What You Need To
Know About The Flea That
(Metaphorically) Killed The Medical Center
A few days ago, a flea bit and killed
the CEO of one of the top-ranked academic medical centers in the nation.
Metaphorically speaking, of course.
And the lessons cut both ways for you
and your organization, whether it’s a medical group, a hospital, an ASC,
or any other sort of business.
In his book, The War of The
Flea, the seminal work on guerrilla warfare, Robert Taber wrote about how
a small band of guerrilla fighters could emerge victorious in a conflict with a
larger, well organized enemy.
“Analogically, the guerrilla
fights the war of the flea, and his military enemy suffers the dog’s
disadvantages: too much to defend; too small, ubiquitous, and agile an enemy to
come to grips with.”
In 2014, Ohio State University concluded
a national search for the new leader of its Wexner Medical Center by hiring
Sheldon Retchin, M.D. as its CEO. His salary? Close to $1 million per
Yet a few days ago, just three letters
signed by a handful of the 1,200 physicians that Wexner employs, triggered his
The first letter, dated May 1, 2017,
signed by only 25 physicians, raised complaints about Dr. Retchin’s
management style. According to a report in The Lantern, the Ohio
State school newspaper, the complaining physicians wrote they had “no
confidence” in Dr. Retchin’s leadership. The signers claimed that
more than 100 other doctors supported their position, but were afraid to join
in the letter.
The two subsequent letters were signed
by 6 physicians each.
Even assuming no crossover in the
signatories, 37 physicians (yes, some in positions of authority) out of 1,200,
that’s only 3%, were able to unseat the king.
Dr. Retchin, the front man for a high
and mighty organization, and, one can argue, the organization itself, became
the latest victims in the war of the flea.
What’s this mean for your
organization and for you, personally?
From the organizational perspective, as
in a guerrilla war, change within the organization, as well as within a domain
in which the organization interacts, can occur as a result of agitation by a
vocal minority. Just as no vote was required for a dictator like Casto to take
over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn
out process among “stakeholders,” is required to topple the status
What you think is permanent is only
temporary. How temporary is the question.
What you do, and how you do it, within
your organization, and how you project it to essential third parties (e.g.,
hospital-based medical group to hospital) is all-important in maintaining
relationships, contracts, and even existence. That’s the flea
And, just the same, from the perspective
of the individual, the small, the “out group,” the
“flea,” a steadfast, vocal, and somewhat intransigent minority, can
kill the dog. The large group can be made irrelevant. The hospital CEO can be
forced out. The small organization can ingest the larger. Yes, the dog bites
back. No win is guaranteed.
Many say that the world is a tough
place. Maybe it is, because it’s not just dog-eat-dog. In Dr. Retchin and
Wexner’s world, it’s flea-kills-dog as well.
Whether you’re the metaphorical
dog or the metaphorical flea, the same applies to you.
Wisdom. Applied. 103 - Why You Must
Know How Framing Changes Value
There is no such thing as fixed value.
Value determination is based on obtaining something worth more than what is
being given up. You can heavily influence how your perceived value by employing
the valuable technique of framing.
I was listening to a business podcast.
The host was interviewing a guest who said, "you can't step into the same river
twice." Wow! That's really Zen-like . . . or is it Zen-lite? (Note: I
pictured the guy with a man bun.)
On a level I imagine the guest never
imagined, that is, on the actual, not metaphorical, level, the one to which I
can certainly relate, he's absolutely correct. That 4 or 14 or 44 gallons of
water that rushed by my left foot in the Owens river will never be at X
longitude / Y latitude again.
But, if one can't step into the same
river twice, why is it that many people step into the same shit twice? After
all, the river of time has moved on, hasn't it?
Yes, each situation is different. Sure,
that's true. But situations often come in categories, and it pays to pay
attention to categories.
Maybe your now metaphorical wet foot
isn't in a river, just some other water that, this time, is circling
Keep your eyes open. Watch where you
Recently Published Blog Posts
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I’ve spoken at dozens of medical group events, healthcare
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governance, and succeeding at negotiations. For more information about a
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Mark F. Weiss
The Mark F. Weiss Law Firm, a Professional Corporation
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Success. Even more success. It’s
what you want. Welcome to the club, which appears to be getting more exclusive
every day, not due to evolution but to self-selection. Of course, sometimes we
get stuck, or at least delayed, by the problems that pop up, blocking the way.
But for many, the problem is that they don’t know what the problem is.
I’ve been working with medical group leaders with the aim of increasing
their group’s profits and managing their risk of loss for over 30 years.
Does that mean that I have all of the answers? No. But what I do have is a
point of view, a way of thinking about your success. So go ahead and start
reading now. No one is going to do it for you. Which, by the way, is thinking
tool number one.
The Impending Death of Hospitals
is available for purchase in hard copy or in Kindle format on Amazon or you can
download a complimentary PDF version here.
Having fallen for the fallacy that
there’s profit in market share, hospitals have gorged on acquisitions and
on employment and alignment of physicians. Many physicians have been willing
participants through practice sales and in the belief that there’s safety
in hospital employment. But it’s becoming evident that physician
employment leads to losses and that integrated care delivers neither better
care nor lower costs. And now, technology is about to moot many of the reasons
for a hospital’s existence. How can your practice survive and even thrive
in the post-hospital world?
The Impending Death of Hospitals is
available for purchase in hard copy or in Kindle format on Amazon or you can
download a complimentary PDF version here.
Some days, it seems as if
everyone, from anesthesia groups to vascular surgery practices, is talking
about selling their practice to a larger group, to private equity investors, or
to a hospital.
The reality is that some practices can
be sold, some can never be sold, and some have nothing to sell.
The reality also is that there are a
number of strategic alternatives to a practice sale.
A perfect storm of factors is
accelerating the market for hospital-based medical group mergers and
The healthcare market is changing
rapidly, bringing new sets of problems.
How can you find a solution, how can
you engage in the right development of strategy, and how can you to plan your,
or your group’s, future without tools to help clarify your thinking?
Directions is a collection of thoughts
as thinking tools, each intended to instruct, inform, and even more so, cause
you to give pause to instruct and inform yourself.
If you're an independent learner or need a refresher on a current
topic, click here to find out about our growing list of
Recent Interviews and Published
Mark's article Why Your Compliance Efforts May Be
Worthless was published in the Spring 2017 volume of Communique. Read or download here.
was quoted in the article ASC Regulatory Areas That Developers Need To
Pay Attention To published on Nov. 9, 2016 in The Ambulatory M&A
Advisor. Read or download here.
Mark's article OIG Advisory Opinion
Secrets and Strategies was published in the Summer 2016 volume
of Communique. Read or download here.
Finders keepers, losers weepers. Except in connection with overpayments from
Medicare, then it’s a violation of the federal False Claims Act leading
to significant liability—that is, unless you repay the overpaid sum
within 60 days. Read CMS Resets the Clock for Return Of Medicare
Overpayments published on AnesthesiologyNews.com in May 2016. Read or download here.
Mark's article A New Strategy
To Profit From Interventional Radiology, co-authored with Cecilia
Kronawitter, was published on AuntMinne.com on May 23, 2016. Read or download here.
Three of Mark’s blog posts were
republished as a column entitled Practice Challenges in the
Spring 2016 issue of the Pennsylvania Society of Anesthesiologists Newsletter,
the Sentinel. Read or download here.
Mark's article Is There An
Interventional Radiology ASC (irASC) In Your Future? was
published in the April/May 2016 volume of Radiology
Business Journal. Read or download here.
Mark's article Impending Death
of Hospitals: Will Your Anesthesia Practice Survive? was published in
the winter 2016 volume of Communique. Read or download here.