Mark's advice for young doctors

With HMOs monopolizing the medical care industry and absorbing thriving medical practices with the swiftness of a well-financed congressional vote, it's tough for a young doctor to get ahead. Which road do you follow: a prestigious executive-style position with a thriving HMO or a joint practice with an established physician/group or the dog-eat-dog world of starting your own practice? Decisions, decisions. Your future is at stake, and you don't really want to accept that 12 years of schooling only gets you a hut in Eastern Cambodia working for the Peace Corps. This is America, and your future depends on knowing the process of maintaining a state-of-the-art medical practice. Simply follow the advice below to enhance your career, no matter which path you choose.

Verify Insurance FIRST

Probably the most important advice, so please take it seriously. For starters, you don't want to waste manhours of time chasing after deadbeats who can't afford to pay their bills. Send them to the emergency room instead. Secondly, the high-dollar tests required to "rule out any possibilities" that necessitate repeat office visits require insurance. Note: Most hospitals will require local physicians to take emergency room referrals, which are usually just future deadbeat problems you don't want. Refer them immediately, preferably to some chiropractor or massage therapist, regardless of their problem.

Seek out elderly (geriatric) patients

Simply put, older patients were raised in a better time. They all believe in insurance, and have Medicaid to fall back on, which ensures a payment for your service. Most of them will hang on each and every word, will accept any test or number of tests without question, and already have a ton of medical problems from eating a lifetime of high-fat, low nutrition food, including lots of steak. Whatever you do, don't let them change their diets! Prescribe medications instead. You know the drill: anti-inflammatories for arthritis pain, anti-coagulants for high blood pressure and heart problems, Prozac for mood regulation, and Viagra just for fun. Proper regulation of thyroid medication can ensure up to two years of monthly visits for a single patient. By prescribing a medication for every ailment, you ensure repeat business. For example, what patient is going to miss an appointment if they know it means they won't get a Prozac refill? If you recommend they change their diets, soon most of their ailments will improve or disappear, which is just bad for business.

Create a "Referral Chain"

Just like the web of life is critical to the continuance of our species, a referral chain is crucial to the survival of your practice. Seek out fellow physicians to be a part of your "chain". Once in place, all you have to do is see a patient (verify insurance, see above) and refer them to a fellow doctor in the chain. This doctor in turn refers the patient to another, and so on. When a chain is operating successfully, a single office visit can be cascaded into many others, depending on the number of physicians in your referral chain. This means that each time a doctor in the chain gets a new patient, each physician gets a guaranteed revenue stream, whether the patient needs the doctors' services or not. That's up to four (or more) times the income! Think of the possibilities!

Never read the Physician's Desk Reference (PDR)

The PDR is a book that lists all FDA-approved prescription drugs and provides critical information such as drug side-effects, allergic reactions and so on. According to the American Medical Association, over 198,000 people die in the U.S. each year from adverse reactions to legally prescribed drugs, which necessitates 23% of all hospitalizations. That's a huge market that you'll miss out on if you read the PDR and know what you're prescribing.

Never spend more that 10 minutes with any patient and use a nurse wisely

Time is money. The trick is to see as many patients in a day as inhumanly possible. To do this, simply spend less than 10 minutes with each patient. If possible, don't see them at all, but send in a nurse instead with an order for a test. This ensures a repeat visit, and lets you "squeeze" in more patients (revenue). Do the math: in an 8 hour day, minus an hour for lunch, you can schedule up to 42 patients a day, or up to 75 if you use a nurse wisely. For a $65 office visit, that's up to $4,875 a day. A nurse only costs you about $125 a day, so that leaves $4,750 just for you!

NEVER listen to the patient

You have years of training. You have a ton of really big manuals to refer to. You trained with physicians that own property in the Grand Cayman Islands. Admit it, by American political standards, you're better. You're so good, you know what your patient is feeling, and probably everything else about their illness before the test results arrive. So don't waste your time listening to patients, they'll just keep you from seeing more patients by reducing your available manhours. This in turn reduces your revenues and creates a host of new responsibilities, such as following up and so forth.

Have a weekly surgery day

Surgery days are great for business. The trick is to never perform surgery that takes more than 15 minutes to accomplish. Some good examples are cystoscopies, vasectomies and polyp removal. This provides a half hour turnaround time for the O.R., which means you can schedule up to 16 procedures a day. For a $700 procedure, that's $11,200 a day -- more than twice as much as seeing patients in the office. Another bonus is that while you're in surgery, your office visits just pile up.

Use your imagination while maintaining medical records

A patient's medical records are protected by privacy laws, so don't fight the system. Since anything you write could eventually be used against you, just write good things that paint you in a positive light. Never record oral conversations, and try not to let a patient see their records unless they start yelling about "The Privacy Act of 1974". If possible, write an observation about the patient's unusually high pain tolerance and their repeat requests for pain medication, even if you've only prescribed Tylenol. This will paint the patient as a "drug seeker" and keep future physicians from taking the patient seriously, unless they're in your "referral chain". In this instance, patients that feel dissatisfied with your care can simply see another doctor in the chain, because no other doctor will take the patient's word over yours. This ensures continued revenues for the life of the customer (patient).

Get rid of problem patients

Sooner or later a patient is going to come along with an ailment that defies your years of knowledge and all the expensive tests. When this happens, don't lose your cool, just blame the patient! Don't even waste your time or your colleagues' time with a referral. Try using this line instead, "I'm sorry, but your problem defies all logic in the conventional sense. I'm truly sorry, but theres nothing more we can do for you."

If you've made it this far, you're off to a great start. By incorporating this advice into your daily practice, you'll soon have an office waiting room adorned with investment and travel magazines. Check back for part two, Mark's advice on that pesky Hippocratic Oath.

That Hypocritical Hippocratic Oath

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