Achieving Stellar Performance by Aligning Employees with Goals

Wendy Fong

Thanks for having me Cheng.

Cheng-Huai Ruan, M.D.

Yeah, so, you know, we have been talking about so many different things on the summit and one thing that we just haven’t addressed yet is how do doctors work together in a practice? Especially if there’s multiple physician partners, which I have a lot of experience with as well. So, but let’s get to like the pain points first, right? So what do you think are the most common causes of like the biggest tension between partners?

Wendy Fong

So one of the biggest issues that I’ve seen is expansion, right? Whether people are interested in acquiring or expanding, hiring more physicians, there’s a lot of risk that comes with it. And most physician partners who have different levels of risks. So think of it as a continuum. On the one side, you’re extremely comfortable with the risk and on the other, you’re extremely cautious that actually creates a huge amount of conflict. And I don’t know that many physicians know that that’s, what’s stopping them. You know, you could have someone who is very gung ho about expanding or hiring or whatnot and then another partner who keeps, you know, bringing them, reigning them back in. And a lot of time they don’t know that that is exactly what’s going on. So, you know, sometimes it can be solved by more information. Sometimes it can be solved by self-awareness. Yeah, okay.

Cheng-Huai Ruan, M.D.

You know, that hits home for me. I’ve experienced this and I’ve seen other practices have it as well. And I would say that’s probably the most common thing ’cause here’s the tricky part about, I think the business of medicine, ’cause you know, you have a practice and the practice grows. And then the doctor ages with the practice and the doctor, some point in time gets either partners or gets hiring other individuals, right? And they’re, they tend to, they tend to be younger. And then another generation leader there’s even younger. Now you have like, almost like two and a half to three generations of doctors to the practice, right?

Wendy Fong

Exactly. 

Cheng-Huai Ruan, M.D.

And not only is there a generational divide, which we actually on another part of the summit, we actually had a boomer versus millennial MD discussion ’cause I’m a millennial, we actually talked about this, but there’s also, like you said, risk, right? And so the definition of risk is also very different between, you know, generations. And I think the other thing is that I think there’s a, there’s not a great culture of communication really between physicians, because we’re not really taught in a way we’re taught to see patients, you know, but are we taught them a way to get together for the greater good in terms of the business sense? No, because physicians are taught to always mitigate risks by sticking within a standard, right? 

Don’t go outside the standard of practicing medicine in there’s nothing wrong with that. But when it comes to the business side, it’s so different. And whenever I think about the different generational divide, but also not even within generations, you have different risks. You know, you could have one person who was thinking about going part-time next year and just wanna keep everything stable ’cause they want more of a family life. You have another partner is like, hey, I don’t have kids. I just wanna go, go, go, but let’s get more partners. But so that level of risk requires investment back into the company, how much money you wanna hold back in the company. And so, yeah, I totally understand the dynamics of risk, but I’m sure there’s answers to this, correct?

Wendy Fong

Yes, absolutely. So I’ll give you an example, I love telling stories. So one of my clients, they were expanding, they were creating a supergroup to bring on more doctors. And one physician in particular was more of a visionary. He was open to risk. He’s also maybe more financially stable, right? And the other ones were really not into it. They know that it needed to happen, but they were almost kind of stopping it or whatnot. And so we did a team assessment to understand why are these conflicts happening? And we found that, you know what, some of us are guardians. So what a guardian is, you know, you guard the process, you guard the current state, right? And some of us are innovators. And so figuring out everybody, having everybody agree on what the preferred future state is, is the number one solve, because then you can always ask, is this action going to get us there or not? If it isn’t, we don’t have to do it but if it is, then we need to talk about how we’re gonna get there. But if everybody has a different idea of what the future state needs to be, that’s the problem.

Cheng-Huai Ruan, M.D.

Yeah, but I find it really common that people are afraid of stating the future idea. You know, it’s like, you know, oh, I’m a younger doctor. I’m a little intimidated to ask my senior partner, hey, is this, this is where we should be going, or should we go this direction, right? And I feel like the actual communication between partners is not great, and that I think that comes from multiple things. And the one thing that really comes to mind and we have to talk about in those sessions as well, when it comes to burnout is the way that physicians are trained. 

So we got medical school and medical school or medical students, and we’re very like observant to the things that are around us. And then we see the hierarchy and the dynamics and the culture, not in a business, but usually in the educational institution, right? And so, and then we go into internship and we see the same dynamics and then we go into residency. So by the time we have residency, we’re like, oh my God, I’m so glad I’m not an intern. And I’m so glad I’m not a medical student. By the time you hit, you know, chief residents, I was like, you know, I’m so glad I’m not a resident anymore. And then it’s like stepping on the hierarchy and all of a sudden we’re attending physicians, we just look around I was like, damn, it’s pretty lonely up here, you know? But what we were taught is that there’s a rank and a hierarchy. It’s very militaristic, right?

Wendy Fong

And you feel outside the rank.

Cheng-Huai Ruan, M.D.

Yeah, yeah, but the problem with that is most, I would dare to say that most of the educational facilities in the United States who teach residents and doctors don’t have the best culture, you know, as well. And so we actually talked about this as well with Halee Fischer-Wright. Actually her book is right here, it’s called Back To Balance. And yeah, she talked about this. She’s the head of MGMA. How a lot of the culture that, that we were taught may not be applicable anymore, especially during the pandemic era, all right? And so here’s the question though, when I, and I tell you all this to say this since so damn ingrained into who we think we are, can we really change who we are? What do you think?

Wendy Fong

So science says that we’re pretty much who we are once we reach adulthood and that’s, you know, how we’re raised and genetics contribute to that, but we can certainly stretch and adapt. We are who we are, but we can learn to adapt, right? And that adaptation comes from knowing who we are in the first place. So if we don’t know who we are, then that’s the problem. But if you do know who you are, then you can start to see, oh, this is where I am kind of stopping the process or reigning somebody in. And what is it that I need to feel more comfortable about this expansion, about this new project or whatever. Maybe I need more information, then I’m gonna ask for it instead of not really knowing, but, and not knowing how to express what I need. Yeah, I definitely think we can stretch.

Cheng-Huai Ruan, M.D.

Yeah, so you said it best. I think, you know, how you have to understand, we have to understand who we really are. That requires some level of emotional intelligence we’re taught to avoid being physicians and we’re not specifically taught to avoid it, but we naturally do because of the lot of really messed up things that we see during training, during residency. And because of that, we acquire what technically are traumatic experiences. Or I like to call them little Ts or microtraumas, and these microtraumas turned out basically mold or subconscious state. So by the time we hit attendings, we’re actually being very reactive to these microtraumas that we don’t realize that that’s really there, which is the study of mind-body medicine. And so, but let’s talk about the emotional intelligence. I think you were calling it out before we started the emotional quotient?

Wendy Fong

EQ, right.

Cheng-Huai Ruan, M.D.

EQ, emotional quotient. So can you kind of define that and how do we, how do we increase our emotional quotient?

Wendy Fong

Yeah, so if you Google emotional intelligence or, you know, the, the most in demand soft skill, you know, today, you know, EQ will come up and it really, really consists of five different areas. So one is awareness, two is empathy, three is motivation, four self-regulation and five is social skills. And I would say that, you know, for physicians, because all of your training has been technical your entire life, you don’t really get any of that. Luckily, a lot of different residency programs now are including leadership skills and coaching into their curriculum. So that’s a great first step in the right direction. But the first step of these five things is self-awareness. So are we aware of who we are? Are we aware of how we are, are seen by others? Do we intimidate our, you know, employees we likely do, or do we, you know, avoid difficult conversations when we had? So that is the very first step is self-awareness.

Cheng-Huai Ruan, M.D.

Yeah, my gosh. I mean that that’s very complex on different levels. I think we need to really get into the books, literally books I have all over the place, mostly half read that really explore our emotional quotient, emotional intelligence, right? But I think, you know, this ties back into the first question is what are the most common causes of tension between physicians partners? And I think that we all try to look at what are our core values that we are and being doctors. A lot of times we find out that from an emotional standpoint, it’s the same, no matter if you’re talking about a 70 year old physician or a 30 year old physician for the most part. But speaking that same language and utilizing the core values of who we are and tying that into hey, what’s really risky here, right? I think that is probably the beginning of the key to unlock, you know, solving some of these relationships. But, you know, sometimes we find out emotionally that you may not belong in a partnership as well, so.

Wendy Fong

Yes and that is perfectly okay. People and people, or I guess partnerships, whether it’s personal partnerships or professional partnerships, they break up all the time. And for the most part, a lot of us get into partnerships without even knowing who our partners are. I have clients who said, you know, they started their practice 20 something 30 years ago. And they were employed physicians who just got put into the same office by, you know, some hospital system, right? And then they decided, okay, we’ve been working together for several years let’s just go open a practice together. They don’t know how each person will react because it was never their money. It was never their practice to begin with. So even though you’ve worked with somebody even for several years, when it’s your own investment, it’s different.

Cheng-Huai Ruan, M.D.

Oh my gosh it really is. And I think you’re right, because if you work with let’s, you know, we talked to two physicians on this, on this series where both of them started, you know, broke off from their previous practice. One was academic, the other one was another private practice. And they kind of, you know, said it enough is enough. But the idea here is that they were put together because of a assumed integration. And what I call assumed integration is that from a role of being an employee of either a larger hospital system or another private practice, you act as that and you get to be a physician to the patient. You don’t worry about your MA salaries, you don’t worry about, you know, who’s not coming back anymore after you go on vacation. 

You don’t worry abut all this stuff, but whenever you have microtraumas that hits your brain in a business setting than everything they’ve experienced since childhood starts being reaggregated if you will, from the subconscious side and that’s where things become really different, you know, and I see that all the time. And there’s one thing, and I want you to, I wanna know if you agree with me, ’cause I’m kind of putting them out there. And this is a statement that I had for a lot of doctors that if you get along with other physicians and they’re like, oh my God, they’re so much like me from the business sense, that’s a red flag because a lot of very similar personalities have very similar downfalls as well, right? An like you said earlier, you know, some of them are the guardians, protectors and some of them are the innovators, right? But the protectors and innovators generally don’t mend as well as the innovators with innovators together, right? Within a business, you kind of need both. Yeah.

Wendy Fong

Yeah. And people make that same mistake when they hire. So I do a behavioral assessment with my clients and sometimes I will go into an organization and give everybody the assessment and it turns out that the supervisor and their, all the people who report to them end up being extremely similar without ever having taken assessments before because we need them, we’re speaking the same language, you like the people who are like you, we, you know, they confirm your thoughts and feelings and they become fast friends, right? And so like, it’s the same with physicians. Like you said, if we get together with the exact same type of people who is going to, let’s say we, all of the guardians get together, who’s gonna innovate for us? Who’s gonna tell us, hey you’re 10 years behind. That technology is really old, let’s do something new.

Cheng-Huai Ruan, M.D.

Right, what assessment do you use? Are there multiple ones or is it just one specific one that you use?

Wendy Fong

So I use multiple ones, but my favorite is called the predictive Index because it takes about six minutes to administer. So it’s the fastest, you know, I know doctors don’t have a lot of time, so it’s the fastest assessment and it’s extremely accurate and the reports are short and they’re very action-oriented. So for example, in one coaching, I was speaking to a client and in the coaching report, it says, you know, you may, you may be seen as overly aggressive by direct report. And I asked him, is this something that you have gotten feedback about? And he said, the only person who’s told me that is my wife. And I was like, well, that’s because your wife is the only person who feels psychologically safe to tell you that, but know that this is something that they they see. And if you want to inspire the best out of your employees, that’s something that we’re gonna have to adjust.

Cheng-Huai Ruan, M.D.

Wow, that was, that was a good quote there, you know. Your wife may be the only person who feels like it’s safe to express that to you. And from a leadership standpoint, that’s probably, for me, that’s probably one, probably the worst thing that I really want to hear, because I really want everyone to be able to allowed to give myself feedback. And that’s part of our culture, you know, one entire day a month. I mean, there’s no one on the phones, we have our whole staff and we just do culture training to the highest degree. And, you know, I’ve tasted the pain point of being that really aggressive type of leader. And I never wanna feel it again. And that really came from when I first started the practice. It was six weeks before Hurricane Harvey hit Houston and all of us and all of a sudden, we’re like, oh my God, we have no volume, we have nothing coming in for a while. And then, so, and I realized that I, I turned as my dad a little bit, or, you know, my dad is the product of the cultural revolution in China. 

So I went to like aggressive war mode and then probably created some more traumas than I actually helped out the of company. But from that, from that pain point, I think I learned quite a bit. And that’s why, you know, dedicate an entire day. So a lot of other physician colleagues, was like, oh my gosh, you put a whole day into like, culture training? Like, you know, how much money are you losing? I was like, well, let’s put it this way. It depends on what you, what you value. Because if I value eventually scaling the company, I’m not gonna lose a dime. Like, it’s all about, you know, getting the people together for the common purpose. So what do you think are the, the elements within a practice or any business really that allow a practice to, to empower leaders actually within the practice, a lot of them to grow, what do you think are the, the main elements?

Wendy Fong

So I am a huge fan of Patrick Lencioni and I really believe in his, you know, five dysfunctions. But the number one I would say is accountability. so I know there’s a lot of accountability in medicine in itself, right? You have, you know, boards where you review cases and things like that, but when it comes to behaviors and maybe talking about it at as long, once the science part leaves, you know, and the behavioral or feeling part, you know, come in, that’s something that generally people, not just physicians, but people, I see a lot of engineers who don’t really wanna talk about it, but they don’t want to have to hold someone accountable.

Cheng-Huai Ruan, M.D.

Do you think that that comes from a lack of emotional intelligence from an emotional quotient? Or what do you think it’s from?

Wendy Fong

I think people are afraid of what the result might be. You know, will this damage my relationship with this person? Think that they have grown up in a hierarchical sense, right? And so you don’t really, you don’t really speak to your, whether it’s your elders, your superiors, or whoever that way. And in order to have a practice that can hum right along, you’re gonna need to have a lot of trust and a lot of accountability. And that means being able to, you know, tell your superiors, hey, look, you know, I didn’t really appreciate, you know, X, Y, and Z. This is what I, you know, would expect out of our relationship. And, you know, because that’s something that we can work on.

Cheng-Huai Ruan, M.D.

Yeah, absolutely. I’m gonna give you a few examples. And before we came on, actually, I always go to Facebook groups, especially private practices physicians in Facebook groups, ’cause every pain point is steady in there multiple times a day. But the one recent one that I just saw was in a private practice physician Facebook group, there’s about 70,000 doctors in here since it’s a humongous group. And there’s one talking about, you know, I don’t know what’s wrong with my medical assistant. Like, she’s the only one that like, wouldn’t give me coffee. You know, I’ve seen 40 places a day. And she knew that, you know, I was too busy to see in between patients, should I fire her? Tell me what you think about that. Must be something ’cause you’re laughing.

Wendy Fong

Yeah, I mean, is it in her job description?

Cheng-Huai Ruan, M.D.

Probably not, exactly.

Wendy Fong

Would you prefer your medical assistant get coffee or to take care of your patients? You know, I think having been in practice management for gosh, almost 20, I’ve sort of seen it all, you know, people who send their medical assistants out to get dry cleaning, to drive their kids around. So I’ve kind of seen,

Cheng-Huai Ruan, M.D.

Drive kids around?

Wendy Fong

Yeah, go pick up the kids.

Cheng-Huai Ruan, M.D.

Really?

Wendy Fong

I would say that, you know, if you are an enlightened physician and you can understand, so it goes back to the emotional intelligence part, right? And you can understand what motivates your employees, your employees are, chose this profession because they want to help people. And if you are asking them to do something that prevents them from doing their primary job of helping people to run errands for you, that that’s not really, I mean, get an assistant, get a separate assistant to do that.

Cheng-Huai Ruan, M.D.

Absolutely, I agree with you. So the first thing that you said is it in the job description? So I think for physicians, we by nature already assumed their job description is to like, get things done as much as we can to see patients, right? And whether that means, you know, using other people to, for us to fuel coffee to see other patients that’s, it’s war mentality, you know? We’re not in a war and we’re in a team building process, you know, setting up those expectations as well as boundaries and boundaries for yourself too. That’s very important. So last night because of coronavirus and because of the new billing systems and codes and telemedicine, I read every single word of my employee handbook. What’s ours is actually digital and it took me about four and a half hours.

Wendy Fong

Wow.

Cheng-Huai Ruan, M.D.

Yeah, and so, yeah, I hadn’t seen this since 2017. And yes, I have an employee handbook. I know a lot of practices don’t, but I’m very detailed about what really should happen in every situation. You know, what happens when someone gets pregnant, what happens when someone’s breastfeeding? It’s all in there, right? And so I actually created this for our residency program in New York Presbyterian Queens. So I see just basically translate a part of that into a portions of the handbook. But I read every single word. And part of it is from our previous PEO company, which is ADP when we first started, we’re no longer with them anymore. And so I was reading and I’m like, man, a lot of this is like, it’s like don’t do this, don’t do this, don’t do this, don’t do this, don’t do this, right? And every time I read a news section of don’t do this, I get, I get scared. I’m like, oh my God, this is like, my employer which technically is myself. 

So I read it in the format of, I am not the owner of the practice that I am an employee coming in as a medical assistant or coming in as a janitor, okay? And then I’m reading this and how do I really feel? What is the overall feeling of this? And I didn’t really feel good about it. And so we were definitely changing it up, but I realized that this is like a standard process. I think the standardized process of, you know, you know, don’t sexually harass someone. Yeah, wanna understand not to do that, but what the things that we do do to support our company culture and that’s not really in there. And so, and in there, I didn’t see anything about getting coffee either. So, and I, and there’s, there’s a section in there that I decided I wanna put in there after I speak with my staff is how do we show each other love and connection within a practice, okay? And do you want to buy coffee for people? Well, that’s fine, that’s fine. You know, by itself you play Bible college for you, but you know what, we will reimburse 80% of that by the end of the year, if you want to, that’s totally cool. 

So those are sort of the rewards systems that, you know, we were looking at. But the whole point of saying that is you got to set up expectations for your partners, for your superiors, for your C-suite, for your janitors, for whoever it is, right? Because you know, every employee has an understanding that something drives them. There’s a reason why they’re actually there. And you know what, in some of these MAs part of their, their reason may be to help you get coffee. And that’s okay because they’re either they’re very motherly or very fatherly and they wanna express a love to you. I have to have two that, that do that very regularly for me. Is it the job description? No, do I think the hell out of them, every time they do it? Absolutely. You knows, I’ll say hey, you don’t really have to do this. It’s like, well, just take it, like thank them profusely, right? And so we don’t see enough of that.

Wendy Fong

I don’t see enough of, so I have one client who is a physician and every time I go to his office, he runs to Starbucks and asks me what I want. And then he’ll buy Starbucks for our, you know, everybody in the meeting, right? And we think, well, why aren’t the MAs getting me coffee? Well, you can change that narrative. Why aren’t good doctors getting me coffee?

Cheng-Huai Ruan, M.D.

Absolutely, absolutely. It’s about the language of gift giving, right? So, you know, and I think the other thing is it’s okay to show love and connection professionally. In fact, it’s, it’s probably best to do so from a leadership standpoint.

Wendy Fong

Yeah, and I would say back to your example of the handbook, maybe instead of, and I do understand that comes from a very detail place where you really like structure and formality, but part of the work that I do with organizations is defining the core values and then defining what behaviors are positive for those core values and what we will reward. And so it’s, instead of not doing something, it’s like, we’re gonna reward you positively, if you, when you do X, Y, or Z so that you know when someone is not acting in the way that, you know, the, the organization has set, then it’s really easy to pick out that one person who’s not, you know, behaving in that way.

Cheng-Huai Ruan, M.D.

Yeah, and a lot of physicians also kind of come to me and say, hey, I have this person who does this and just not, it’s just like, it’s like the one person that doesn’t really fit, right? I’m scared of, you know, getting rid of him or her. And, you know, and I tell a lot of docs. It’s like, well, you know, first did you, did you try to resolve the problem? And if you did, then why is that person still there? And the lesson here is you get what you tolerate. And if you, the more you tolerate, well, you know, it’s insane to think something different is gonna come out of it as well. But the first step is to have that level of emotional intelligence to solve the problem, which is through speaking, right?

Wendy Fong

Yeah, and you know, I do think that sometimes people are afraid to look for that future state, like, you know, this is my right-hand person, if I lose them, you know, all of these things aren’t gonna be done and it’s gonna cause me to be behind. So I’m gonna, even though I’m only happy about 20% of the work that’s enough, you know, and they’re afraid that of what might happen. And I’ve actually had to convince so many physicians that hey, we need to make a change. And that’s a process. That’s a process, right? And then once that change happens and somebody new comes in, they’re always happier. Nobody ever regrets having moved someone on. But it’s just that first step what’s preventing you from taking that first step?

Cheng-Huai Ruan, M.D.

Yeah, and again you’re so right. I think a majority of what I feel is preventing most people from the first step is the abilities for them to understand it’s okay to talk about it because, you know, from a, I see a lot of doctors do this to their owner of a practice. They push a lot of stuff on, onto the office manager, right? Or in my case, my director of operations and strategy. So because someone stuff is pushed off the doctors like, no, I just wanna, I just wanna be a doctor for like a week. And I don’t wanna think about this and can you handle that And they’re like, okay, we can handle that. But you know, that comes with his own pain points too, is that things become invisible. And when things become invisible, then the culture of the practice ultimately changes. And then the quality changes. 

And so then all of a sudden you’re getting, not as many good five star reviews or any five star reviews after a while. It’s because it trickles down into the patient care. and that’s pretty detrimental in its own. And I can’t tell you how many times a lot of doctors come to me and they say, you know what, you know, I get good reviews like myself, but you could see most of these one star reviews, that’s my staff, the doc, one star that doctor is fantastic, five stars, but the one star is actually for this one front desk person that may or may not even work there anymore, right? And so that comes from the leadership side. And I think there’s certain things that you can’t push off to other people and some things that you can, but it’s got to be able to find that balance, you know?

Wendy Fong

Yeah, and I, yeah. And you’re right, that, you know, sometimes people are blind to it until someone comes in and makes the change. and then you’re like, oh wow, why didn’t I see this before? One example that I have is, you know, when I worked at a neurosurgery practice, we had affordable patient satisfaction and we had front desk employees who were extremely rude. You know, it was back when, you know, you walk into a doctor’s office and they’re like, driver’s license and insurance card, you know, there’s no greeting, no anything. And so I turned that around, raised the standards and people self select out. So I didn’t really even have to fire that many people because they were like, okay, this person cares what we’re doing and I don’t wanna have to do that so I’m gonna leave, right? And so after about six months, a cancer patient, you know, came for a visit and the neuro ONC asked me to come out to the clinic. 

And I thought there was a problem ’cause I’m only called when there’s a problem. And I came out and the patient said I don’t know what you did to that front office, but I wanna tell you how appreciative I am. I used to dread coming to this office because of how the front office was. And I was floored because I hadn’t kind of thought about it from the patient’s perspective in that way, because I usually don’t care about people being rude or, you know, but can you imagine the cancer patient coming into a neurosurgery practice and dreading coming in because of, not because of the treatment that they have to do or, you know, the prognosis or anything, but because of the attitude at the front office. And so it was very impactful for me to kind of get that feedback.

Cheng-Huai Ruan, M.D.

Yeah, no, that’s super impactful because if you look at a lot of the clinical studies, especially cancer patients, as it turns out the more times and the more touch points they have with practitioners and offices, the longer they live independent of what treatment they’re getting. It could be on a very natural holistic treatment, or they’re on chemo radiation. It’s completely independent of that. There’s a number of touch points. Same thing in speaking of neuro same thing with dementia. As it turns out, mortality is better for, and outcomes are better for those with Alzheimer’s disease if there’s more touch points between a doctor and the patient. 

Once again, independent of treatment, because actually there’s, there’s no medicine that cures dementia, right? And look, let’s look at hospice, which I think hospice is probably the best imperfect system in medicine in the United States. If you take a look at hospice, all it is is about touch points and customer care and connection, right? And those people with stage three and stage four lung cancer have better mortality outcomes in a hospice setting than they do getting aggressive treatment as well from either surgical chemo or radiation, right? So the power of the placebo is really high. It’s that if people believe that they’re better in something and that they’re being cared for, their pain skills are better, their depression score starts to decrease and you’re literally like improving patient, not just improving patient outcomes, but actually prolonging their lives and improving their quality of life. And that’s the whole reason why we went to practice medicine in the first place and actually starts with, like you said, raising your standards and understanding that there’s an emotional intelligence that’s needed to set the standards.

Wendy Fong

Well, you know, mediocrity, which unfortunately our healthcare systems promote right now.

Cheng-Huai Ruan, M.D.

Yeah, and I don’t think it’s intentionally promoting, I think it was kind of set up this way and this is, you know, the whole different reasons, a lot of bureaucracy into it. But I do think that there needs to be more physician leaders within the higher levels of institutions in the C-suites and the institutions that do have that have, you know, great outcomes as well. What’s a quarter of them are actually on the summit. So, which was fabulous. And then the other thing is, I’m gonna throw women a really big applause here is that as it turns out that women physician leaders tend to have a much higher outcome and satisfaction within the company culture as well. So, you know, women, don’t more luck than the men. My wife agrees with me on that one. So yeah, so we’re heading, we’re definitely heading towards that direction, but anyways, God, we’ve talked about a lot about, you know, examples and doom and gloom, but let’s talk about some, some really cool stuff here. All right, this is what I wanna know. And this is a, that’s sort of the stage in my career as well. Where and when should I start looking for partners to join the practice?

Wendy Fong

So if you’re looking for a partner, I would say, you should be on the lookout all the time. And you would know if you don’t, you know, I think once you start your own practice, you kind of know, oh, I don’t like to be the sole person making all of the decisions. I like, I’d like to have comradery, right? And so I would say the minute you start feeling that you need to be looking out for it because it’s gonna take a long time. Sort of like dating you, you have to kiss a lot of frogs to find the right one. And then I would say, how do you find the right one? You have to find someone who can compliment you. Someone who is totally different than who you are, so that you can balance each other. So that someone, when you have an outrageous idea, they might say, hey Cheng you know, I think we should look at, you know, actually study this before we kind of jump off the deep end into this investment. And then on your end, you could say, you know, I know this might be, this might seem risky to you, but I’ve done the research on this and I really think it’s a good investment. And building that trust between the two is really gonna help both partners realize I really need this other person to have the 360 view, yeah.

Cheng-Huai Ruan, M.D.

Yeah, so wonderfully stated. That takes time, you’re right.

Wendy Fong

It does it does and you’re going to, like I said, kiss a lot of frogs.

Cheng-Huai Ruan, M.D.

Yeah, absolutely. I, you know, I found actually the perfect person in 2019, she’s actually part of our team now, which is wonderful. And it just kinda fell into my lap. I literally just put it out there on LinkedIn, but then I, and it was so refreshing how different she was than I am because she always made me think twice, right? And she continues to do so and I so appreciate her for it.

Wendy Fong

That’s amazing though, that you recognize that and you appreciate it as opposed to, you know, being like, oh no, my idea is the best idea, right? So I mean, you have to be self-aware enough to know this person is challenging me to do better, to do more, to do differently.

Cheng-Huai Ruan, M.D.

Yeah, absolutely. I think you’re absolutely right. Is there a way to, I don’t wanna say to do it faster, but you know, in terms of like growing and scaling a company, and then once you set everything aside, okay, it’s time to add more clinicians to the mix, right? But is there a way or some assessment or tests that can let me know who’s probably the best possible candidates and just put it out there?

Wendy Fong

Yeah, so I actually, so part of Predictive Index has a profile tool and it makes you really think through who is it that I really am looking for? Am I looking for, you know, someone who likes to build relationships? So let’s say you are in a, you’re pediatrician and you need physicians who might be better at building long-term relationships with their patients than surgeons who might only see their patient once or twice, right? And so there’s actually a way to assess all these so that you can see who’s the best match for your culture. I’m not saying that a physician or a pediatrician can’t be introverted and vice versa, but each organization has their own culture. And if everybody in your, you know, organization loves to hug and talk things out, and then you have the one person who doesn’t, they’re gonna feel kind of left out and you have to be aware, I’m not saying not to hire them, but you have to be aware of how can I make this person feel included?

Cheng-Huai Ruan, M.D.

That’s hard. I’m the huggy and talkie type. And so is my two of operations. But my manager, she’s quite the opposite and she’s very like let’s just get to the point. Let’s just do it, like there’s no hugs here. And a lot of times, a lot of times I put a timer on my watch and it beeps me. I’m like, okay, well, like Christina, what do you think? You know? And then I was like, no one talk until she’s finished. And I think that process over the last four years has really brought us a lot closer, you know? And then now she’ll stop. I was like, it’s like, just stop for two seconds. Let me just think this over real quick which is really nice. 

I really enjoy that within our organization. And, but you know, it wasn’t always like that. It took a lot of pain. It took a lot of pain from me and to get rid of my limiting beliefs of what I was taught from a Chinese cultural standpoint, from immigrant standpoint, to what it really takes to actually develop a team that we can sort of accelerate together to go in the future. And now I think, you know, we’re, it’s time to just keep innovating, but 10% and 90% I’ll make sure that our process is nice and documented which is exactly why I went into our employee handbook because that’s very unlike me to read details in employee handbook, but I specifically have structures set up for myself or I make myself think like my other teammates and what would they would think. And I think because the actions are actually do that and a lot of them know I actually do that, they really appreciate it as well as they, well, you know, thanks for doing that. Very totally uncharacteristic of you. I was like yeah, you know, I try to do my best.

Wendy Fong

And you are showing them, you’re modeling that behavior. Like, hey, I wanna know what it’s like to be in your shoes, you know, as opposed to just expecting coffee, you know, not realizing, but I have 15 calls to return. What is, you know, more important to me, right?

Cheng-Huai Ruan, M.D.

Yeah, yeah and you know, on the other side, not, about the coffee scenario, you may have the opposite problem where an employee actually, after they clock out, they keep working, okay?

Wendy Fong

I have heard a lot of that.

Cheng-Huai Ruan, M.D.

I think that’s, that’s just as not so great is, is because you have someone that, and, you know, I hire people who have been in the military, people in the military that will clock out, but all just keep going because they just wanna make sure everything’s done, you know, sort of a yes, sir and they won’t say a word. And until I asked, I was like, I saw you send me a message at 6:44 PM. And I saw you clocked out onto our app. I’m like, why are you still working? Stop it. And I think that’s that level is something that I think physicians almost expect out of people if their head MAs are kind of doing that, you know? And so, and that’s, I think that is another boundary, but can you kind of talk about that dynamic and what do we do about that dynamic?

Wendy Fong

Yeah, so, you know, you are absolutely right. There are people who gravitate towards medicine because they wanna help people. And just because I tell them, hey, we can’t have too much over time, so everybody, you know, make sure you say within over time, they’ll just clock out, right? And that doesn’t help me because it doesn’t tell me how much work is actually needed to support this practice.

Cheng-Huai Ruan, M.D.

Right, exactly.

Wendy Fong

You’re giving me secret free work which I don’t want this also illegal. So, you know, but I also think that part of it is how we model that to our employees, because you know, there is a very much a hierarchy. And so if your doctor is emailing you at 10:00 or 11:00 PM at night, you might feel, you know, the real need to respond because they’ve emailed you. And so one thing that I’ve actually set with my clients is let’s have group norms. You know, nowadays in our email, it just, you can set it to send later, right? So talk about not texting MAs, you know, after hours, not emailing, if it’s something that and who it’s okay. So we agreed that okay, well for the partners is okay. Anytime is okay because we’re business owners, whereas, you know, the next level down, we really don’t want to do that. And so, because we know that they’re gonna put in the work if we send the email. So we agree as a group that we’re not going to and we’re gonna just delay the send until Monday morning. And so creating some of those structural boundaries is actually really helpful because some of us can only catch up on the weekends, but we’re not intending for our MAs, our office manager or whoever to work on the weekends. It’s just, we end up frequently, you know, kind of starting that process.

Cheng-Huai Ruan, M.D.

Yeah, it’s true. Man I’m so guilty of that. I do really do email at midnight sometimes.

Wendy Fong

Too late then. 

Cheng-Huai Ruan, M.D.

You know, so I put my daughters to bed at 10:00 PM and it’s really two hours of good work. And then I’ll also wake up at 5:00 and send more emails sometimes. So I’m guilty of that. But I recently started using this platform, this email platform called superhuman. Actually I, another summit speaker is the CEO of that company, but I can set when it actually goes out now. And so I’ve set up times for, it’s called email delay times. And I didn’t realize that you can actually do that within Gmail now, that’s, that’s.

Wendy Fong

In Gmail and Outlook.

Cheng-Huai Ruan, M.D.

Outlook too yeah. Yeah, I used to use Outlook to do that, but now I’ve, when I say now I’m literally on what two days ago, I’m like okay, I’ve decided to create this structure and it’s because that was when I interviewed Rahul the founder of the company. And then I’m like, okay, I need to have much better boundaries when it comes to communication. And I know that my email is going to my operations director’s Apple watch. And as, and I’ve told her for three years now, I was like, you guys stop responding to me. I’m just doing this so I can have time to take my girls to school in the morning ’cause otherwise I can’t, that’s why I’m doing this at midnight, right? Well, so I don’t want you to look. She said I can’t help it. And so anyway, but you’re right. I think setting up boundaries like that and setting up the norms and, you know, knowing me, it’s something that I would actually put into the employee handbook.

Wendy Fong

Say do not check your email before 8:00 AM.

Cheng-Huai Ruan, M.D.

Yeah, and you’re not expected to, and it’s counterproductive, but I never thought about what you just said earlier is that, hey, you know, if you’re giving me extra work, I don’t know how, what my actual overhead is to run this for the actual company. And then that may be very detrimental. Plus if that employee ever leaves, then I didn’t realize this employee was doing the job of like one of 1.75 people, right? And that hurts a whole lot more as well. So, but yeah, no, I think you’re, you’re absolutely right about that. But anyways, so one last is I’ve kept you for super long. One last question is, you know, you’ve worked with practices now. And do you think there is just one thing, like one maybe small change that a practice can do to improve the dynamics between the employees and the physicians within the practice?

Wendy Fong

Empowerment.

Cheng-Huai Ruan, M.D.

Oh, good one.

Wendy Fong

I mean, no, I mean, it’s just one little word or one big word, but it’s a lot of work. I think if sometimes when our staff make a decision, if we bite their heads off, because it’s the wrong decision, they’re not going to make any more decisions and it’s going to keep pushing more work onto the office manager or the physician. And I really love the service model where I believe it’s Four Seasons, but they allow even the janitors to spend up to $2,000 to make something right for a client. Now, I don’t know if they’ve changed that policy since I’ve read the case study or not, but that’s, that’s empowerment. 

That’s saying you have the power to make it right. And you don’t have to ask 10 people up the totem pole before you can satisfy this customer. So, you know, a lot of times I’m sure, you know, this patients call in and then they’re like, oh, we don’t have any appointments available. Well, let me ask to see if you can be slotted into this spot, right? And then they have to be on hold and have to ask someone else to get approval. And then they come back and say, okay, like what if, what if we allow our, you know, we first we have to train our employees what it is that we want, right? But once they get that, what if we allow them to actually make decisions? How will our customers or clients or patients feel? They’re gonna feel like, wow, this person that I called really tried to help me out and she solved my problem or he solved my problem and I really appreciate this practice. So I will say empowerment of employees at all levels.

Cheng-Huai Ruan, M.D.

Yeah, no, that’s huge. And I actually experienced that during coronavirus and we, we set up policies on my schedules. Like here is eight slots that’s open, it’s only four people on the same day if there’s symptomatic for coronavirus, right? And that really was, I mean, it’s just very appreciative by the patients. I think the staff really enjoyed that level of structure. Like they knew what they can do. You’re right in that it’s one word with a lot of different meanings, but it’s also one word with a very simple action is set up structures to allow your staff just scheduling, just scheduling alone is massive. And the people are gonna actually gonna see more smiles, you know? And in fact, I think a lot of the people actually I’ll tell you this from, so from my practice Texas Center for Lifestyle Medicine, a lot of the doctors that we actually send our patients to already have that structure within their practice. So, and they actually tell me about it and say, hey, just tell the patients to say this and this and this, my staff will set them up. I’m like, oh, thanks. And they actually get a lot of referrals from us ’cause like, it’s not like they’re doing anything different per se, than anyone else, except the customer service is outstanding, you know?

Wendy Fong

And you make it easy for the patients. They are getting easy service. They don’t have to try to advocate for themselves. You’re already doing that job for them.

Cheng-Huai Ruan, M.D.

No, absolutely. Absolutely, well, we’re gonna close it off, but hey, how do people find you? Because you’re a very knowledgeable person and we gotta get more of you. How do people find you?

Wendy Fong

Yeah, so my business name is Chief Gigs right here behind the wall. And you can go to chiefgigs.com to look me up.

Cheng-Huai Ruan, M.D.

Thank you so much. And I’ll tell you that whoever listens to this whole thing, got a big treat in huge lessons, huge, huge lessons. And if you apply even one or two of the things that we talk about in this, it’s absolutely gonna change your life, is gonna decrease your burnout and improve your relationships and that’s what it’s all about these days, all about relationships. So, yeah. All right, thanks everyone for watching. Thank you, Wendy for being on the summit and we’re gonna sign off. Thank you.