The View From The Backside Of The Mule

For years, a dear friend and I mused over coffee at Starbucks about someday making a career change. At the time, she was a VP in a national surgery center development company and I was a local interim practice management specialist. We would laugh about becoming baristas and spending the later phase of our lives wiping down counters and bantering with customers, a real change from the stresses and drama of health care administration.

Oh sure, there’d still be real work to do, things like ordering supplies, stocking shelves, doing accounts payable, etc. But think of it! After all that is done, the most stressful thing we’d have to do is get coffee orders correct and be nice to people all day. What’s not to love about that?!

Hey Maria, toss me that apron, will ya? I think Joe Cocker had us in mind when he released the song “It’s High Time We Went.” Lyrics: “Well it’s 5 o’clock in the morning and it feels just like the end of a mule. Somebody’s been yawning, trying to break out of the rules. Ain’t it high time we went?

Chaos Theory

As a turnaround specialist [glorified clean up lady] who spent her career helping struggling medical practices, I spent beaucoup years right down there at eye level, staring at the back end of that mule. Granted, the smell wasn’t great, but I was able to carve out quite a niche for myself. I brought up the rear [pun intended] by cleaning up other people’s messes. Yes, the commodity I traded in was chaos and multiplicities of practice dysfunction.

I proudly boast that I have decades of experience as a circus ringmaster. I was quite an expert at juggling things like billing backlogs, office politics, ballooning overhead, obstinate staff, disruptive physicians, etc. Come to think of it, Barnum & Bailey would have been a logical lateral career move had I not decided to just go ahead and retire early. Sounds enticing doesn’t it? You riveted yet?

Enter Guns Blazing

Essentially I was a hired gun brought in by physicians and/or their accountants to do whatever was necessary. My job was to get things turned around quickly. And did I ever take my job seriously! You can’t see me but I’m doing that sticking my finger down my throat gesture. Oh puhleeze!

On Day 1, I would arrive at the said/appointed practice wearing my black kevlar business suit. I always accessorized well, bringing a coordinating asbestos shield and a full array of tactical gear. The first order of business was a meet and greet to get my marching orders from the physician board. Then, with a snappy salute and a perfunctory clicking of the heels of my sensible-yet-stylish shoes, I spun around and became Mary Poppins. I promptly marched out of the board room and set about ‘getting things done’ in textbook David Allen fashion. [Eye roll.]

Metrics Busting Was My Thing

As I say in great detail in another post, I gravitated into doing this kind of work partially because I couldn’t say no and partially because I was trying to prove my relevancy to someone [anyone!] at that point in my life’s journey. And boy, did I trip the light fantastic as a people pleaser.

Oh how I loved delivering my “Here’s what it was when I got here and here’s what it is now” presentations to the doctors. I loved documenting how much I’d gotten accomplished on their behalf. [Can anyone say codependent people pleaser?] Then, to increase the wow factor and further emphasize the improvements I’d made, I window-dressed everything with colorful charts, graphics, and bold revenue numbers.

Get Out Of Jail Free

After being questioned about the validity of the improved numbers by one physician’s skeptical accountant, I took it upon myself to learn a complex data modeling and visualization software package. Using this tool, I put together a nice three-ring binder of indisputable data. This well-meaning curly-haired accountant had triggered my indignation by the mere suggestion that I’d gotten such low days outstanding by doing inappropriate contractual write-offs.

When those words proceeded out of his mouth, suddenly the lightning flashed, the thunder rolled, and the words: “It’s Not Nice To Fool Mother Nature!” reverberated through the upstairs board room. Okay, maybe they just reverberated inside my head.

In any event, I became a woman on a mission. During the next board meeting, I proudly whipped out my binder and proved his uneducated assumptions wrong. I beat him into silent submission using his own favorite weapon: numbers.

He wanted numbers … I gave him numbers. Yes indeed, I gave him numbers sliced and diced so many ways they looked like they’d been run through a Ronco french fry cutter from one of those late nite infomercials.

From that day forward, my friend Maria and I satirically dubbed my new monthly format my ‘Get Out Of Jail Report’.

Simply put, I was on an ego trip when it came to doing practice turnarounds. I thought I was a bag of chips and all that. Some have suggested that it’s not bragging when what you’re presenting are actual facts. And mine were facts. My claims of improvements were always supported by accountant-approved financial statements, and best of all, validated bank deposits.

Trust me boys and girls, nothing says success to doctors like the color green. Green dropping ‘below the line’ for distribution to their personal W2’s. Doctors’ wives love it. And when doctors’ wives are happy with you, this too is good for one’s career. LOL

Cleaning The Entire House

I didn’t just work my magic on the financial side of the house. I also mopped up all the excrement in the HR department as well, handling hot-potato performance issues that derelict predecessors had allowed to languish unattended for sometimes years before my arrival. But like the good little Pollyanna People Pleaser that I was at the time, I dutifully stood in the blast furnace and took the heat for the physicians.

Channeling Wonder Woman, I caught bullets with my teeth on a daily basis. My role required me to make wholesale and often very unpopular changes to the status quo. The changes I made were always overseen by The Physician Board who many times hid under my skirt later and acted as if they had no prior knowledge of the action plan when the things they directed me to do were not well received. But it was all in a day’s work.

Dirty Deeds (Not) Done Dirt Cheap

I still chuckle about how one particular physician described my management style as “appropriate gravitas”. Yeah well, that’s just Yale-speak, a  codified way of blowing smoke up my skirt and saying that I always stepped up and did what had to be done. That, and the fact that the surviving staff members weren’t too afraid to walk past my door. At least on most days.

By cleaning up backlogged and dysfunctional business offices, the docs got paid the maximum amount that they were due from the insurance companies. I did this on a consistent basis. By streamlining their clinical and business processes, they were able to see more patient in a day and therefore bill more charges. The medical groups I led always became what the medical industry calls ‘better performers’, significantly surpassing  industry benchmarks for efficiency.

P.S. Long story short: The doctors made more money. They paid me well. And a good time was had by all.

Hidden In The Fine Print

So what’s not to love about doing this kind of work? And why am I so happy that I don’t have to do it anymore? The short answer is that nothing is inherently wrong with doing this kind of work. It’s very similar to cleaning toilets, someone has to do it. And in the case of physicians and their oft-dysfunctional offices, that special someone that they bring in from the outside to do the clean up usually gets paid handsomely to poke around in the poo.

But, hidden in all those dusty law books was the fact that I was never cut out for, nor did I really enjoy, that kind work. Now that I’m permanently retired and therefore don’t give a rip what people think, I can admit it. Yes, I can finally say it. Loud and proud. I didn’t particularly care for being anyone’s boss. I’d much rather work alone.

Wait. What?

Yes, I was simply playing a role. I played my role well, because I got paid well. But the honest truth was that I hated it each time I had to be the bad guy. I moonlighted as The Big Bad Boss from 9 to 5, but the unvarnished truth was that I wasn’t big or bad at all. A secret that I held close to my vest, and protected with all that was in me was the fact that I had a very soft underbelly.

P.S. Long story short: I was born sanguine. To.The.Bone.

Put simply, playing the role of the sometimes-ominous/yet-friendly boss was how I supported my addiction to food, clothing, and shelter. But that whole ‘strictly business’ side of me was never the dominant center of my intelligence, nor was it even my comfort zone. The Real Me, unpacked and straight-out-of-the-box, is one of a playful Creative. I’m happiest when I’m writing, doing graphics, and staying behind the scenes being the funny one. Who knew?! No one actually. And that’s the way I wanted it to stay.

Meanwhile … Back At The Ranch

So, until I get that call from Maria to join her at the coffee shop, I’m spending my days playing with digital media and indulging my creative side. Trust me, I have much to write about and illustrate. I witnessed a ton of funny stuff during my time crouched down behind that mule.

Expected to stay in Stepford mode all those years, I took things way too seriously, but not any more! Twisted Sister here thinks it’s high time to mine my experiences for all they’re worth.

Who knows? I may even publish my own humorous expose on practice management. Now, now … before sweat beads start popping out on anyone’s pretty little foreheads … relax and take a chill pill. You know me. I’m a nice person. I would never use any real names.

But that’s not to say that I couldn’t be like Taylor Swift and hide a few clues here and there for entertainment purposes and to keep things interesting. So if I do publish a kiss-and-tell, you’ll just have to use your imagination to see if you can deduce the identify of any of the characters who served as my creative inspiration. In the meantime, I think it’s high time we went.

To be continued ….