Welcome to the Healthcare CEO podcast. Join us as Daniel Fernandez, healthcare leader and patient experience advocate leads dynamic one-on-one discussions with healthcare executives, consultants, and other industry experts. Listen in as they share actionable insights and unique perspectives into the day in the life of a healthcare CEO.
*The following has been adapted from our full-length interview, which can be found here.
Meet Dr. Scott Powell
Dr. Powell is a physician partner at Florida ENT & Allergy, and one of the original four practitioners at the practice. He has received numerous awards and honors, including Outstanding Surgical Student from the American College of Surgeons’ Ambrose Paré Award, and Outstanding Otolaryngology student, from the University of South Florida. As a practitioner, he’s been voted one of America’s Top Doctors since 2011, and his focus is on nasal and sinus disorders, and treatment, allergy, and pediatric ENT.
Planning for a Healthcare Practice’s Exponential Growth
Daniel Fernandez (DF): During this podcast, we talk about what it’s like work in a fast-paced organization and the newer technologies that are making their way in healthcare today. Welcome to the show, Dr. Powell.
Scott Powell (SP): Thank you for having me.
DF: You’re one of the original four practitioners thirteen years ago. How large is the team today?
SP: We’re 25 physicians.
DF: And there’s a recent merger taking place as well?
SP: Yes. Our group here in the Tampa area, we were loosely associated with an ENT group. So we joined with a group of 65 practitioners spread out all across Florida. So now we’re approaching the magical 90 to 100 mark.
DF: That’s probably making you now one of the largest groups?
SP: We’re the largest one in the country. Technically, there’s a larger one in New York, but they have allergists and other people in their group. So that’s a feather on our cap now.
DF: Now, I can imagine over the last 13 years, you’ve learned a lot. If we could transport ourselves back in time to the beginning, what are some of those lessons you would tell your younger self?
SP: You know the cliché “it’s never as good as you think”? It’s never as bad as you think. Just when we think that we’re settling down and things are even-keeled and stable, something’s gonna come along. Sometimes, it’s something negative. Other times it’s an opportunity. And we have to unanchor and move forward.
In other times, when things are moving in a different direction, and something’s going on that’s adverse, we have to realize it’ll pass, that we’ll move through it. Those are the things — it’s never too great, and it’s never as bad as you think.
DF: I’d imagine, back then, with a smaller team, you probably didn’t have so many capabilities as you have today. Have roles been added along the way that have made an impact?
SP: For a while, when we first started out, we were four and two offices, and everyone wore multiple hats. And as you start to grow, you start to cross over the mark where people can’t do one or two things great, they just do a lot of things pretty well. So we started almost to subspecialize within the team. Back then, we took a trip to the big group in New York. There were about 200 ENTs. We met them and we wanted to take it to the next level. We said, ok, let’s take a trip. We’ll go up there and learn how they grew in an organized fashion. From that, we added a call center, got a call center manager — who’s been great — and everything became a lot more subspecialized, instead of having everyone do a little bit of everything. We started doing things in a more structured way.
DF: Were there any pivotal moments that contributed to the overall growth throughout the years?
SP: During that same trip, we discussed whether we were going to disrupt things in our area and do things bigger and better? Because one of our partners, Dr. Miguel Rivera, was lynch pinned to have all the ENTs play in the same sandbox. And from there, having that coordination allowed us to work with other physicians. Having the background of where we wanted to go and find a path to get there. We would find a window of opportunity and instead of remaining in the status quo, make that jump — make that leap — and go from there.
DF: As a physician who’s going through the various changes of scaling up, what goes through a physician’s mind during that process?
SP: It’s difficult. It’s very easy not to change anything and to remain in the status quo. The biggest thing with the impetus to change is, whether we like it or not, it’s happening. We either evolve with it or it’s going to evolve without us. The dangerous part about it is growing too fast. If we overgrow too soon, we can crumble from within. At the end of the day, there’s a business side to all of this, but you don’t prioritize patient care, the business is going to shrivel up. That’s the biggest issue — making sure you grow, but remembering that it’s all about caring for the patients first, and everything else is a background to that.
Developing Effective Leadership
DF: Our audience is comprised of physicians within healthcare organizations and executives. What advice would you give to the executive leaders out there who are working with physicians through these stages of development and growth?
SP: Find your leaders. You can’t have everyone being a cook in the kitchen. Whether people take turns or some people decide they will be the ones to stand up and be a physician leader — essentially, the C-suite, the administrators, the corporate types — they won’t automatically get the respect of the group. So having the partner physicians behind them, all in the same mindset, at some point, the physicians will back off and practice medicine and support the structure more than being the driving force. Our day job is our day job. So if you’re trying to run a business during your day job, you’ll start faltering and you won’t be able to do each of them really great. So then it becomes a night job, and you start becoming burned out. And your work/life balance becomes faulty, and it’s not a long-term solution.
So, on the administrative side, getting good leaders to back you up and support you is probably the most important thing.
DF: One of the wonderful things about you and your perspective is that you actually chose to go back to get your MBA — which is very unique in this space. What made you decide to want to do that?
SP: I was lucky. During medical school, the Dean of the school [at the time] had an MBA and he talked about its value. So he talked to incoming students about doing a dual program. Most dual MD/MBA programs are five years, but he was telling us about ways to do it in four. So for the summers between each year of medical school, we’d stay behind and do courses in business school. Some people dropped out, but those of us who stuck with it, we’d work nights during medical school doing projects and the final courses to finish up the degrees.
DF: Do you think having an MBA has given you a different perspective on running the business, overall?
SP: Yes and no. Luckily, I’ve always had that mindset. That has given me some background about reading documents from business types and acquisition types. You can at least speak the language. But there are some people I know — my partner included — who have a knack for it. For me, it was nice to have that infrastructure I could build on. I can go back and look it up and refresh my memory. It’s nice that it’s a base for me for sure.
Covering All Your Bases Regarding Patient Care and Regulation Compliance
DF: What ultimately led to the merger decision?
SP: As we were growing, the biggest issue was, how do we protect ourselves? ENT is a weird world where there’s not a lot of us in the country — or in the world, for that matter. So there are a lot of external forces pushing things one way or the other, and everyone tends to look out for themselves. From this standpoint, we have more control over how to practice medicine. We’re not being told what to do, we can stay independent. Whether it’s how to cover hospitals or patients, we can have conversations with the hospitals. We’ve been able to expand our services to the patients in different ways and keep up with the regulations that are coming down that are coming over and over. If you’re one or two or three people, you may miss something and be in violation of something. This allows having people looking out for your back and vice versa.
Pivoting During the COVID-19 Pandemic
DF: And sometimes, I know there are external factors. Like, in 2008, there was the financial crisis. Most recently, we’ve had to deal with a global pandemic. Is there strength in numbers as well?
SP: For sure. During the pandemic, a close example, it was our spring break and my other manager and myself, we were both away. And as this was happening, we spent the entire spring break on phone calls, deciding how we’re going to do this. We then knew what was going to happen before it happened. We knew some of the guidelines from the CDC standpoint. We could run out and roll out protocols and processes in advance; whereas if we had been all alone, we would have just been there trying to figure out how to keep the lights on. It was a scary time for everyone. I’m 45 and I can’t imagine being more aligned so quickly at that point.
DF: Here’s a big question. Is the age of solo practitioners dead?
SP: I think it is — except for some rural areas where they don’t necessarily need more than one. But that’s becoming more rare. But I just don’t see it continuing. Between covering for themselves and what they need to cover, and then getting pigeonholed with insurance contracts, and those types of things where they have no leverage. And if Dr. Smith across the street has a group of three, they’ll just send the patients there, and Dr. Jones doesn’t have a leg to stand on. It’s unfortunate, but I think it’s going to be a dying breed very, very quickly.
DF: We recently talked with a CIO who was talking about how AI is now becoming baked into pretty much everything in healthcare. And that the smaller groups of physicians will have no access to those capabilities. What are some options for physicians today on a smaller side of things?
SP: Three generic options. You can go into a single specialty, which is the safest route. For example, in our group of 90+, there are subdivisions. So it’s not a top-down corporate issue. We have some people in this group who are in a single or double practitioner office. But they have this infrastructure behind them, that they feel they have 90 others watching their back. Otherwise, there’s hospital-based or hospital-owned, and then there’s private equity — which is rearing its head quite a bit. We were approached on that as well, and everyone has their own sunset when it comes to their career. It’s one of the ways you can monetize your practice. Because when you retire, a lot of the time, there are no buyouts. It’s just a thank you, a firm handshake, and you’re out the door. Some people say, well, I built this practice. I want some retirement return.
DF: Are there any pros and cons for each of those?
SP: Going in reverse, I think private equity can overlap a little bit into a hospital-based or large multi-specialty group, because a lot of times, you are in contracts and if you’re struggling with efficiencies, they can just come in and fix that. They’ll buy a portion of your practice and then forever, you get a fee going forward. The same goes for hospital-based. I see a lot of primary care who have done that. They’ll get the contracts and not have to worry so much about the business side or the contracts or HR. It’s a completely reasonable want. And finally, in a single specialty, you just have control of your life. I have a mantra that I always want to be my own boss. I have partners I want to live up to, but it’s my own time, my own life, and I decide where I am and when.
Is work/life balance a myth?
DF: As you’ve grown, have you been able to maintain some semblance of a work/life balance?
SP: It is an ever-changing answer for me. I get into a place when I think I’m doing well with it. Then something happens in the practice that rocks the boat — good or bad — and meetings tend to drift towards nighttime and outside of working hours. So I find myself drifting in the wrong direction. And to be honest, my wife has always been very good at luring me back — whether softly or not softly in telling me this. Her mantra is, listen, one day the kids will be gone and they won’t care if you’re there. Right now they care, so why not spend time with them now? That gets me every time because she’s right. No one’s gonna regret the other stuff. They’re gonna regret it if they miss a few things with their kids. My kids are getting older, so I know that timeline is running low. That’s my big, big mental reminder over and over.
The Future of Technology in Healthcare
DF: Are there technologies that you may have ruled out over the last year or so that maybe you had on your future roadmap, but you rolled out very quickly — like telehealth or something of that nature?
SP: Yes. Absolutely. Telehealth happened in a microwave state. That same week we were planning for the pandemic, we rolled out telehealth makeshift options. And I do think it’s here to stay. It has a role in medicine for sure. Some areas way more than others. Ours is so procedural based that it doesn’t have as much value, but there are some appointments that can definitely be done through video. That happened within a week’s time.
As for other stuff that definitely piques my interest, I think AI is both scary and exciting at the same time. I think there are some specialties that will be greatly impacted by it — radiology, pathology, anesthesiology — where machines can start doing a lot of the work. And that’s kind of scary as well. And the virtual reality side in the surgical field is probably where it’s going to affect us the most. There’s a lot of software coming out where you not only can wear goggles and watch somebody, but you can augment reality to the point where the camera’s set up so that you feel like you’re standing in the operating room next to the surgeon, almost to the point where you want to reach over and tap them on the shoulder, but they’re not actually there. So that’s neat for training purposes, but theoretically, it can be extrapolated to more rural and even third world areas, where you’re walking somebody through a difficult surgery and you’re there to kind of guide them over their shoulder as they’re doing surgeries. That kind of stuff has a lot of potential value to expand the medical opportunities.
DF: You’re talking about robotics helping to perform a procedure. Have you seen anything happening where maybe a procedure can be performed remotely? With maybe just some local guidance?
SP: Yes, I’ve heard of the robotic side in the general surgery world. There’s some talk of that, where somebody could be in a different room — or country — where they’re seeing what the robot’s seeing, and someone’s in the operating room as a rescue. So that’s happening. Is it a switch where you’re doing it, and then the robot just tracks your movements, and then the next patient comes in… I don’t think we’re there yet. Some of the AI side may input in that at some point in time. I think there’s enough human error in the world that having AI looking over your shoulder probably has some value. We just don’t know where to draw those lines. It’s interesting. It’s a fun time.
DF: Some are calling it the Age of Innovation right now, because innovation is happening at the speed of light — especially in healthcare. What does Florida ENT & Allergy look like five to ten years from now, based on these things that you’ve seen coming out?
SP: We’ve talked about those types of timelines. And when we get into theoreticals, we’ve pulled back based on reality. At one point we were named Tampa ENT & Allergy, and we changed it because we did have a Florida vision. Does that mean that I’m covering offices in Orlando and Jacksonville? Absolutely not. But we do think that our model has a growth potential where people will see the benefit of being affiliated with us. And being part of this larger group, it’s kind of gonna happen indirectly. We have some internal efficiencies and benefits within it. We do foresee expansion of that model.
On the surgical side of things, we’re trying to push the envelope and be on the forefront of research studies and all the fun stuff that you can do on the healthcare side that makes it more than just seeing the same thing every day in the office. We want that, when something new comes along and a patient goes “have you heard of this?” We go, absolutely! In fact, we’re doing that. We never wanna be caught flat-footed. That’s kind of the main thing. Keep us slowly growing in an efficient way and staying cutting-edge with this technology.
DF: Do you think that the pandemic has given us a nudge in the right direction? I feel like, prior to this, there were still a lot of pencils and clipboards still out there, and now there are fewer and fewer of those today.
SP: Some places don’t take cash anymore. Maybe the penny will disappear, finally. I think most places realized that we have a lull here. What can we do to optimize less paper? Our system is almost exclusively iPad-based when it comes to medical records. And people can sign that way. If we can go to Mars, I feel like we can tackle paper.
Words of Wisdom for Healthcare Executives
DF: A few closing questions. What’s your favorite book that you would recommend?
SP: One that helped my work/life balance, probably Blink, my Michael Gladwell. I got tangled up between reading this and listening to tapes while traveling. It sucked me in. The way he looks at things is really interesting.
DF: What’s your favorite quote?
SP: “It is what it is.” A spinoff of that is “It takes what it takes.”
DF: What has the last year taught you personally?
SP: That there’s so much more than what I think is going on in my own world. I’m totally myopic in a lot of ways. Sometimes we think that things are more important than they really are. But being home, kids being out of school, out of sports, eating dinner together, it was weird. But I’ve learned to realize how to reprioritize things. And not just in terms of my family, but going around and seeing neighbors and people outside, and saying hello. It’s a better way to be.
DF: I agree. Final closing thoughts? What would you tell our listeners? Healthcare executives? Physicians? The floor is yours.
SP: From a physician’s standpoint, we all need to have a common voice. We really don’t have a singular voice to speak for ourselves and our patients. We’ve given a lot of that voice to corporate America and insurance companies. In order to have good, meaningful conversation with all parties, you need to have a united front. Having that unified front so that all parties have a voice where it all makes sense, just come together and make decisions that are sound with all parties involved.
Learn More about How Dr. Powell and Other Healthcare Leaders Are Shaping the Future of Healthcare
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