagement. Again, there’s our little SEO terms that we tend to cling to.  But both of those are very big, complicated concepts and I would say they’re at the root of any successful practice. In general, there are many things that go into compensation. There are many factors that affect it. You know, I mean, there are many things that come out of it, different types of compensation, satisfaction with compensation and so on.

Mark Henderson Leary:

 When you talk about physician[s], I want to make sure this is broadly applicable as possible. Can you speak to how this affects other non-physician, licensed health care [workers]? This mindset. [Does] this extend to nursing? Is this extended to non-licensed [healthcare workers]? So, if somebody’s listening to this and they’re in Chiro or Optometry, or anywhere else, I want to put [into] context of how to apply this thinking outside of just an MD.

Stu Schaff:

Yeah, I would say, generally speaking, we tend to focus on, I’m trying to be careful with terminology, because, you know, people have different opinions about terminology. Generally speaking, I would say healthcare providers, you could say, licensed professionals. But even within that, that category, you know, you might include an RN, for example. The reality is, in the world that we live in, things tend to be a little more cut and dry for certain types of members of a practice, like an MA, like an RN. You know, where you say, oh, I understand I pay this person [a] salary based on a certain level of experience, or exposure, or specialty, or whatever it may be. Or I pay them, you know, an hourly rate. Again, based on those kinds of factors. And when you get to a certain level, when we’re talking about physician assistant or associates, depending on who you’re talking to, again, there’s that terminology, you know, nurse practitioners, CRNAs, and so on up to the physician, you know, as you kind of climb that ladder of the scope of practice, it tends to get a little more complex. And that’s where we find that our clients have maybe a little bit more use for the kinds of things that we’re talking about. But ultimately, the principles that we work on around setting clear expectations, paying fairly for, you know, meeting those expectations, and I’m way boiling down here, you know, figuring out what you can meaningfully incentivize and things. Those kinds of things apply really to any labor, right? So, it doesn’t matter what role we’re talking about. This is all just about the application. And again, where we tend to work with our clients is how to apply those principles. In a way that makes a meaningful difference to their practice and to the practice owners, for providers, primarily physicians, but also with our non-physician providers as well.

Mark Henderson Leary:

Okay, cool. So, continue… One of the things you talk about in compensation is objectives.

Stu Schaff:

Right.

Mark Henderson Leary:

How many physician leaders, physician entrepreneurs come to you with a clear set of objectives?

Stu Schaff:

That’s typically not how they lead, right? So, what will often happen to us, and we work with both, you know, individual practices, private practices, as well as more institutional clients, hospital affiliated, [and] health system affiliated. But I’ll focus on the independence here. So they’ll come to us, the physician owner of a practice, and they’ll say, I want to hire a new physician, or I have a physician or other health care providers in my practice, and I don’t know how to pay them or what to pay them, or both, what and how to pay them. What’s the right compensation model? Right. And, you know, we can go down a whole rabbit hole of well, you know, I’m going to give you 20 questions about your practice and that may give me a better sense of what direction to point you in. But really, that’s what I have found is a much more helpful question to ask is, what are you trying to accomplish? And nine times out of 10, they’re saying, well, I want my currently employed or to-be employed doctors to be incentivized to do more. Right.

Stu Schaff:

And then my next question is, why? Right? Maybe it sounds obvious that you’d want people to do more. I’m sure that a lot of the practice owners that might be listening to this would say like, well, that’s it’s an obvious question, right? You know, but what I’ve found is that, in most cases, these practice owners feel some pressure as a result of the fixed costs. The decisions that they’ve made before. Their leases, you know, the rent that they have to pay, their employees. The physician employees that we’re talking about here, the cost that they have to bear for them. The personal expenses that that physician has. Their mortgage, their car payments, their kids’ education, [and] so on. And they’re feeling overextended. And it’s sort of like, okay, well, I have this business here. There are certain levers that I can pull and one of those levers is my people, and everybody tells me that the best way to get more profit is to get more revenue, right? And so therefore, I want my people to do more. How do I incentivize them to do more? Totally natural, right, that it gets to that point, but I want to ground them in that why.

Mark Henderson Leary:

Yeah.

Stu Schaff: 

Why are you doing this?

Mark Henderson Leary:

And that’s interesting because that’s a pillar point for people to come to me. It’s hyper dependency on one or more people. It’s like, you know, the more successful this organization is, and the more time passes, the more I feel the burden of nearly everything in the organization, not the least of which is its money-making capacity. And so, it makes perfect sense to me, [that] they’re like, everybody’s lazy around here, nobody gets it, nobody cares like I do, nobody feels what I feel, which is largely true, because the pain has been magnified to sit on one or a very small number of people. And so, that frustration when they come to you is probably no less painful than when they come to me.

Stu Schaff:

 Absolutely. And there’s one other thing that I would mention as something that doesn’t really get talked about a lot in these conversations, but that I’m very aware of. I think the conversation is starting to happen more, which is that our society also points to more, in big shining lights. Like if you remember those old cartoons where the bad guys hide out, and the big lights and the sign that says more, right? You know, that’s the default. More profit, more revenue, more volume, more employees, more offices. You ever heard the expression if you’re not growing, you’re dying, right? It’s not necessarily a bad thing to grow, right? You know, I want to grow my business. You want to grow your business. Our clients want to grow their businesses. It’s not necessarily a bad thing. But what I really try to focus on with our clients, and by grounding them in the why, is how we can grow in a way that’s sustainable for them.

Mark Henderson Leary:

Yeah, I think that this sort of hyper dependency is the pain, as a result of years of unconscious behavior. Unintentionally, maybe a bad following of well-intended bad advice. Lots of that, which creates this pain, which creates what you’re saying. And I experienced it just the same as anybody else. It is like, you know what, I have a pain, and what can solve it is more. And so, I think there’s two things and maybe you’re going there, but this ties into sustainability. Which you can ask that question. But it’s still a middle ground from intentionality. Where’s this going? Where does this need to be three years from now or 10 years from now? Are you just solving a short-term problem by just making the machine run hotter for no clear reason? Where’s it going to go and what’s the organizational return on investment going to be to get more? And to your point, maybe even create a positive feedback loop of even more sustainability. The more we win, the more we want to win as opposed to the more we win, the hotter everything gets and hopefully, we can replace these people after they burn out.

Stu Schaff:

Where does it need to be in three to five years for you and for your team? Right? That’s the question. Because it’s not just about someone else’s idea of what a practice should look like. Everybody is happy to tell you all day what your practice should look like. There’s plenty of websites out. There plenty of conferences. Plenty of folks running around that will tell you, you need to meet this benchmark in your practice of revenue per FTE, or, you know, you got to have this kind of compensation model or whatever it may be. But they’re not asking, well, what do you want? Right. And that is the key important point is, what do I envision for myself? What will work for me and then, how do we get there?

Mark Henderson Leary:

So, what do you find when you ask that question?

Stu Schaff:

Well, I’m going to give the consultant’s favorite answer. It depends, right? It’s going to naturally depend on the individual person. I have worked with some practices, where there are a good number of providers or physicians, primarily, where they have decided that work is a means to an end for them, right? They want to practice medicine, they want to care for folks, but they are very grounded in this reality, from their perspective, that I have a family to raise and that is my primary responsibility. I have some time that I will devote towards practicing the craft of medicine, but it is not an all-consuming consideration for me. Right? So, the box within which I operate, my kind of boundaries are whatever I need to do for my family. Right? If you think back to what I was talking about, about that question of how do I get them to do more, you’re speaking a foreign language to those folks. They are bounded, right? So, if you go and you say, I’m going to pay you more if you do more, they say, well, great. Mike, I don’t care.  It could be net neutral for them in that situation or depending on how the whole thing is structured, it could actually be a demotivator ; because sometimes, you end up creating a culture where the impact of that formula saying,  oh, I’m going to do an extra wRVU, I’m going to see an extra patient to generate that, [which] leads to situations where you’ve got folks who are motivated, more motivated by the money hoarding or double booking or triple booking patients, you know, doing different types of things that are actually disruptive to those other folks. You may end up driving out a very good member of your team, unintentionally, based on this desire that’s rooted in these other considerations, that’s not then tied back to the team that you, have the team that is working for you. Right?

Mark Henderson Leary:

Yeah, I think that’s a very rich point. And I’ll try not to derail us for a half an hour on this topic because I think.. just from a morale perspective, if somebody’s like, I just want to get out of here at five and you say, you know, if you stayed until 5:30, that would make a big difference. When they leave at five, they’re going to be like, well, I feel like I’m flying under the radar.  I don’t want to be seen. I don’t want anybody to notice and now I’m not plugged into the culture. Which goes back to this idea of intentional culture, core values, which is a pillar of all business’ culture elements and [is] newer to healthcare organizations and really any highly paid, professional organization where the money sort of lead’s [the] culture. But we really have to establish what is the culture around here? Is work life balance? Is it work at all costs? Is it research driven? What is this culture? And so, it’s very common to have some number of associates, I think, probably more common with associates usually, that I think have slightly higher bias towards sort of partners, or [the] more as more mentality. But that doesn’t actually mean we’re on the same page with the culture, actually. But it usually means we’re on the same page with working hard.

Mark Henderson Leary:

So, this idea of, you know, what percentage of the people are kind of on board with this? Did we ask any questions? Or did we hire generic doctors that we assume had the same exact core values as us? And what kind of cultural and business level disruption is it going to be? If we realize that three out of the five doctors’ associates or even healthcare of any kind, it doesn’t matter, ODs, whatever, I see this all over the map. And anybody who’s in the organization, who’s a primary money producer, when you sort of hold up this, our culture is driven around quality, patient experience, and whatever efficiency. And just like, wow, I just realized that these people do not share these [values]. We’re going to have to figure out a way to solve this. And it’s a massively risky feeling. And it’s not an overnight thing. I’ve navigated many organizations through that. And I can assure you, it’s totally survivable, and amazingly gratifying when you get it figured out. But that realization that oh, my gosh, we are way out of whack here. If I really put the screws to pushing this organization to be all it can be, we’re going to have some people [who are] very uncomfortable, very fast, and they’re not going to line up behind it, they’re going to rebel.

Stu Schaff:

Right. And you know, in that example, that I was giving a moment ago, I have found that a lot of the challenge comes from the fact that what they’re trying to do with a compensation model often doesn’t align with whatever that culture, whatever those vision elements were. And as a result, you create this disconnect, right? And that makes people very uncomfortable. And that can lead to you know, earlier burnout and things. And what we often talk about with our clients is setting very clear expectations, which essentially take those vision[s], the strategy elements, the cultural elements, and say, hey, we’re going to get really clear about what kind of effort we expect from you. Right, and what kind of outcomes [do] we expect, right? Because there’s those two different types of expectations. And only then, can you determine what it is what’s reasonable to pay for that. Only then can you determine how you can support them in meeting those expectations. Only then, can you really understand in a very meaningful way, how can we incentivize people to exceed expectations to the extent that they’re motivated to do so, right.

Mark Henderson Leary:

 Right.

Stu Schaff:

By the way, something that doesn’t get said, I don’t think often enough is, it is perfectly fine in a lot of situations, you need to have average people, right? It is okay to meet expectations. You know, for someone like me, someone like you, I had parents who were like, if you came home with an A minus, what was the problem? So, it was really difficult for me to understand for a long time in my career, that it was okay for someone to want to go home at five o’clock, you know. And not to always be bringing your work home with them and not be all consumed with it the same that I was because if I wasn’t, you know, succeeding at the highest level, then I would be doing something wrong, right. But for someone to be exceptional, they have to be the exception to something. Right. So, anyway, my point is that the goal, one thing that we do is we work to set clear expectations, but we also try to reorient the mindset to saying, look, the goal is to get people to meet expectations. That doesn’t mean the expectations should be low. Absolutely not, right? But they should be clear, and then understand that not everybody is going to exceed expectations. If everybody exceeds expectations, your expectations are too low. Right?

Mark Henderson Leary:

Right, right. That makes perfect sense.

Stu Schaff:

 So, there’s a lot of that. And this is what I mean when I say that compensation is more than compensation. All of these factors go into it. But they’re not necessarily what someone would think of if we were playing Family Feud, and I said, you know, what is compensation? You’d probably not be up on the board.

Mark Henderson Leary: 

Yeah. And one of the things that I think needs to be called out here is, everything you described is opted in to especially. And that’s the scary part of your existing leaders, providers. You’re going to say, hey, here’s the comp package [or] incentive package, and here’s the objectives, goals, and minimum standards. I think the tendency is probably to just sort of say it, here they are, and go, and congratulations for the new potential upside. And there’s no like, hey, did that motivate you [or] demotivate you? Is this more in line or less in line with what you were thinking? Is this going to seem like it’s going to be a good thing for you for the next year or two? Or is this going to be something where you realize that you made a mistake, or we made a mistake, or something is going to require some adjustment. I think it’s a little more of that built into the interview process. But even there, I would suspect that there’s a lot of assumption around, hey, the total comp looks like this, it’s in the city you want, it’s in the specialty you want, and therefore it’s great, right? And that shouldn’t be an assumption, it needs to be very open and honest. It’s like, you know, I want more research in my life, or oh, my God, for God’s sake, no research. Can’t do that stuff.

Stu Schaff:

Yes, absolutely. You know, I think that it’s easy to grab on to a number, right? And it’s because it’s something that’s not literally, but it’s tangible, right? And it feels like a tangible response to a question, right? And in detail, if you want to be scientific about it, call it you know, your hypothesis. This is my hypothesis of what I need to do to get someone to come here and stay, right. And I understand why people want to reach for a tangible answer and then move on. Because, you know, there’s a million other things to do, right. But a practice is nothing without its providers. Right. Practice is nothing without its providers. So, you know, whether we’re talking about physicians, whether we’re talking about ODs, you know, whatever it may be. And, as a result, I think it’s worth the time and investment to get to deeply understand who your people are, and what journey they’re on in their life. I know, that sounds really Woo. You know, but it’s important, right.

Mark Henderson Leary:

100%. 100%. So much about what I talk about is exactly that. That’s right,.

Stu Schaff:

Understand the journey that they’re on in their life; both professionally, but also personally, to the extent that you can. What are they trying to accomplish? Because you are going to take up their time, right? Their time, their effort, their energy, and in return, you’re going to give them, the most likely, greatest source of their income that they get in exchange, right. So, in that relationship, you and when I say you, I mean the, you know, a practice, are responsible for two huge aspects of their life. Why would you not want to try and get that aligned so that it works smoothly, right? And maybe it ends up sort of nudging you in a slightly different direction than you thought you were going to go. But that could very much be a good thing, right? People don’t fit, generally, perfectly into a box. And sometimes you need to extend the box or redraw its boundaries, or whatever it may be. And that’s a good thing. And that’s how you get successful practices that evolve over time. And don’t just, you know, gauge, and turn into dust.

Mark Henderson Leary:

Yeah. Well, I think this is all, you know, is all right. And I think that people would intuitively get that. In practice though, I think there’s a lot of fear. I think a lot of fear of, I don’t know, what is about to be said. I don’t know what curveball I’m going to be thrown. And I think even when it’s relatively easy to find providers, it still doesn’t feel easy. It feels like if I get somebody who sits down in front of me and they might take the job, the last thing I want to do is reduce the odds of them taking that job because all of the plans sitting right behind this key hire. And some providers, it’s like you get one or two shots a year. And so because of the way the graduates move and the way physicians move, or whatever, and so it’s like, we can’t waste a shot and if we get it wrong, we’d be, I feel like it would be better to have the wrong one for a year because if I don’t get anybody in the seat, then I have nobody in the seat for a year. And so, there’s a lot of dismantle disincentive to be asking these harder questions that don’t go someplace predictable.

Stu Schaff:

I understand. Right. At the same time, I would say, would you rather understand what’s going on behind that person’s eyes? Right, and increase your chances of, for lack of a better term, making a deal, right, that we know has a better chance of working long term, right, assuming that two people are being honest with each other sitting across the table? Or would you rather throw out a number or whatever, you know, the year schedule, you know, whatever it may be, without having that context? And maybe you get it right? Maybe you totally [will] because you had no idea what they were thinking? I mean, to me, it’s an obvious answer. Especially the way I just phrased it. But I think, you know, having a clear understanding of who you’re talking to, what they’re trying to accomplish. Oh, and by the way, how many of us have wasted a tremendous amount of time and money or at least felt that we’ve wasted a tremendous amount of time and money? Because we made a frankly, avoidable mistake of entering into a relationship with someone who wasn’t the right fit. And I purposely phrased it that way. Because you could also say that personally in your life, right?

Mark Henderson Leary:

For sure. We talked about this earlier, but I’m thinking about, of course, projecting a lot of my own mindset on a lot of my clients and people I don’t know, but like, I’m so impatient. A lot of visionary types are just like, hey, you know, I get this is important, but like, I can like carve out a few minutes anyway and it seems like [it’s] just much more convenient to hope that I get it right and just hope that I, you know, hit the grand slam on this. But obviously, obviously to me, part of what the problem is we got the wrong person in the conversation. This is a high stakes decision that easily intellectually justifies slowing the process down and getting it right. It’s just that somebody like me is like, that’s all rationally right, I just can’t make myself do it. Because I’m too busy in moment doing too many different things. So, in my world, I’m definitely saying, well, we’ve got to have our integrator mindset. We’ve got to have the business manager.  We’ve got to have a team and a process and the right people in the conversations. And you just got to, you can’t leave this to chance. You have to have the right who driving this process, so these questions don’t get skipped. And we collect the feedback, and we respond to the feedback. Not just oh, we got it. I don’t know, they seem like they’re not a good fit, but they’re ready to start, so get them going. So how do you help people with that, and sort of getting the who’s involved?

Stu Schaff:

I want to say what you just said even a little bit more in a pithy way. And maybe this is just like, maybe this is just my pattern of cockiness or something. But like, if you don’t care about building the team, why are you the person who’s involved in building the team? Right, like, you’re maybe not the right person, if it doesn’t feel like a priority. I 100% agree with you that it should be delegated to others, right? Probably multiple others. Right.

Mark Henderson Leary:

Yeah.

Stu Schaff:

To your point.

Mark Henderson Leary:

Yeah.

Stu Schaff:

Yeah, I agree. I mean, I think that, again, the practice is nothing more than a collection of these folks. And you know, in my experience, I’m still, I’m looking for, you know, quantitative studies as often as I can to try and back this stuff up. But in my experience, the organizations that are most concerned about the goals, and the desires, and the working philosophies, and you know, all that, that goes into people, they’re the ones who have the best success. They have the most engaged workforce. They have the folks who are retained. They have folks who are out there, plot proselytizing. You’ve got to come work here. Right. And that, to me, is a dream. In an environment where we have a shortage of physicians in this country. And I’m going to keep saying physicians, it’s a bad habit. We have a, you know, we have a shortage of physicians and other healthcare providers in this country, and it is a structural issue. It is expected to only grow as our population ages and, you know, the workforce doesn’t grow at the same pace. And if we think that our government is going to step in and fix this problem overnight I think that I have some, you know, waterfront real estate I can sell [to] you as well. So, you know, it is incumbent upon us as individual practices to make our organizations the places where those folks, where those physicians and other health care providers want to work. Because if you don’t, someone else will eat your lunch. There’s only so many folks, there’s only so many people to go around for these positions, right? And someone is going to get it. And if it’s not you, it will be someone else. And I don’t want to catastrophize it, but like, in the long run, the practice could, you know, go away with you if you’re not doing these things successfully. And the thing that I find criminal is that a lot of these organizations end up driving people out of medicine.

Mark Henderson Leary:

Right.

Stu Schaff:

 Right. And I worry, going back to that whole mission thing, call me selfish, but like, who’s going to take care of me? Who’s going to take care of my family, right? So I’m very motivated to not seeing that happen. And I want to help these organizations who are interested in understanding the lives and the trajectories of their physicians or other health care providers, so that they can build the organization around them, right … that you can grow in a sustainable way, that people are happy, that you go back to this situation where, you know, you’ve got folks who’ve been on your team for 20 plus years, and they love working there and they couldn’t imagine working anywhere else. And they’re doing great work for your patients and your communities and so on. And everybody benefits.

Mark Henderson Leary:

Yeah, I work with organizations, both ends of the spectrum of what you’re describing; meaning loyal, strong, healthy, evangelical cultures, like they have a line at the door of sorts, and people are really happy to work there. They don’t want to leave, and when they do they just evangelize. So, when they have that, that holy grail of a healthy evangelical contagious culture, and my passion, my plea to them is always, you need to really preserve this asset. It’s a goose that lays golden eggs, and it is so valuable. Take care of it and it will take care of you forever. Then I work with the other ones who struggle. When they’re serious about it, and they start making changes, you know, it’s like, I have to caution them that they are going in the right direction, and it is worth it. It is going to take them years, 1,2,3 years to get that culture to really turnover; to be that self-sustaining culture… where it goes from like, there was there was nobody we had to cert, everybody we hired sucked, we had to fire four to five people, or more. And nobody from those days is you know from last year, it’s still here. Moving that to like, man, it’s just so great to have people who are so happy. I like pull up in the parking lot. Everybody’s fun and awesome. And it’s a great experience. I want that for everybody. And that’s the secret sauce for this problem, which is, you know, attracting and retaining those people. And as you described, if we’re talking about private health care practice, that is the practice. Those providers. And that’s the core. Getting them aligned. Getting them loyal and having the entire organization loyal and aligned. Man, it’s just the night and day difference on all aspects of the profitability. And if nothing else, the fun of showing up there.

Stu Schaff:

Yeah, there’s a reason why, you know, you start hearing about reclaiming the joy in medicine, and different things like that, which has been a conversation that people are having more often now. And I’m glad that we are finally in a time where people are starting to have these conversations. But you better believe there are still folks out there that are saying, oh, you know, poor doctor, you know, with his Lamborghini or whatever, right. But at least the conversation is starting to happen.

Mark Henderson Leary:

Yeah, for sure. And I guess just a note on that separation because I talked about this at length. The abundance mindset. The scarcity mindset. You know, it’s true. The most expensive cars in the parking lot are often those of the physicians. Not always. There’s always, oftentimes, somebody in the middle who’s like, you know, I live in an apartment, but I want the Maserati. Okay, that’s your choice. But it’s not a surprise to the lab techs that the physician has made more money. That’s not a surprise. The ODs make more money. We know this though. The practice owner is the person whose name is on the sign outside. You know, not a surprise. That person makes a lot of money. And there’s this sphere that we can’t talk about. Abundance and growth and the mission and all that, and that is absolute bullshit. So, I want to be crystal clear on that. Those people show up into an organization where they can grow and be better in the journey they’re on. To your point earlier, like, what journey are you on? That front office coordinator, that person is on a totally different journey than the senior plastic surgeon, and so on. Are those differences? and understand that both of those journeys can feed each other and grow, and you can have a happy, amazing culture. And it’s not without some care to have the conversations that you know, you have to be aware of [this] us and them mentality. It’s kind of a natural tendency. But it doesn’t have to be that toxic. We don’t talk to each other. And we keep secrets from each other mentality at all. And people can really be excited about the organization they’re in.

Stu Schaff:

Absolutely. I mean, I know if it was me, that’s the ladder example, I would run away from that organization, that just, is not, does not work for me.

Mark Henderson Leary:

Yeah. And it’s amazing what you can get out of people who are given an opportunity. And when you close the organization down, you close that conversation off. So don’t get wrapped up around the compensation and the nice cars as being a separation. Understand that everybody in the organization needs to be a good citizen, and being crystal clear on what good citizenship looks like, and holding all members of the organization to the same standards of excellence as to what that looks like, is the way to do that.

Stu Schaff:

Yeah.

Mark Henderson Leary:

So, I got it to take us off a little bit. I want to make sure we’re getting to what you want to talk about.

Stu Schaff:

Well, I was just going to say one thing, you know. And I think we’ve started to tiptoe around this maybe a little bit. So, let’s dive in directly. There are some key and often overlooked differences between, I’m going to use the term again, physician owners and physician employees. So, if you do your little, you know, quadrant box, someone is a physician or provider, non-physician, non-provider, that’s one side of the box. And then employees and owners are the others. Right. So, you know, we tend to focus again, for the reasons that I talked about earlier on the providers, whether they’re owners or employees. You know, if you have a non-physician employee, and you don’t tend to have a lot of practices that have non physician owners, although those kinds of things are becoming more common. So, there are some really key differences that are really important to understand. And that might help get behind the mindset. You know, the physician owners, clearly, obviously, are aligned with doing more. Going back to that question that I talked about earlier because that leads to profit. More profit in their role as owners. This kind of interesting thing that happens is that they tend to look at their physician colleagues. And I chose that word purposely. Their physician colleagues within their practice and wonder why they’re not doing the same. And that’s because they’re not mentally separating that role of physician and owner or employee, depending on what box you’re in. Right. And it’s really important to understand that. To understand the economic difference between those roles that leads to a difference in mindset between those people. So, I gave the example earlier of the, you know, the people who were, you know, kind of doing medicine, I want to say as a hobby. But they’re doing it part time with their highest priority [being] their family, or maybe not part time, but just not at the same level as someone else might be.

Mark Henderson Leary:

People check out at the end of the day and not taking much work home mentally.

Stu Schaff:

But I mean, the economic difference between an owner and a physician, which is you know, really access, it’s the whole risk versus reward. It’s access to profit, all that. In most practices, those employed providers are being paid a salary or percentage of revenue, or some combination thereof. And I’m boiling way down to the fundamentals. But you know, they don’t have that profit distribution possibility. So, I’ll just quickly, if you’ll indulge me, I’ll just talk a little bit about each of the pros and cons. So, this I think helps ground some of the questions that I get around, you know, what is the right model. So, if we’re talking about a salary for provider employees, you know, there’s no financial incentive to increase revenue, or to decrease costs, right? They’re getting paid the same regardless of what that looks like, right? And how does that relate to mindset. They’re going to default to have a very human instinct, to prioritize their own comfort over the long-term gain of the business, right, which is what you most care about as an owner. So, I’m not necessarily saying like, oh, this is a bad thing. In this example of those people who are really working to fill in the time, look, all they want is a fair exchange for the time that they’re giving to the practice. Right. And that may work perfectly well, right. And if they meet the expectation to see, say, the expectation is to see a certain number of patients within that timeframe, and to practice in a particular way that everybody feels clinically works best, you know, then that could be perfectly reasonable. But it’s important to understand how the economics of the situation informs the mindset, right?

Stu Schaff:

For the revenue, that percentage of revenue folks were the more you do, the more you make, you know, you have to understand that number one, not everybody is motivated by money in that same way. At a certain point, they’re going to tap out, and everybody’s point is different. Right? So, someone may say, well, look, I’m very happy, being you know, doing a certain amount of procedures, seeing a certain amount of patients, whatever it may be, in a in a day, in a week. And it’s good, right? For most people, there just is not an unlimited capacity. Right. And that’s kind of what it comes down to, which is important to understand. There is some point beyond which family, their personal health, things like that are more important than money. And it’s important to understand what that is, right. And so I mentioned blends, you know, that’s what those types of models are intended to address. But you still have to be careful because you know, you could end up setting a threshold for an incentive to kick in that’s too high, and then that becomes demotivating, right?  There’s a lot of art, and there’s a lot of science to it. And I think that, you know, going back to that desire to grab on to a number, grab onto a formula [and] build a better mousetrap that’s like what we’re doing in medicine anyway. Right? In a sense, I completely understand it. But there’s just not as much motivation. Yeah, I’ll say motivation. There’s not as much motivation, or interest, or, you know, other words that I’ve read in that area to really dive in on the art side, which is having those conversations and really understanding.

Mark Henderson Leary:

How much appetite do you suggest or encounter for trying things and changing them? I guess that’s the operative part of the question. How often do you see people sort of [say] it’s terrible. I’m afraid to change it, versus like, hey, we’re going to try this out, and if it works for six months, we will stick with it. And if it doesn’t, we’ll change it.

Stu Schaff:

Mark, I wish I could say that ..My clients have a huge appetite for taking risks in that sense, they love to experiment, and they’re really in there, and they’re just trying to do the right thing. And everybody understands. There is a fear of change. Very human fear of change, right? And what I have started doing over the last couple years, and this came from work that I did, personally with my coach, which was to really understand what you’re afraid of, right? What do you believe is going to happen? Right, and I’ve started to bring that into these conversations to try and help practices [and] practice owners understand that everything really does need to be on the table. And that while that may seem scary because it’s unknown, when you work through what they are concerned about, generally speaking, not just me, but they are also able to say, you know, that probably isn’t going to happen, or we can address that in a particular way. And still take these risks, which are right headed. I don’t know if that’s a word. I know wrong headedness, but, you know, which, you know, intended to be, you know, positive things, right. And you work through it, and you’re not just making edicts. You’re working through these things together with your teams. So, you know, I wish that more people thought that way, but sometimes it takes a real grounding to get them too there.

Mark Henderson Leary:

Yeah. Yeah, that makes sense. But is it to your point, the fear of that the stakes are so high. I just wish there was more tolerance for the humility. Like, hey, man, I have this right and let’s learn as we go.

Stu Schaff:

Absolutely. Any now, there’s other compensation models that I didn’t mention. Revenue. Less expenses. Another very common one where everybody basically gets their own P&L, and that’s got tons of challenges associated with it [and] tons of benefits as well, you know, if you want to look at it that way. But the bottom line is there is no one size fits all model. There’s no magic bullet. And, you know, and generally speaking, I have found that just implementing a new compensation model tends not to solve the underlying issues that you’re feeling. Right? Even, you may not necessarily say like, oh, I know exactly what the issues are here. Right? Odds are that you’re feeling their impact. People are being burned out, people being unhappy, people leaving, right. And or even difficult to getting them into the practice, right. So, it’s kind of like putting a band-aid on cancer; just to throw in a new compensation model and say that that’s going to help, right, without actually working on the underlying issues. We’re talking about preventive medicine here, more than we’re talking about acute care. There are some aspects of both, but that’s the thing that’s most important.

Mark Henderson Leary:

 In realistic terms, what do you think, besides money, [are] the most valuable attractions now?  What are people really wanting. more commonly?  It’s probably different varieties of graduates and existing mature physicians have varying flavors,. So, speak to different archetypes. There’s the one who wants the money. There’s the one who wants the work life balance. What are the things that we should add to the toolset for incentive, in attraction beyond just more money for production?

Stu Schaff:

Right. well, you know, we haven’t talked about ownership and ownership paths. But that’s something that certain people are interested in; I want to become a partner in this practice. And there’s different reasons why they might want to do that. For some people, it’s prestige. For some people, it’s access to [an] additional pool of funds in the form of profit. For some people, it’s the ability to control.

Stu Schaff:

Right. And for some people, it’s, you know, it’s some combination thereof, say, you know, that’s one aspect of it.

Mark Henderson Leary:

Yeah.

Mark Henderson Leary:

You find a lot of people who think they want ownership and when you unpack … they really don’t.

Stu Schaff 

100%. Yes. And those are the people that I would say probably wanted from the prestige factor more than the other two. Right. And, you know, and to their credit, I’ve talked with, gosh, half a dozen physicians in the last year or so I would say that have said, as we’ve been working through things, like, I have no interest in having that responsibility [and] attention on me, right. And so good for them for knowing, you know, what they want [and] what they don’t want. Actually, in some of those situations, I said, well, this is what it looks like. You know, maybe you ought to consider what you’re afraid of here, right? For the same thing. So yeah. So that’s one aspect of it. You know, another thing to think about is the money. So, there’s the context that they’re in. Do they have a tremendous amount of loans to repay for medical school? Yeah, that tends to be the most immediately relevant, but then there’s all the other stuff, right? What about their family? What is the situation with their family? A lot of not to draw with too broad a brush. But you know, a lot of immigrant families, for example, have a situation where they’re supporting their families back home. Right. And that’s something that you’re not necessarily thinking about? Or are they in over their heads financially, for different reasons. Maybe they bought a house at a particular time. Maybe they have 12 kids that are all due to go to college, you know. Like, there’s so many different things that can go on and those things will impact the, you know, the priority importance that they put on different factors on that ownership on the compensation side of things.

Stu Schaff:

I remember, there was a I’ve got be careful that I don’t get too specific with this example. But there was a physician who many years ago I was working on this project, and he must have had 12 different jobs. He was taking call one and two. He was this pediatric surgeon. A bunch of different directorships and vice presidencies, and, you know, different things that he was doing. And, you know, we’re asking the question, well, how does this connect? Does this guy actually do all this work? Because it seems superhuman. And the answer was, he’s got three alimonies to pay. So that can be a motivating factor, right?

Mark Henderson Leary: 

Yeah.

Stu Schaff:

And, you know, not necessarily the kind of thing that you’re going to get into in an interview, but something that, you know, it’s important to understand the motivation where people are coming from. The third key bucket, I would say is, people want to know what is expected of them. And what I have found, it took a while for it to click first. And then for a while, I scratched my head about it. Before deciding, like, we just have to do something about this, there is a tendency in our society, to put physicians on a pedestal, to the extent of like you’re a doctor, you know what to do, right? Instead of, like, helping them understand what is expected, right, which we do in literally every other job. I can’t think of any other job where it’s like, you know, what you’re doing, go do it. Right. Lawyers have expectations that they have on them generally, in the form of billable hours and, you know, ethics codes and different things, you know, different things like that. Just as you know, one example, and there are many, many, many others. In fact, healthcare is amazing at writing job descriptions, except when it comes to doctors. I don’t know why, right. And the only thing I can think of is that we put them on this pedestal and figure that they’ll figure it out. And it leads to the kind of situations; if it wasn’t so like, if it didn’t make me want to cry, I would laugh about it more.

Stu Schaff: 

 It’s like those situations that happen in movies where like, if the two people only communicated, you wouldn’t have this trauma, but then there wouldn’t be a fun movie to watch. Well, this is real life, right? Like, if we don’t set clear expectations, and then we still hold people accountable [for] the expectations that we had in our heads. And I’m speaking as like administrators, or practice owners, or whatever it may be. We’re not setting ourselves up for success here. Right. So, the third thing is having a really clear understanding of what is expected of them, and support in meeting those expectations. Because the reality is, there’s only so many things that a healthcare provider can control, whether it’s related to the effort aspect of expectations, but really even more on the outcome side of things, right? So, if you say, we want to make sure you’re hitting a certain level of volume or a certain level of revenue, well, are they doing all the scheduling? Right? Are they doing all the marketing? Are they signing the lease to make sure that there’s enough space there? Are they managing the schedule for the MAs to support them and all that. There’s a lot that we have to do as owners and folks who are running these practices to make sure that they can, once those expectations are clearly defined; that they can be matched, because again, it’s not entirely within their control. Right. So, I guess maybe we can say that’s the 3a, the support and meeting those expectations. I think those are really the key things that they need to think about.

Mark Henderson Leary:

So, in this more academic model, small practice, small support system, the physician or the doctor, provider, whatever, you know, sort of building an ecosystem around themselves. If the organization is scaling, to your point, and they’re actually, you know, trying to build a more efficient scheduling process, and we’re going to try to get more patients of particular conditions seen faster, the doctor has to be in, in that loop. Your job is diagnosis, or your job is not diagnosis, it is strictly surgical experience or surgical outcomes of this particular type. And I see it even in my clients where the doctor is like, you know, I really wish we started getting you know, they’re not doing as good enough job upstream, diagnosing this like, well, don’t you understand? You are the diagnostician. In this case, we’re getting referrals from someone who could not do that. So, I’m giving you a very specific example. But, setting the expectations, building the process to support it. We’ve got somebody in charge of essentially a process, a business process, and I don’t want to humanize it to, like a manufacturing process, but it’s the same kind of science that if we were going to optimize for a job, we’re going to optimize for outcome … Your clinic time needs to be doing these things and you need to be efficient with that. And if that’s not what you’re designed to do, then maybe you’re not the right person for that, or research or whatever it is. So, we can get your skills and your interest in line without it or just telling you what to expect. So, you’re not surprised.

Stu Schaff:

Right, right. I don’t know how much of a sports guy you are. But I think of how, basically, every professional sports team works [and] every professional athlete works. They spend a lot of time training and preparing for something, and then they do the thing to the best of their ability. And then they spend a lot of time reviewing what happened and how they can do it better.

Mark Henderson Leary:

Yeah.

Stu Schaff:

And, you know, our prep in medicine is, you know, is the education, the ongoing education. So, you know, maybe we’re doing that kind of stuff, we certainly get a lot of reps, right? We certainly spend a lot of time, you know, seeing patients, doing the work over and over again. We really don’t spend a whole lot of time reflecting on how well things have gone and how they could go better. And getting back to the fundamental principles that we have and making sure the way that we’re working is alignment with it. And if it’s not, that we are realigning things and trying to figure out how we can do things better. And that is a huge piece that I think really needs to be put into place. We are a team after all, and the big question of how do we work best as a team for the benefit of our patients. Right? You know, that’s really the most important question. Every team is different. There is no pat answer for this.

Mark Henderson Leary:

Right, but you got to understand the position because if you do that sort of, let’s look at the tape. Well, here’s you being a wide receiver, here’s you being the quarterback, here’s you being the coach, here’s your playing defense. Like, well, what are we trying to optimize for here? Like, I can’t make sense of how to get better, because there’s no clarity of which was the one I was supposed to be best at. As opposed to, you’re an NFL football player, you should know what to do.

Stu Schaff:

Listen, I would say everything needs to be on the table. Medicine is complicated enough as it is when you are faced with a business issue. And you know, a lot of those business issues tend to be people oriented. You can’t afford to just do things because you’ve always done them, right, in that in that way and that’s what you’re doomed to do. If you’re not looking at the position folks are playing, if you’re not looking at how they’re playing those positions. And yeah, I mean, it’s, I like to say things in a way that’s as clear and obvious as possible, but doing it takes time. It takes effort. And I know that is asking a lot of the folks who we work with, but the people who are truly invested in doing bigger, better things are the ones who understand that making that investment today is the thing that secures a brighter future, not only for them, but for the folks that they work with, for their patients, for the industry. Right. And it’s asking a lot, but at some point, the people that I work with, and I imagine the folks that you work with, tend to get some kind of inspiration to see that, right? Something unlocks, and they say, oh, you know, what I’m doing isn’t working. And I need to figure out what will work and it’s going to be scary. But, you know, I’m willing to get in there and put everything on the table. And it’s going to be uncomfortable. But, but ultimately, I’m going to be left with a practice that works for me, works for the people that I care about with folks that are in my practice. And yeah, I mean, that’s what jazz’s me up, you know, you talked about that passion earlier. That’s what I’m passionate about.

Mark Henderson Leary: 

I love it. We’ve covered a lot of ground man, what did we miss?

Stu Schaff: 

You know, I mean, I’m sure that we could talk, I know that we could talk for hours and hours about this. You know, every practice is different. And … I understand the desire to try and get an answer off the shelf and apply it as best as possible. But I would just encourage people and I know it can sound self-serving to say. It is, but I’ll just say it generally, that I would just encourage practice owners to ask for help. Right? The fact that you’re listening to this right now probably means that, you know, you don’t have all the answers. So, you’re open to that idea. But talking about what’s going on, being somewhat vulnerable, I can just say, from personal experience, it has led to the best. I was going to say, transformations, but really just the best sort of transformations in my life. And, and I really think that, based on my professional experience, and the practices that I’ve worked with, I would. I don’t want to speak for them, but I would venture a guess that they would say the same.

Mark Henderson Leary:

That makes a lot of sense. And I think that especially in my world, learning how to ask for help is like a skill. Because what do you ask for help for? And are you asking them to learn how to do something? Or are you asking for somebody to help [do]it? And it’s really powerful for me. Healthcare, I believe that no one’s challenged me on this hypothesis yet. Physicians are taught to know the answers and to be the helper. So, it’s a total reversal of mindset to say, hey, I actually don’t know the answer. And so that’s totally anathema to what … doctors are answer[ing] to people. Healthcare providers answer people, patients come in the door, and I don’t know what I need, tell me what I need. And if you’re not able to answer that, well, it’s a failure. So, I can see why that’s fundamentally difficult.

Stu Schaff:

Yep. And if I, you know, if I could just say, again, if, you know, if you are going to ask an employee to do more, you need to make sure that they are clear on what’s expected of them. And you need to make sure that they are fully supported in meeting those expectations.

Mark Henderson Leary:

And if they don’t want that path, they’ve been given an exit. So, you don’t frustrate each other.

Stu Schaff:

Yes.

Mark Henderson Leary:

That’s so important. And that’s scary. Look, man, passionate plea, man. I know, we’re kind of, we’re burning time. We had a good conversation. I feel like I want to let you free for the day. But what’s your passionate plea to entrepreneurial leadership in healthcare or anywhere today?

Stu Schaff:

So, kind of you my passionate plea to entrepreneurial healthcare leaders is, please invest the time, the effort, and yes, the money in making your practice the place where you and your colleagues love to practice. That’s it.

Mark Henderson Leary 

100% agree. I have nothing to add to that. That’s so spot on with what I’m passionate about and what we do. Look, man, still, I’m grateful for the time and the wisdom. And like you said, we could talk about this for hours and the time flew by, and I’d love to keep going. But if somebody wants to continue the conversation with you, find you, what’s the easiest way for somebody to do that?

Stu Schaff:

Our website is intentionate.com.  And I believe that’s going to be in the show notes. Right, Mark?

Mark Henderson Leary:

Yes, yes, they will.

Stu Schaff:

And you can also connect with me on LinkedIn, Stu Schaff. And I would be happy to speak with any of you about what’s going on in your practices.

Mark Henderson Leary:

So grateful, so grateful for the sharing. That’s our time for today. Just a quick reminder, give us feedback. We’ve got some feedback mechanism right in the show notes. Click the link to SpeakPipe. Send us some voice feedback, and we can communicate directly with you. Of course, if you need help along the way, if you’re stuck, please don’t hesitate to reach out you can get to us at practicefreedom.com/schedule to find some time to talk through the first step, which in my opinion, the first step of finding your way to the next level in your practice is implementing a business operating system. And we can talk about whether that makes sense for you or not. But again, share this please like, subscribe, share this with your friends and make sure people who could use this information are not kept from it because it’s not valuable if they don’t get [it] in their hands. But that’s our time for today. We’ll see you next time. Thank you for your time, Stu Schaff and we’ll see you next time.

Stu Schaff:

Thanks.