Learn How To Create A Budget For Your Medical Practice

In medicine, the mention of the word profit is often viewed or interpreted as a dirty word. It is as if the word does not belong in the lexicon when health care is addressed.
 Broke doctor
I argue (in the context of the private medical practice setting) that profitability is a medical practice’s responsibility for one simple reason. If the medical practice (also known as a business) doesn’t deliver profits, health care providers are unable to provide for those in need.

Why Profits?

Profits pay for infrastructure, technology, education and human resources, all of which translate to superior pediatric care when employed correctly.
Another way I like to put it is by saying,


…a broke doctor does do anybody any good.


Calling vs Profits

Indeed, our medical businesses differ from other companies in that we care for children. And the notion of withholding medical services or restricting access to a sick child merely by the patient’s parents inability to pay for health care services is simply not in a pediatrician’s DNA.
However, it is important to accept the reality that without a way for a doctor or the practice’s income to outpace expenses, health care providers are unable to provide services of any kind. At least not for the long term.

Is there a solution?

How do we reconcile these two competing issues? On one hand, it is necessary for a medical practice to deliver profits if it wants to remain sustainable. On the other, we have an intrinsic motivation to put the patient’s needs first.
I am glad you asked.
These two dichotomies can co-exist – and even flourish – alongside each other. There is indeed numerous tools and principles rooted in business that can help medical practices manage what otherwise appears to be opposing forces.

A Resource You Don’t Want to Miss

Today, I want to tell you about a resource I’ve been working on to help your office obtain financial success, while simultaneously providing unsurpassed pediatric care to your patients.

To help you succeed in your financial success, I’ve written a comprehensive eBook on budgeting that walks you through the process of creating a budget for your medical practice. The materials also cover basic principles necessary to put the exercise into perspective.

Budgeting is a major component of financial success. Moreover, financial success is essential to the continuity of care.

To read more about this offering, click on the image below.

Medical Practice Budgeting
Click on the image

I do hope that you buy the book, but more important, that you find the eBook helpful, useful and valuable.

11 Straightforward And Practical Tips To Improve Your Practice’s Bottom Line

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

You do not have to be a marine captain to know that there are countless potential dangers navigating waters.

With a little imagination you know there are many risks. Some hidden, like currents, while others are painfully apparent (i.e. howling winds, waves and torrential storms).


Compass Direction GuideWe know there isn’t anything the captain can do to eliminate weather conditions or enforce her will on ocean currents.

However, we can all agree the captain has control over the vessel. We can also agree that the captain has the responsibility to equip the ship and its crew member to its maximum potential if they have any intention of overcoming environmental threats.

Running a “profitable” practice is indeed becoming more of a challenge. For many, it is uncharted territory. And while there are many extrinsic reasons – like decreasing insurance payments, high deductible plans, and the increased cost of providing care – that are contributing towards the “remaining profitable” challenge, the truth is, there is little – if anything – we can do to eliminate those threats.

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

Below are 11 STRAIGHTFORWARD and practical tips you can implement immediately to help you navigate these rough waters.

  1. Review fee schedules regularly to ensure your fees reflect market conditions in your region.
  2. Adjust fee schedules for certain procedures to improve providers’ competitiveness.
  3. Review all E&M charges by a certified coder before submitting claims.
  4. Hire coding consultants for annual chart reviews to ensure accurate coding.
  5. Monitor and report payments of your top insurance-payers.
  6. Run reports to understand payments by different networks or other contract types.
  7. Renegotiating (or consider dropping) contracts with payers who have low payments.
  8. Monitor how long it takes for charges to be entered and claims to be submitted to make sure claims are being filed timely.
  9. Consider provider training or implement random audits to ensure billing slips are completed clearly and accurately.
  10. Review your practice’s policies for routing super-bills to ensure claim submissions are sent as soon as possible.
  11. Implement processes so your billing staff works missing super-bills, claims, denials, consistently.

Imagine for a moment navigating open waters without navigation tools. Now, imagine what would happen if conditions were less than excellent?

If your boat ran off course or worse, capsized, would you blame the environmental conditions? Or would you take responsibility because you didn’t have the proper equipment and tools to navigate in challenging conditions?

How Well Do Parents Know What You Do As a Pediatrician?

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

During the summer months, I posted on our practice’s Facebook page, a note encouraging parents, to schedule their children’s wellness visits.

Although the message was for our entire Facebook community, I wanted to catch the eye of parents with teenagers. Don’t know how well you manage teens in your office, but in our office, we have decent wellness visit numbers with younger patients. The teen population?

Not so much. Once the teen years kick in, we mostly see them when they are sick.Screen Shot 2016-02-26 at 11.48.51 AM

I wanted to encourage parents to make their wellness visits but also throw in a subtle nudge to parents with teens.To get their attention, I opened with this line: Did you know pediatricians are trained to treat children from birth to adolescence? Then I went on to talk about the importance of wellness visits etc.

Something interesting happened. The post outperformed other Facebook post. It received more likes that than the ordinary. But that the surprise me. What surprised me the most, were the comments from parents.

One mom said, “it’s good to know the pediatrician can see my teen.”

Another said, ” Timothy is going to be so happy when I tell him Dr. B can still see him.”


It’s an age-old lesson. It’s a lesson on assumptions and what happens when we make them.

That simple, otherwise ordinary status update, got me thinking about how well (or not) we communicate what it is that we do as pediatricians. If so many people weren’t aware that pediatricians can treat teens and beyond (0-21), what else don’t they know? The irony is that our website is tagged with the line “Pediatric & Adolescent Medicine.”


We clearly have a communication problem. And I would argue that our lack of proper communication about what it is we do as pediatricians (more than runny noses and giving shots) is why many parents don’t see the distinction between a retail clinic and a pediatrician.


It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.



The good news is that there is a significant opportunity for pediatricians to cover a lot of ground. How so? By using social media channels to educate our community about all the great services we are trained to provide.

I also believe that leveraging this opportunity could aid your practice in differentiating itself from the competition.


Since I realized there was a chasm between our assumptions and the reality, I’ve been intentional about informing our community about the training, knowledge and expertise our pediatricians can address.

Some of it may seem too obvious for those of us that do this every day. Like explaining the importance of wellness visits.

But the truth is, some parents don’t know about yearly wellness visits. They assume that because the child no longer needs shots, they don’t need to go to the doctor.

Beyond promoting wellness visits, I use many of the things included in the Bright Futures guidelines as a way to highlight that a visit to the pediatricians is highly comprehensive.

And by educating our population, I’m also marketing our practice in a unique way. Instead of mentioning in a promotional piece that we accept most insurance plans, I may mention that how we can provide family support, safety and injury prevention, or mental health.


Not only is promoting and sharing this information relevant and valuable to parents, but I also think it is an excellent way to differentiate ourselves from the MinuteClinics or other medical services that overlap with pediatrics (i.e. Urgent Centers, Family Practice, Telemedicine).


Think about your medical practice’s communication strategy, or lack thereof. What is your practices unique selling proposition? What problems do you solve that others don’t? Then think about how best to communicate your message. Also, consider the channels you’ll be delivering your message. By channels I mean, traditional advertising, email campaigns, social media, etc.

Remember, each channel is unique, thus requires you to craft the message differently.

I’ll leave you with this… times are changing. That is certain. And we have two options, two paths to choose from. Disagree with how things are changing, or find ways to agree with the shifts in a way that benefits you and your practice.

Let’s Talk About What Happened In Vegas

My friends from the Pediatric Management Institute (PMI) put on another great practice management conference in Las Vegas last January.Screen Shot 2016-02-21 at 10.55.37 AM

The content was excellent, thanks to the fabulous faculty PMI brought in.

The topics varied from customer service principles to fundamental changes happening in the health insurance industry and how those changes are – or soon will be – affecting doctors’ financial bottom line.

Below are a few highlights and notable points that resonated with me.


Dr. Jeanne Marconi presented an account of how her practice diversifies income streams by incorporating ancillary services into her practice.

Admittedly Dr. Marconi’s comprehensive – almost overwhelming – plethora of services (they even offer in-house exercise training programs for children with high BMI) is probably too much for the standard practice to implement.

But for me, her talk wasn’t an invitation to follow her footsteps, but instead, provide insight into what is possible, what can be done and what is available to practices.

Dr. Marconi dished out several challenges to the physicians in the crowd. But the one that resonated with me the most was her call for pediatric practices to challenge the status quo, expand their minds, think creatively (or to use a cliche, think outside the box) and begin to think about ways to diversify practice’s revenue streams.


Susanne Madden arrived in Vegas with her extensive knowledge and expertise of the health insurance industry.

Screen Shot 2016-02-21 at 11.10.10 AM
Dr. Jeanne Marconi and Susanne Madden

She presented attendees the sobering reality of how health insurance companies are adjusting, changing – even experimenting in some cases – with their models to continue delivering value to “their” shareholders. And by value, she means lower cost and higher profits.

Susanne underscored the importance of implementing quality measures such as P4P, HEIDIS, PCMH into our medical practices. But not for the reasons you might think.

While many of these health insurance programs are currently in place as rewards (e.g., enhanced or incentive payments) for medical practices that achieve quality measures thresholds in patient care, Susanne highlighted that these programs will soon become a requirement for practices.

What does this mean exactly? Insurance companies will soon stop offering enhanced payments programs to practices for achieving PCMH level III certification (or other types of incentives). Instead, they will reduce payments to doctors don’t meet PCMH certification.

As if that wasn’t bad enough, she added that many payers are evaluating providers based on how much the provider costs the company in benefits payouts.

How is that different than what they do now?

The difference is that they are not looking at the practice as a whole, but rather evaluating each provider individually.

The implications are that if you have physicians in your practice that don’t adhere to designated quality standards, payors can potentially pay each doctor in the practice different amounts.


PMI’s very own Paul Vanchiere gave two of his hallmark presentations. The first one focused on customer service using the acronym KIDS (Kindness, Integrity, Dignity & Service).

His second talk was my favorite. Why? Because Paul took a complicated, MBA, executive consulting level exercise (determining how much can your practice afford to pay an employed provider) and distilled it into an easy to follow, step-by-step, process, which only requires one to understand a few financial concepts and enter value sets into a spreadsheet.


Dr. Rich Lander went over the fundamentals of proper coding. In addition to reviewing the differences between coding Level 2, 3, 4 & 5 for a sick visit, Dr. Lander stressed the importance of documenting “time” correctly in a patient’s chart.

Screen Shot 2016-02-21 at 10.56.21 AM
Joanne Blanchard and Dr. Richard Lander

Dr. Lander shared multiple clinical scenarios that we often encounter with patients. But some of the codes he suggested I wasn’t all too familiar with. I couldn’t recall if we used them.

So I wrote down a reminder to myself to check how well (or not) providers at Salud Pediatrics were using the full scope of codes available.


Dr. John Moore – a new PMI faculty member – brought us up to speed with some of the new social media trends (Are you familiar with SnapChat and how kids are using it?)

Screen Shot 2016-02-21 at 11.10.19 AM
Dr. John Moore and Paul Vanchiere

One of the points that Dr. Moore articulated that I appreciated the most was the importance for pediatricians to embrace social media.

He said something that I’ve been saying for a long time; which is, had pediatricians adopted social media at a faster clip, the pro-vaccine vs. anti-vaccine arguments would have been balanced. Moreover, there was the potential to stifle the anti-vax movement.


You can always count on Chip Hart to deliver great wisdom and insight. Chip also gave two talks.Screen Shot 2016-02-21 at 10.56.11 AM

I’ve heard Chip speak many times, but this time, I felt his talks were different. Chip’s talks had a subtle, tough-love tone to them.

While addressing the challenges practices are facing today, he stressed that pediatricians have faced similar challenges before. He mentioned that during all previous tectonic shifts (aka industry changes) naysayers shouted out the demise of private practices. Much like many are shouting today.

Chip eloquently argued that not only are the doomsayers wrong, but that pediatricians are actually in a better situation than most think.

Chip wasn’t disregarding the challenges or downplaying the potential threats. We are indeed going through tough times. But these tough times were an opportunity to transform and reinvent our practices, he argued.

My takeaway was: If the plan is to defend the status quo and hedge the long-term success of your business on account that you have the initials MD after your name, thus somehow inoculated from change, the end is certainly near for you.


Attending a seminar like this to learn from the speakers is certainly worth the price and the time. But more often than not, the icing on the cake, at least for me, is the immeasurable, intangible value I glean from networking.

The people who attend these events are the smartest and brightest in my opinion (and I’m not talking about the faculty, although they are good too).

Whether attendees are veterans in managing practices or opened their first private practices last week and believe they have no clue what they are doing, the truth is, there is opportunity to learn from everybody.

The faculty makes the trip worthwhile. But I would say the attendees make the event special.

Next year I hope to see you there. Especially if you didn’t get a chance to attend this year.

Place: New Orleans
Dates: Jan 27-28th 2017


How Many Miles Before Your Pediatric Practice Runs Out Of Gasoline?

My Grandfather shared with me once that back in the day (in the 1950s), he and his buddies would drive around town until the empty light on the car’s dashboard lit up. Once the light was on, they’d reset the car’s odometer and drive until the car would run out of gas.

Screen Shot 2015-02-22 at 4.00.47 PM

The purpose?

The purpose of the exercise was to know with certainty how far their cars could take them once the gauge indicated empty.

As it turns out, gasoline stations were few and far between in rural Texas, so knowing you had enough gas to reach the next town was, in fact, a very good idea.

Let’s say your medical practice is a car, cash is gasoline and miles are weeks.

With that in mind, consider these questions:

  • Does your car (practice) have a gasoline (cash) gauge that displays full – half – empty?
  • If your car (practice) doesn’t have a gauge, how do you know when the gasoline (cash) falls below critical levels?
  • With a full tank of gas (cash) how many miles (weeks) is your car (practice) able to cover?
  • How much and how often do you need to fill your car’s (practice) gas tank (bank)?
  • Do you know your car’s (practice) empty light threshold?
  • When it lights up, because your car’s (practice) gasoline (cash) is reaching empty, would you know – like my grandfather and his buddies knew – how many miles (weeks) you could cover before running out of gas (cash)?
  • Do you carry a portable gasoline tank (i.e. savings or line of credit) to use if there isn’t a gas station for miles (weeks)?

I think it is safe to assume that most everybody agrees, driving a car around without a gasoline gauge is foolish. Equally foolish would be to disregard the “empty” light on your car’s dashboard. And we can all agree it would be unwise to look for a gas station after your car runs out of gasoline instead of before.

Many however, manage their practices believing the practice will never run out of gasoline. Many, don’t even have gasoline gauges, which is bad enough, but even worse is disregarding the “empty” light all together when it lights up. Others have a huge hole in their gasoline tank and keep wondering where their gas is going?

In the How The Mighty Fall: And Why Some Companies Never Give In, Jim Collins talks about how companies start to fall apart way before they actually fall apart. Like a disease that starts to affect the body before symptoms are visible, many companies start the decline before the leadership is even able to make a diagnosis. And often times, by the time the leadership realizes there is a problem, it is often too late.

Don’t let your practice be one of the companies Collins is talking about and make sure your practice monitors cash-flow the way drivers manage their car’s fuel needs.

(By the way, in case you were wondering. My grandfather carried with him a portable gasoline tank during the “how far can the car go before it runs out of gasoline” experiment). 

What Good Is A Broke Doctor?

Screen Shot 2015-02-22 at 1.45.24 PMI was invited a few years back to give a talk on vaccine management. The audience was mainly adult doctors from various specialties. My assignment was to pull back the curtain on how our pediatric practice managed vaccines.

In preparation for the talk I spoke to several family practice and internal med practice managers to understand what were the obstacles that steered their practices away from giving vaccines.

The practice managers I spoke with said that the time, risk, cost and poor return on their investment made it difficult to justify carrying vaccines. It wasn’t worth it to them.

With that information, I structured my presentation with the message that “vaccines are good for patients and good for business.”

One of the sponsors of the event was a vaccine manufacture and a representative from the vaccine company was present during my talk. I received word afterwards that the sponsors did not like my “…vaccines can be good for business” tone and I should tone it down in that regard.

Let me get this straight, I said to the messenger, a pharmaceutical company, which makes billions of money ON VACCINES, is telling me that I can’t talk about making money with vaccines? The messenger said, yes. They want you to focus on storage, logging refrigerator temperatures, proper vaccine handling, etc.

A few weeks later, the issue of profitability centered around the flu vaccine came up in a discussion. I shared with the group that the flu vaccine is profitable for our practice. Not huge margins, but certainly not a loss.

A primary care physician announced to the group, that we ought to be careful what we disclose because insurance companies may find out. The gentleman was implying that this profitability “revelation”may be harmful to physicians in the form of lower payments.

I find these two incidents disconcerting. This implicit taboo-like mentality that shuns people away from discussing healthcare is a business (thus profitability needs to exist) needs challenging. Talking about cost, revenue, margins should not be kept quite or even discussed discretely. On the contrary. We need to make people aware.

Besides doctors, who in healthcare does not embrace profitability? Pharma? EMR vendors? Malpractice attorneys? What about Welch Allen or McKesson? BCBS? United Health Care?

I believe private medical providers have an obligation to be profitable. Profitability allows us to buy the best technology, hire the best doctors, nurses, staff, buy the best equipment so that we can offer the best pediatric care. Does the grocery store apologize for making a profit by fulfilling a biological need? No. Of course not. Then why should doctors?

Simply put, we can’t help people in need, if our practices are in need ($$) too. Profitability allows us to continue providing healthcare services.

Here is a challenge. Let’s talk openly, candidly and honestly about making a profit. Our livelihood depends on it.


Extra, Extra – Now Offering Coaching Services

Screen Shot 2015-02-03 at 7.56.46 PMPeople always ask me if I do practice management consulting.There was a time when I did. But for the past two or so years, I’ve responded by saying no. I enjoy consulting and love to do it, but I had to stop because of the time commitment.

Recently, I was talking with a loyal reader of PediatricInc about this very topic and she suggested I do remote coaching.

My friend, who owns her practice, explained that she doesn’t necessarily need a comprehensive on-site consult. “I just want to ask a question about my practice or run things by someone familiar with practice management,” she said.

She went on to say, “…you know doctors don’t get training on business, management, marketing, collections…. having somebody to reach out to that has the business and practice management training would be valuable.”

“Like a practice management coach?” I asked. And she said, “ yeah, that is a good way to put it.”

We talked a little while longer. By the time we finished up, my loyal reader and friend had convinced me.

Today I’m announcing a new service on PediatricInc called PMB Coaching for those pediatricians and/or managers that want my perspective on practice management, discuss in detail a blog post, run something by me or provide another set of eyes.

Interested in learning about the PMB Coaching?

Click on this link.


Time Management Lesson That Has Helped Me Increase My Productivity


Last year, I put myself at a crossroad. I’m sure you’ve been at the same crossroads before. It is where things to do, the things I want to do, and things I had to do intersected with this little nuance we all agreed to call time (or lack thereof).

Like many, I would find ways to be more efficient and find ways to get better at time management. But this strategy was not working out. I was still overworked and felt unproductive as if I was in a hamster wheel. I felt the need to approach my crossroads differently.

I decided to approach my dilemma by exploring and thinking about how successful people, whether they were business leaders, athletes or artist, dealt with  time management.

I discovered that people that are experts at a craft, writing, a sport, or an instrument, for example, all had enough time to do what they do. If it weren’t true, they would have not reached their level of mastery.

I realized that my problem wasn’t a time management problem or using my time more efficiently, but rather my problem was a task management prioritization issue.

The people that have time to do the things they need or want to do was not as a result of applying Steven Covey’s time management methods better than me, but rather because they are jealous of their time and only what is really important to them gets the time. Everything else, has to wait.

Which led me to conclude that:

The thing that distinguishes me from them is not better time management skills, but rather they are better determining the order of dealing with task according to their relative importance.

What did I do with this insight? How did I apply this to be a better practice manager of a small business? Glad you asked.

I sat down and I wrote all the things I did. This included everything from projects I was working inside and outside the practice, like speaking engagements, consulting and the blog. I then added all the things I wanted to do, but couldn’t find the time to do them. This included things like working out to finding time to meet with people that are smarter than me.

Once I looked at the list, it was apparent why I wasn’t being effective. It was too long. Nobody, no matter how good or disciplined they are, could manage a list that long and still be effective.

What did I do next? I prioritized all the things on the list. But before doing that, I took time to determine what was important (not urgent) to me/us ( us = partner ). In order to determine the important over the urgent, you need to have clarity with what it is you are trying to accomplish, exactly. Like, you know… have goals.

Once that was figured out,  I drew a line after number three on my list. Top three were now my only areas of focus.

I make it sound easy of course. But cutting down the list to three main areas of focus wasn’t easy. There were  a bunch of things I really wanted to do that fell below the line I drew.

Moreover, the focus on the three couldn’t happen over night. I was already committed to several projects that weren’t on the list, but I still had to deliver on.

But with a clear focus on what I needed to do, I began to get a better handle on how to protect my time and put more effort into carving out time for those things that only enhanced, improved or were in pursuit of the three main things.

What does have to do with practice management?

Simply put, nobody drifts into productivity. Nobody “happens” to find time to exercise, garden  or write a book. Nobody just happens to get better at something. In order to be better, you have to be intentional. And being intentional with our time, instead of letting  all of our “things” dictate our time, is not a scalable solution. At best you’ll crank the hamster wheel a little faster.

If you want to make progress at something, you have to direct your focus at that something. Thus, in order for me to become the best practice manager I could be and lead my team well (in addition to being a better husband and father), I needed to stop doing more – which was hindering my progress altogether – and start saying no.

Perhaps some of you  are thinking this is absolutely unreasonable and if I knew everything that is going on in your life, I would agree with you that you couldn’t keep a list of only three things to focus on.

I’m going to disagree. I too have a super hectic life. But it can be done.

Read the biography of any great leader in history, whether a politician, CEO, or successful entrepreneur, and you’ll begin to see that despite their crazy busy schedule and work demands, they were laser focused with a few priorities.

Keep this in mind… the top three things are areas of focus… not necessarily specific task. What I mean is that one will still have a lot to do. But the difference for me is that each task, job, interview, meeting, outreach is done with a purpose.

And remember, we make time for our priorities. But if we don’t have priorities, areas of improvement or specific goals of what to do with our finite time, well, then, it is no wonder we don’t have time.

So my challenge for you today is this; start looking at your time management issue as a task management issue and shift your mind to think in terms of areas of focus and let that determine how you should spend your time. And I bet that once you do that, you’ll have a bunch of time on your hands to do the things that are important.

Until next time.

10 Time Management Axioms For The Dedicated Medical Practice Manager

At the end of last year I went to a leadership conference. Among the session, there was one on time management. This, of course is an area that many of us struggle with.

Show of hands, how many of you have uttered these words? there just isn’t enough time in the day.

That is what I thought!

I’ve had to think a lot about time management in recent years due to life circumstances. Life has gotten more hectic with a growing practice, and growing kids. So I was eager to hear what Craig Groeschel had to say.

Craig is the head of a large organization. He is behind one of the most downloaded smartphone app of all time; he writes books, is a well known speaker, and as if that wasn’t enough, he’s a father to 6 children.

I think he may have a thing or two to say about how to manage time.

So what did Craig say? Well, lucky for you, I wrote notes. But instead of writing them here on the blog, I created a pretty slide show that highlights Craig’s main lessons from his time management session.

Of course, it isn’t going to be the same without Craig’s insight, context, and gifted speaking ability. But at least you will get enough to incite a few thoughts and tailor your own approach towards time management.

Hope you enjoy the axioms and the slide show. (By the way, I’m aware of the typo on the last slide. I’ll fix it soon.)

If you are interested in learning about the leadership conference I referenced, check out this link to learn more about it.

What Disney Can Teach Medical Practices About Keeping Employees Motivated

Screen Shot 2013-12-08 at 9.58.02 AMWhile touring Magic Kingdom as part of the Disney Institute customer service program, I learned that Disney doesn’t pay better salaries than other companies. I also learned that promotions are hard to come by.

With 60,000 employees working at the parks alone, it is difficult to be chosen for a promotion when thousands of people are also applying for the job.

Disney Park employees work long hours, mostly standing, in 100% humidity for a good portion of the year, work weekends and holidays, all while maintaining exceptional, customer centric, above and beyond, unsurpassed customer service, always.

As it turns out, our pediatric medical practices have a lot in common with Disney. We hardly can afford to pay support staff above average salaries, they are required to work long hours, mostly standing, and chances a medical assistant or receptionist will get promoted to a high management position is very, very slim; especially if they work at a smaller office.

And if you think about it, Disney employees have it easier than many of our employees. Parents and children want to be at Disney, whereas nobody wants to visit the pediatrician. Instead of dealing with happy mom, dads and children, our staff has to deal with grumpy, moody, sleep deprived, overworked, anxious parents and their sick, uncomfortable children.

So I asked the tour guide how or what do they do to keep their staff otherwise known as cast members, up-beat, motivated and willingly to always go the extra mile for every guest. Not everybody gets to be Cinderella on top of a parade float waving to excited children.

He said it was difficult to encapsulate in a sentence or two, but the easiest and fastest way to explain it, is that each person has to find their own applause.

You see, Disney embraces the notion that they are an entertainment business. So, they view everything through a stage or movie production prism. That is why they call their employee cast members. When on the job, they refer to it as “on-stage.”

But the remarkable thing about their company culture is that the notion of being in the entertainment business is not limited to the stage. It permeates all the way throughout every single person in the organization, including the custodial staff that clean and sweep the park.

Thus the “everybody needs to find their own applause” is a profound metaphor to explain how they keep staff motivated despite the not so always great working conditions.

It means that the Disney employee has to find an intrinsic motivation to deliver on Disney’s promise. Going the extra mile to make a family or a child’s experience at Disney that much better is the actual motivation. Not the money, or the potential for career advancement.

I found this nugget of information worth the entire trip. Because it crystalizes for me the importance of hiring staff members that find joy in delivering on our core values rather than finding people that can simply do the job. It was clear to me that as a leader of our little practice, it isn’t always my job to keep staff engaged and motivated with incentives, raises and perks, but rather work with each of them find their own reward, applause, or motivation.

For me it was also a reminder to lead employees rather than to instruct them to find that intrinsic sense of purpose. Because at the end of the day, you can always train someone a process, but you can’t teach someone to be nice.

Are you helping staff members, employees, or your cast members find their own applause? Do you hire based on an employee’s ability to deliver on your promise to patients and parents? What motivates your employees? Money? Promotions? Time off? Smiles from parents and their children?