How to Prosper AFTER Startup

How to Prosper AFTER Startup


by: Ivan Delman, DC

As always, practice management is as much an art as a science. As such, it must always be practiced and worked on.

I took the liberty of pulling a section out of my up-coming book. This section addresses the three areas a doctor might want to look when first trying to figure out how to start to really manage his or her practice.

Here's the section called, "Try Managing These First"


Below are three critical areas of your practice requiring close management:

Planning then directing the operation of your business...You already know your business and are aware of what you want to accomplish. It's not enough, however, just to plan your business expecting it to operate your personal direction. This principle applies even if you have competent office staff. As sure as the sun will rise tomorrow, sans proper supervision, your staff will wander off the road leading to your goals and objectives. You mustn't remain nailed to your desk playing executive especially during the operating hours of your office. You have to be aware of every operating detail in yourpractice. This includes following up on assigned staff responsibilities. I call this Mobile Management. Here's how it works.

During patient hours and whenever staff worked in my office, I would make it a point to "do rounds". I walked through every part of the office, checking areas for cleanliness, machine maintenance and supplies. I also observed staff interaction with patients, how they handled scheduling and so on. This was done in an obvious, not sneaky. fashion. I wanted to be seen walking around the office. I wanted staff to know I consistently check on procedures and protocols.

If I didn't totally understand a working area of my office, I would spend extra time there until I felt comfortable with it's functions.

The majority of my desk time was during off hours. Until you are of sufficient size to warrant hiring an office manager who will then utilize Mobile Management", the doctor's place is out in his office, not behind his desk. Even when I had an office manager, I made "Rounds." Just not as often.


Cash-flow simply is the moneys coming and going in your business. It is essential to know your future cash requirements as well as current cash expenditures. Most successful companies use some form of cash flow projection. The extraordinary manager can carry the information in his or her head, however, that's an exception. A cash flow budget and projection can be as simple or complex as you want to make it. Normally, a cash flow budget will list all possible anticipated and actual income / expense items in your practice. Gathering the cash flow data is as simple as looking back to your prior basic income and expense items, setting them down on paper anticipating similar numbers in the future. Then, after you reach the anticipated time period, you write the actual numbers in a column next to your budget. You then analyze and adjust your budget for any differences. The answers will give you the details regarding the life's blood of your practice, your cash flow.

I used an informal system which included charting all income and expenses over the years. That cyclical information allowed me to plan for low cash periods (See sample cash flow chart). I also kept a separate cash reserve for unforeseen expenditures such as emergency equipment repair. If additional funds were needed, they were obtained via short-term bank loans at negotiated interest rates. The business axiom, "The best time to borrow money is when you don't need it" holds true. It's to your advantage to predict low cash periods then borrow when you're in a strong cash position. Some of my colleagues use their credit cards in lieu of bank loans. This is not a smart business practice. Credit card financing is very expensive and should be utilized only if that loan can be paid off within thirty days or less thus avoiding their high interest charges.

Inventory Management...

How much money do you want to tie up in vitamins, appliances, literature and equipment? You'll be shocked to find how much capital you have sitting on your shelves. Take the time to see what moves and what gathers dust while sitting on your shelves.

If you have any questions, please contact Ivan Delman, DC at

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