21 Jun 2023

Transforming medical practices: addressing the lives of doctors and patients

Steven Macarounas is the founder of the Business Money Life Institute and programme director for the South African Health Business Academy. With over 37 years of experience working alongside healthcare professionals, he is passionate about helping doctors prioritise their own lives alongside their professional responsibilities.  

In this interview, he unpacks his work in more detail and describes how it is intrinsically intertwined with the development of the future-ready private practice.  

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What motivated you to create the Business Money Life Institute and the South African Health Business Academy?

My passion is to help doctors address the value of their lives and I’ve been working with doctors and other healthcare professionals for over 37 years. They are, without exception, the most selfless professionals of the professional community that I have ever met.

But, because of their focus on patient needs, they often ignore their own needs. They focus purely on their clinical life and ignore their financial, business and personal lives.

After years of providing financial management to doctors, I learned that no matter how much money they earned and respect they had, they were living poor lives in terms of their engagement with their families and the other aspects of a quality life.

The other common experience within a doctor's life is that they continue to work beyond retirement age. Mostly, they haven’t been efficient and effective enough around building financial lives and business lives that continue to thrive despite them.

Most business-oriented professionals will have structured their business lives so they continue to work and derive income despite their personal exertion or have built financial lives that generate income to provide the lifestyle they require into retirement.

You have a team of consultants who give doctors principles of running a business successfully. How does this process work?

Our programme is not designed to make doctors specialists in business or financial management disciplines. We're not trying to convert doctors into accountants, lawyers or marketing specialists.

However, it's important that they understand enough about each of these disciplines and know the language these professionals employ.

They will be better able to understand the strategies, the initiatives and the advice that they're receiving, so that they can make informed decisions. It will allow them to form a picture of the ideal practice life and create efficient private practice management.

Once we've educated doctors on what the options are and what the different disciplines mean to them in terms of their professional, business and personal lives, then we can advise them through one-on-one consulting.

Why do you believe the business model of medicine is going to look so different?

Any business exists to serve its stakeholders. In the case of private practice management, the stakeholder is the patient and patient needs.

Today, the average patient is simply not having their needs met by the medical profession. Most medical practices focus on delivering the clinical needs, but the patient requires more.

Patients are empowered by the democratisation of information. Doctors often complain about Doctor Google, but the truth is that patients have done their own research. Also, people demand customer service in every other aspect of their lives and the only experience where patients don't get customer service is in the medical space.

The patient experience is important and medical practices will need to deliver customer service; they will need to address the unmet and underserved needs of the patient. Patients are demanding a better experience.

The practice of the future will need to take a multidisciplinary approach. The average patient doesn’t care that there are silos of specialisation. What they're interested in is a medical solution to their problems.

For example, the orthopaedic surgeon combining services with the rheumatologist, spinal surgeon, physiotherapist and pain physician.

How does a medical professional keep up to date with medical innovations?

Keeping a practice future-fit is not easy or inexpensive. To incorporate medical technology advancements within a practice doesn’t only require a mind shift but significant investment.

The only way to make the return on that investment worthwhile is to adopt sound business and financial principles and to convert your practice into a business. In order to stay relevant and future-fit, there’s this notion of working on your practice as well as in the practice. It’s about staying not only relevant but staying viable.

It's almost impossible for the one doctor in one practice to have the time and resources to adopt the newest medical technology we’re seeing in the digital healthcare landscape. The only way to afford that is to provide scale to a group practice with multiple principals.

How do you see AI disrupting medical practices going forward?

The confluence of advancing technologies has already proven itself to be more efficient and effective at diagnosing than individual doctors.

The bandwidth of these incredibly sophisticated machines, which are processing incredible amounts of data, are far more effective at making a diagnosis than any individual doctor.

Having said that, what's important in medicine is not so much the diagnosis. It's the soft skills that patients have been asking for (communication, education and assurance, etc).

AI is a threat only if you consider yourself to be purely a diagnostician and you're not flexible enough to adjust to what medicine will need to be and to shift into moving forward.

How does a busy GP, surgeon or specialist find time for banking, family and themselves?

At the risk of sounding like a broken record, the only way that a doctor will free themselves is to adopt sound principles in business and financial management and run their financial lives with efficiency and effectiveness.

There's a direct relationship between the practice that's run like a business and the amount of time that you have available to allow you to indulge in your passions.

That means spending time working on the practice and not just within it. To spend time developing their level of knowledge around managing their finances, so that their financial affairs are profitable and returning a return on investment to allow them to - at a certain point - not need to worry about working.

Doctors should understand the importance of specialisation, in finding the best accountants, lawyers and business consultants.

How can failing to adequately plan ahead lead to working longer than retirement?

Doctors work longer than they need or want to. Doctors have adopted this model for success, which has served them well to a degree, but up to a point beyond which is starts to be a huge detriment to their lives.

The problem with not planning and simply working hard is that you end up having to do that for the rest of your life. You should be looking at is a three-fold scenario and asking three key questions about your business, financial and personal life.

Firstly, ‘What should my practice look like, to best deliver on my promise to the community that I've set out to serve?’ Secondly, ‘What should my financial life look like so that my lifestyle needs are met by my investments and the income from my assets as soon as possible, to allow me to slow down at work or practice only the medicine I want to, not the medicine I have to?’

And the third should be ‘On a day-to-day basis, what does my life look like? Do I want to have breakfast with my children in the morning? Where do I go on holiday? Have I got the time and the freedom and the flexibility to spend time with family and loved ones?’

The first mistake doctors make is that they don't trust anybody and do it all themselves. But, they don't have the specialisation, experience or training to manage their financial affairs properly. The second mistake is that they trust too easily. Doctors are fair game for unscrupulous financial advisers and don’t always make informed decisions.

What are the basic principles that will have a positive impact on doctors, their practices and their lives?

Medicine has to be reimagined. If we start to reimagine the way that medicine is delivered and we start to reimagine our role, not just as a clinician, but as a wife, a husband, a father, and a son, we think beyond simply being medical practitioners.

To change the trajectory of their life, doctors need to accept that there can be and should be a better way of running a business that leads to a better quality of life.

Why is it important for financial brands, like Investec, to play a part in empowering medical professionals?

It's important that financial brands play a part in empowering healthcare professionals.

They have a valuable service to provide, without which it's difficult for doctors to achieve success. Doctors must receive education, training and empowerment around the importance of that discipline in their lives.

It may be an accounting practice, legal firm, marketing company or insurance adviser that specialises in the medical space. Each of these specialist financial organisations must accept their responsibility as educators. In this way, doctors can have their level of knowledge lifted to a level where they can make informed decisions.

The South African Health Business Academy creates a curriculum that delivers education and empowerment. Investec, as one of the key and foundational partners in the Academy, will help propel this education across the broadest possible range of South African doctors.


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