Keith Pitchford, DO, 48, an orthopedic surgeon specializing in sports medicine, is the president and CEO of Great Lakes Orthopedics & Sports Medicine in St. John, Ind., and is the medical director for the Sports Medicine Institute in Crown Point, Ind., a joint venture athletic training, treatment and rehabilitation center with St. Anthony Medical Center in Crown Point. Dr. Pitchford, a gregarious practitioner who engages his patients and is popular with local athletes and their coaches, says in building his practice he took to heart the "Three As" taught in medical school.
"I accepted that affability, availability and ability would help make me a better and more successful doctor," Dr. Pitchford says. "It's pretty basic stuff, but it's true. If you can be affable with your patients, they'll open up to you. You have to be available when they need you and able once they test you and you measure up to the demands. But that's just the jumping off point."
He says it's crucial to have a well-defined mission and to hire and train an office staff that understands the mission that the practice must be patient centered.
"Patients come to our office hurt and frightened. They don't know if they'll play sports or work again," he says. "We have to shepherd them and try not to corral them to a recording when they call and try not to make them wait except for emergencies."
And in building his practice he wasn't afraid to refer patients to other specialists.
"You can't have the hubris to think you can do everything," he cautions. "If you can't help a patient, send him to someone who can. Some doctors think if they refer patients to other specialists, that they'll never come back. That's wrong. If you can't help patients in need at all, then they're lost to you forever. But if you help them, they'll see you as at the go-to guy. Not having an ego in that process is very helpful."
Dr. Pitchford says some physicians create problems down the road by failing to explain the proposed course of treatment in plain English.
"I think people appreciate that I try to explain things well. While it's true patients possess different levels of education and understanding, I believe the more that patients know, the better they'll do," he says. "Almost everyone is capable of understanding the segment of information important to them. And they're motivated to learn it. The fear of the unknown is always the worst thing. Reality is never as bad as what's anticipated. If you can help patients to understand what's going, it diminishes fear and establishes a relationship of trust."
Here are five critical steps he took that helped grow his orthopedic practice.
1. Trust your judgment. "When I completed my fellowship in sports medicine in 1995, I joined a big orthopedics group," he remembers. "But they didn't have a business sense and ran the practice like it was the 1950s. It was very top-heavy and our overhead was impressively high. The first decision I made was to structure my compensation as performance-related. Rather than taking a big upfront guaranteed salary, I chose to incentivize it through bonuses. My compensation was determined by how hard I worked. I went from the brand new guy to the number two guy in nine months.
"They were so overwhelmed by the size of my bonus that they couldn't pay me at once and had to pro-rate the payments," Dr. Pitchford says. "The following year it became even more of an issue. I had this huge pile of money they owed me. Some time earlier I decided this group wasn't working for me. I thought I had a better idea for a more efficient office. So when I left they paid me monthly installments for more than one year. I used that as seed money to start my own practice and because it was paid to me in monthly installments, it was like I'd been saving it all along. It boiled down to control and once I left I finally had the input to make those things happen."
2. If you can, live in the community in which you work. "The best decision I made was to move back to Northwest Indiana. I could relate to the people better. I've seen many doctors who live in Chicago and commute to work here. It's like they're not invested in the communities they serve, like they don't want to belong here," he says. "But if you live here, you see people, you become part of the church and the PTA and a member of the community and people see you. It reinforces the brand and heightens your visibility. And living in the community also encourages you to do a good job ... People see you at the grocery store and it keeps you on top of your game every day. If don't live locally, you may have a level of anonymity and it may give you a shield, but you're viewed differently."
3. Reinvest in the practice. Instead of taking it all out, Dr. Pitchford says he socked his profits back into the practice, eventually building a new facility, adding therapies that better served patients and investing in a talented staff.
"We've all been to doctors' offices that look like grandpa's back storage room," he says. "Crowded waiting rooms. Inaccessible doors. It looks bad, like the doctor doesn't care. But if you invest back into your practice, patients see that you care and take pride in the physical plant and by extension, your practice."
4. It's better to build a bridge than to burn one. Dr. Pitchford has chosen to collaborate with nearby St. Anthony Medical Center on the Sports Medicine Institute because he says it's important for a physician to ally with larger entities. "St. Anthony's has been consistently reasonable as hospital systems go and it's better having them inside my tent working with me than outside working against me," he says. "My decision was to work with the hospital. In the scheme of things it's vital to have good relations with the big players in your market."
5. Practice your profession well or somebody else will. He advises orthopedic surgeons to stay current with the latest procedures, not just to successfully compete with others in the marketplace, but for survival.
"Like Warren Buffet said, don't be the first to buy the stock or the last to sell it," he says. "You need to be willing and able to perform new, tested procedures, or have a good reason not to if you won't. It pays to explore them and read the journals and take the classes. I've made it a point to go to courses to learn new procedures. They're not cheap and they take me away from my family and practice. But you need to become an expert on new procedures as they hit the horizon and stay abreast with trends in your specialty. You can't just be competent. You must become proficient at those procedures."