Enter, Guns A Blazing

Female Gunslinger

Mary Poppins, The Unassuming Gunslinger

I used to work as a gunslinger. No, silly, not that kind of gunslinger. I made my living as a medical practice turnaround specialist — that kind of gunslinger.

In other words, I was the ‘hired gun’ brought in by doctors and/or their accountants to do whatever was necessary to get their office operations efficient and their financial health well again. Often this was long after the physician partners had been paying practice expenses by loaning their personal funds to the corporation. Yes, some practices were that bad.

It was a serious job, and did I ever take my role to heart!

Day 1 ~ The Eagle Has Landed

I would arrive at the new facility on the date specified in the engagement letter. I drifted slowly down like Mary Poppins, wearing my black kevlar business attire (tastefully accessorized with an asbestos shield, by the way) and toting my full array of tactical gear.

With a snappy salute and a perfunctory clicking together of the heels of my sensible-yet-stylish dress shoes, I wasted no time getting things done (GTD) — in textbook David Allen fashion.

I got into this kind of work primarily because I couldn’t say no.

I’d be remiss if I didn’t point out that I was also trying to prove my relevance in this world to someone — pretty much anyone — back in those days. And, oh boy, did I trip the light fantastic to please.

Metrics Was My Thing

At the end of each of my stints as a practice rescuer, I would assemble all the docs in the conference room to give them my “Here’s what your practice looked like when I got here” and “Here’s what it looks like now” presentations.

To increase the wow factor and emphasize my improvements, I presented the financials in neat three-ring tabbed binders full of colorful charts, beautiful graphics, and bold revenue numbers.

Toddler Doctor With Money Jar

Audited Financials

Some would suggest that it’s not bragging when what you’re crowing about is true— and my presentations were always accurate. Validated bank deposits and accountant-prepared financial statements endorsed my assertions.

Trust me, boys and girls, nothing turns on the happiness in a room full of doctors like the color green. And by that I mean the green that ‘drops below the line’ and therefore is available for distribution to the physicians as bonuses. And after all, isn’t a paycheck the primary reason any of us work in the first place?

Doctors’ spouses and partners loved when things were green in the office. When already-happy doctors made those at home happy with large distributions, the work environment got even jollier.

The reverse was also true. We’ve all heard the saying: ‘When Mama (or Papa) ain’t happy’ … well, that part is true as well.

Stepping Up

While on assignment as Mary Poppins/Annie Oakley, I didn’t just work on the financial side of the house. It was also my job to take care of hot-potato personnel and performance issues that dilatory predecessors had allowed to languish unattended — sometimes for years before my arrival.

Pretending I was a superhero, I stood in the blast furnace and took the heat on behalf of the physicians. Channeling Wonder Woman, I caught speeding bullets with my teeth, day in and day out.

My role required me to implement wholesale —and  often very unpopular — changes to the status quo. It’s important to note that physician boards in these practices debated, ratified, and directed all significant changes beforehand.

However, when the slightest hint of blowback from disgruntled employees wafted their way, certain darling physicians ran and immediately hid under my desk. Suddenly, they feigned amnesia with no prior knowledge of (their) pre-approved action plans.

This annoyed me, but it was part and parcel of why they paid me so well so I couldn’t throw them under the bus.

Yeah, Whatever

I remember one particular doctor trying to flatter me by calling my management style one of “approachable gravitas”–Yale-speak at its finest.

All that meant was that I always stepped up and did whatever was necessary (i.e., their dirty work) and that surviving staff members weren’t too afraid to walk past my door —most days.

Speaking Of Which

In one particularly memorable practice, the doctors had to get a TPO (temporary protective order) to ensure my safety after one board meeting.

With their year-end distributions contingent upon the final numbers — everyone was particularly focused on lower overhead percentages.

With saving on salary expenses  in the future the goal, the doctors ignored my vehement objections and voted to terminate a young registered nurse with three small children — the week before Christmas.

What made this so distasteful to me, was that this pleasant young lady had no clue that the doctors were unhappy with her performance. Her clinical skills were not being questioned; their beef was that she wasn’t ‘turning the rooms’ fast enough. Her supervisor had never counseled or even spoken to her about a possible performance improvement plan. Anyone who’s ever read half an article on human resource management knows better than this.

That said, I was overruled and it fell my lot to terminate her employment. Mere minutes after this nurse left the building, her angry, verbally abusive husband called the office demanding to speak with me.

When I came to the phone, he threatened my life as well as that of my family members — on a recorded phone line. Obviously, the irate man wasn’t sporting a brain trust.

What was I going to do? I certainly couldn’t throw the doctors under the bus. I had to be professional, even if they weren’t.

So, until the dust settled, staff members gave me the side-eye, moved to the other side of the hallways, and ducked into empty exam rooms when they saw me coming.

Just another day in the Wild Wild West of practice turnaround consulting.

Fast Forward to Now

I am so glad that the days of trying to prove anything in the career world are behind me because my ability to suffer fools is gone. The thought of ever identifying as a gunslinger again — in real life or on TV — is preposterous. But I did keep the shotgun, tee hee.

It wasn’t all wasted time, though; I did learn a few things:

  • With age comes wisdom.
  • Wisdom tells me that only idiots try to catch bullets with their teeth. Besides, dental insurance is too expensive for that nonsense.
  • And that whole business about people using me as a human shield? I told you — I kept the gun. So step back, Jack.

Sigh … try as I might, I can’t seem to resurrect Mary Poppins or Annie Oakley–may they rest in peace. My brain and nervous system have exceeded their bandwidth.

These days, the only processes I care to organize and manage are daily laundry, bed-making, and kitchen clean-up.

Oh yes, I guess I could include organizing and managing the writing process, but then again, it could be argued that it doesn’t appear that I’m very good at organizing that process either. It’s more like shooting from the hip now.

For Everyone’s Good

Trust me; retirement was the right decision. I’m know too much — way too much. I know where all the [proverbial] bodies are buried.

Come closer so I can whisper: I know who leaves all those incomplete charts, and I have contacts in the Medicare audit department. Hold on, don’t anyone get your knickers in a knot! That was humor — a joke.

Rest assured, I spent too many years helping doctors to ever be the one to drop a dime on any of them. Besides, I’d have to care to summon up enough energy to do that, and frankly, I don’t care anymore. Grandma’s too old and tired.

No, dear darlings, Ms. Approachable Gravitas has left the building. There’s not enough money in the Vatican or Fort Knox to entice her into throwing the car into reverse and backing up into that hot mess again.

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