Manage Your Practice Strategy

How to Avoid a Common Strategy Problem Any Dog Would Know

May 16, 2022

Hot dog!

In English, we have a number of dog expressions all of which are interesting idioms but one of which, in particular, is instructive for medical group leaders. No, it’s not to “avoid dogs” (which, by the way, is culturally insensitive to dogs . . . just kidding); it’s to not let the tail wag the dog.

For readers for whom English is not your native language or, for some, not your 2nd or even your 3rd, the expression means to not let things of lesser importance control something of greater importance. As such, what appears to be a silly saying packs a lot of meaning into a few words.

Why then do we see medical group leaders pursuing, sometimes at great expense in time, effort, and money, things which clearly are “tails” wagging the entire group’s success, or even existence, i.e., the dog?

For example, take Pulmonologists of the Upper Peninsula (“PUP”), a group providing services out of three offices, each located near a hospital campus. Duke, PUP’s leader, gives one physician, Dr. Boots, an exception to the group’s hard and fast rule that all employed physicians must devote their entire professional efforts to the group’s business. Why? Because Duke doesn’t want Boots to leave. Yet, Duke hasn’t factored in that once an exception has been granted, it can quickly result in jealousy, anger, and a slew of additional requests, no, demands, to permit others the same “kindness”. The group becomes unstable. Why risk the group to, perhaps, save the relationship with one physician? What other ways were there to save the relationship with one physician if it should be saved at all?

Or consider, Spike, a former sans-medal Olympian turned orthopedic surgeon, an otherwise control freak who’s fixated on creating a joint venture with a not-for-profit hospital. But why, one might ask, when nearly any joint venture with a not-for-profit hospital will result in lack of control? Is it to “have” one? * What is in Spike’s actual long-term interest and is it really advanced via a joint venture? How might it be better advanced?

The takeaway here for you is that it’s essential that you first consider what’s most important for your group’s success. What truly drives that success and is what you’re considering minor, or at least minor in relationship, to it. What decisions should be subordinate to overall strategy and success? What seemingly small decision might upset the larger strategy or success? What seems to be important, but, actually, isn’t?

The corollary is that significant business decisions can’t be made in a vacuum. No decision of any import can be made piecemeal. Almost every decision must be made in the context of the group’s overall strategy. As I like to say, “it’s all related.”


*This issue is by no means particular to medical group leaders; it’s a management disease that runs across professions and industries. Years ago, my firm occupied the 17th floor in a building in Los Angeles. Another firm occupied both the 16th and 18th floors. The managing partner of the other firm asked to meet with me concerning swapping floors with us so that their two floors would be contiguous. When we met, I asked him why that was so important to him and he said that he wanted to put in an open staircase between the floors, something that I knew might cost close to a million dollars. I then asked him why an open staircase was so important to him, and he burst out, almost screaming, “because the office in New York has one and I want one too!”

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