Keeping up With the Kalish's - Top Ten Reasons Functional Medicine Practices Fail

Learn from my mistakes, please! I've made many mistakes in building three different clinics and am happy to share a "what not to do" list to save you from these pitfalls. And it's not just me, I see these same mistakes made over and over by the doctors of my generation who are all now in practice 20-30 years. I guess what NOT to do is as important in some ways as what TO do. 1. Not hiring sufficient support staff - so the doctor overworks in areas that don't generate income, like doing the billing, opening the mail, answering the phone or scheduling patients. Everything I do in my clinic now, only I could do, everything I could possibly outsource, is done by someone else. 2. Not hiring the right support staff based on personality and performance ability, rather hiring someone you like or someone like you or someone interested in natural medicine rather than the right person for that specific job. I've done this so many times. "Let's hire Maryanne, she's interested in natural health." "Let's hire Jon, he seems like a nice guy, easy to be around." Hire people that can perform the job, I find this means they are quite different personality wise from me. 3. Lack of financial planning and financial projections. In my practice I know if I work x hours I'll have y pretax income in my pocket at the end of the year. My practice operates on a 57% margin meaning if I collect $100,000 this year, I'll keep $57,000. If I collect $1,000,000 this year I'll keep $570,000. Since I know my margins I understand exactly how much I have to work to generate any given amount of money. I went for years not knowing what a margin was, let alone what my businesses margins were. Know your margins, month to month, year to year. 4. Trying to do or offer too much. I used to have dozens of lab tests available, up to one hundred possible supplements, often times individual products only taken by one or two patients. Only when I streamlined my business did it become profitable. I carry five or six lab tests and usually only use three. I carry 35 supplements and my big sellers number about 12. 5. Inability to create simple, clear, reproducible model. For years I approached each new case as if everything would be completely unknown and different. It's like running a restaurant where the customers come in and say what they want to eat and then the chef has to shop and cook random things! Now, my clinic has a menu, I don't veer from my menu. 1) Neuroendocrine, 2) GI, 3) Detox. That's it. I offer three menu items and still get great results. In the years when I did so much more my bottom line suffered and I was stressed out of my mind trying to do everything for everyone. 6. Not referring people out enough. I refer out now for everything to everyone I know that is an expert, I refer out my Lyme patients, my SIBO patients, my psychiatric patients, my structural patients. I no longer try to do everything for everyone and guess what? These doctors in turn refer patients to me when they know I am the right person for the job. I used to see a referral out as admission that I couldn't help the person, but in those days I thought I had to be able to help everyone with everything. No longer. 7. Overwork. We all work way too much. This year I'm taking ten weeks off! Ten weeks of sitting on the beach. Not. I'm taking ten weeks off of my regular practice to work on projects, from fixing bicycles to writing the next book and patient education program. It's time away from my day to day practice that allows me to focus on doing the things that #1 help me relax and #2 help me build the practice by creating new content, programs and patient materials. It's hard to build the practice if you are always working in the office long hours. 8. Overall lack of exercise. This plagues a lot of doctors they just don't have time to stay fit. This will sink your practice fast. We all need physical energy and vitality, the more so because we spend our days around sick and exhausted people. It's easy to lose energy and be dragged down by our work when we need to, in order to help others, be the most vital, energetic and fit person in the room. I run, bicycle, do yoga, weights and chi gung each week. In fact my main problem with exercise is doing too much of it, which doesn't work so well either. 9. Lack of vision as to what you want. I see many practices where the doctor is conforming to the patients that they see, meaning the doctor is passively waiting for patients to show up and then adjusting their practice style and lifestyle around the patients that randomly appear. If you have a clear vision of what you want you can guide the process, a clear vision might be: family practice; geriatric practice; working with kids and new moms; working with athletes or executives; Hashimoto's patients; mood disorders; eating disorders; alcoholics; autoimmune cases; chronic fatigue... The list is endless. I worked hard and built a chronic fatigue practice and didn't plan it, it just happened. Turned out in the end I didn't enjoy working with 100% chronic fatigue patients and I had to change gears. Would have saved time to determine what I wanted first. 10. Spiritual disconnection. This work requires intense levels of energy and I have burned myself out several times. Divorce, overwork, lack of fun, lack of meditation. Now I'm super careful on this one, I meditate two hours every day, I keep recharged and I have wonderful relationships with my family and partner.