Landmark or Landmine?

Lately, my most enjoyable consulting time spent with my clients has given me cause to look back on all the events in private practice during the last year. Lots of what I first wrote about in “Practice by Design” (Miami 2007) “Commanders of Change™” (Marina Del Rey 2008) and Impeccable Systems” (Boston) 2009 has come to pass.

Future Shock is here, and as Toffler observed, may very well be modern mans most serious psychological affliction. Now, we are on the verge of a major dismantling of the doctor patient relationship by politicians and the greatest victory for health insurers, ever.


What now Mr. President?

Two years ago members recently so poignantly asked me “John, you keep talking about all the changes. What do you mean, and what’s happening?” Now, it’s all self evident.

So what I thought I would do is summarize how the events of the last 12 months have impacted doctor’s behaviors and decisions in private practice. Don’t read any further if you want sugarcoated op-ed. This is not it.

The most striking thing I warned doctors about was that unless you the Doctor clearly handle finances in private practice (no, its not like the ER), patients are gone, especially in the scared and frightening media driven economics for so many of those we serve. In essence, you need to be crystal clear, and also priced for the realities of your own future!  Are you serving humanity to the best of your abilities, and at the same time selling higher tiers of care to those who want and will gladly pay in full? Not everyone wants or needs a Rolls Royce, but they still make and sell plenty of them.

Patients are no different, when unique service is needed. And wanted. Help give them their health back, teach them how to maintain it, and it’s the greatest gift ever.

For further information contact us at Perfect Practice Web

If I sound pissed…hope you are too.

If I sound pissed…hope you are too.

It’s been a huge month for you, indeed an incredible year of opportunity, even in the midst of economic and political meltdowns.

One fact will never change.

Position YOUR PRACTICE as the go-to place for Private healthcare, give patients what they need and will gladly pay for, and you’ll never be worried about the future.


It sure as hell is not going to be some government directive that does not get to the core of patient behaviors, lifestyles and choices.

And if I sound pissed, I can hardly contain myself. As a leader in private healthcare delivery and management, in a democracy lead by tyrants and zealot ideologues who have turned out to be exactly as founding father Thomas Paine warned about.

What ultimately stands is anybody’s guess. But, it’s likely there will be attempts to saddle you with more regulation, red tape, tax your children’s children, and now maybe even your investments!

I’m SO Glad I wasn’t in the office…

I’m SO Glad I wasn’t in the office…

This is one story I’d hope I’d never get to write.

But it’s very important within the context of the work with clients and yes, even time with some of my friends. Its way more important than getting the next new patient, insurance hassles, and yes even the amount of today’s deposit.

My wife and I hung a bird feeder near her dad Al’s window yesterday. He’s 85, and in his last days on earth.

When we went to his shed to look for some screws and a bracket to use, we were both overcome with sadness.
You see, in that shed were things we had given him 25+ years ago, along our extensive journeys together. Tools, a fishing hat, stainless steel rigging knife, and stuff I haven’t seen in years.

How did we do all that stuff together I asked myself?

Then it all comes back. We did it all while I was building an enormous practice, getting a DABCO and an MS while practicing all day, doing many workshops at night, building a race car, running frequent road races and even a marathon.


Here’s a partial list of times we’ve spent. Together we built and raced a 1970 Mustang, from the ground up. Friends frequently lent a hand. Literally we built it from the frame up, tubbed, roll-cage, engines, rear-end, you name it. We even rented a local garage on weekends complete with lifts and all the impact tools, at one point spending 24 hrs over weekends fixing the car I broke the weekend before. (I personally NEVER saw patients beyond 1245 pm on Fridays in the summer).

I ultimately got sick of towing the “Beast” as I used to call it, so I got one of the locals to rent us his flatbed on weekends. Al and My daughter Caitlin would pile in and drive 135 miles to the track, and back on many a Saturday.

We also had a 29 ft travel trailer, and set up camp each summer in Maine, and 3 years on Cape Cod. Lots of campfires and cold beer. At night, the telescopes would come out, and sometimes we’d be there for hours.

Then, we shared 3 boats together. Over 22 years. Thousands of hours together with friends and family. Of course I still have the latest one, and hopefully a new story one that soon.

We vacationed summers on Nantucket, renting some pretty incredible properties and bringing the entire family.

Every weekend and vacation was an adventure. Even went to Daytona about 18 times in February.

I’ll never forget an early morning Florida pre-fishing trip to a diner, where Al orders a chilidog before 5 AM!  I could barely sip coffee in the cold dark morning and he’s eating like were at a barbeque!

One particular trip, we went red fishing on the Indian River Lagoon. It was so cool; the space program gantries of Cape Kennedy dotted the skyline. We fished with a legendary Guide (and philosopher/writer). We all hit it off really well, hooting and hollering like 5 year-olds. So as a unique experience for us, the Guide parked the boat on one of the islands, so we could fish some totally unprotected water. His only admonishing was to watch for gators. Big ones. If memory serves me well, he did have a handgun.

What a spectacular piece of nature that was. Birds, incredible trees, and alligators.I did manage to hook a fabulous redfish in the isolated lagoon. Meanwhile, Al wanders off on his own without saying a word. For about 20 minutes the guide and I searched for Al. I was at one point seriously wondering how I’d explain his death to my wife!

Then he casually reappears and the guide then quickly puts him back on the boat. Eight plus foot alligators in the warm winter sun getting hungry will do that when you are responsible for a strangers safety.

And then there was Al’s first bluefin tuna in the canyons off Block Island. 12-foot seas and he’s the only one not barfing. Must have been all those days on the aircraft carrier in WWII…

Fortunately, I had great mentors along the way that I really listened to intently so I’m just kind of passing this on. My friends and I paid handsomely for practice building (and life) advice, frequently traveling to be with the best as there was no PPW, and boy are we glad now we actually applied their advice!

Here’s the most important message from all this.

Live, and Practice, by your Design, not default.


There are after all, no second chances with your life.

One of your highest purposes.

As the tendency towards overwhelm occurs in so many areas of modern life these days, building a compelling future, no matter what the past, has certain fundamental requirements of you as an executive and architect of your own future.

We cannot control what’s going on in the outside environment, but we can control what’s going on between our own two ears. We can take a very proactive stance with our own head space. We can educate our patients. We can educate our staff. We can educate our communities.

But in order to do really do this, you cannot come from fear.

You cannot come from lack. You have to make sure that you are coming from your highest purpose when you enter the office every single day.

One of your highest purposes has got to be your own financial freedom and your own unique prosperity.

Join us tomorrow for some steps you need to take .
For further information contact us at Perfect Practice Web.

Instant Patient Newsletter

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this is a state of the art auto-pilot
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system for this decade and beyond
written by DCs, for DCs!


…is written under Dr. Hayes direction to educate your patients and referring MDs, DPMs, RNs, PAs, DMDs and other professionals on the myriad of health benefits of Chirpractic Care YOUR OFFICE PROVIDES and is designed to be used in email, mail and fax, all from one system!

Please watch the video at Instant Patient Newsletter in its entirety, read through the FAQ’s.
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What is Practice by Design?

Practice by Design – What does it take? – kewego
How to develop a thriving practice without giving up weekends and without spending a fortune guaranteed. For more info please visit

Video from jhayes

George Foreman

Just met George Foreman at the GKIC Info Summit, what an awesome guy! Cant wait to post the photo…

It’s all just a “test”

It’s all just a “test”

Yesterday, I spoke about the power of planning, and then implementation.
All fine, and essential.
But happens when your plan does not work as intended?

What can I as your coach do to help?

There is a saying in marketing that there are no failures, only tests.

And so it is in the world we live in right now. What worked so great in practice a while back may not be working so well right now.

What do most people do? Stop trying!

Whats a better way?

Analyze, fine tune, make some appropriate changes, and “test” again. Then again. Seriously. Every great practice and business is built upon the backs of many, many failed “tests”…

Have an Awesome Day! John

Last Call…

WCS 2010 Financial Summit for Doctors ends at 1PM EST today…

Yesterday was another day with two awesome guests, Dr. David Phillips, and Bruce Goldsmith. George Youssef and I will wrap it all up at 1PM EST. It’s been a great week. A very special thank you to all our guests and docs who have participated.

From a very concerned patient…National Health Plan?? – please read

Subject: National Health Plan?? – please read

Something I felt the need to pass along –
Please forward this to anyone you can think of, Republican or Democrat.Now, onto the doctor’s digest of the bill. If you read anything this year, read this:

The healthcare bill that Congress seems intent on passing is far worse and Orwellian than anything you might have imagined. I am not trying to be histrionic, the way people often get over just about anything. This is life-altering and, unlike most pieces of bad legislation, we will never be able to go back. A doctor (who is a friend of someone I know) has taken the time to read the 1000 page+ bill, something I don’t think a single politician has bothered to do. (Yesterday, John Conyers, a big proponent, actually said this:

“What good is reading the bill if its a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?” You can’t make this stuff up.) This doctor has done the work so we, as citizens, don’t have to all sit down and read the entire thing ourselves. What he found is
frightening in the extreme.

But before I get to his comments, let me disabuse you of one common lie about healthcare: that 46 million Americans are uninsured. Once you remove illegal aliens, the young or well-off who choose to self-insure, and those who are only
lack insurance for temporary periods (less than a year), the real number is closer to 8 million.

Please read what’s in the bill below. After you have read it, I hope you feel the need to call, write, or email your elected representatives. It’s effective, even if you know they won’t likely vote your way. To email, just type the politicians name into your browser, hit the first link, and then hit “contact.” If we can’t be bothered to stand up to something like this, then we truly deserve what we get. The whole process takes maybe 5 minutes.

The citings below are from the proposed house version of the healthcare bill.

[There is a link below to determine who your representatives are in the US House and US Senate. Please take a few minutes in the next day or say and call them to express your displeasure with this bill. Also, please forward this to your friends and ask them to do the same.]

BTW, I saved the best for last.


* Page 16: States that if you have insurance at the time of the bill becoming
law and change, you will be required to take a similar plan. If that is not
available, you will be required to take the govt option!
* Page 22: Mandates audits of all employers that self-insure!
* Page 29: Admission: your health care will be rationed!
* Page 42: The “Health Choices Commissioner” will decide health benefits for
you. You will have no choice. None.
* Page 50: All non-US citizens, illegal or not, will be provided with free
healthcare services.
* Page 58: Every person will be issued a National ID Healthcard.
* Page 59: The federal government will have direct, real-time access to all
individual bank accounts for electronic funds transfer.
* Page 65: Taxpayers will subsidize all union retiree20and community organizer
health plans (example: SEIU, UAW and ACORN)
* Page 72: All private healthcare plans must conform to government rules to
participate in a Healthcare Exchange.
* Page 84: All private healthcare plans must participate in the Healthcare
Exchange (i.e., total government control of private plans)
* Page 91: Government mandates linguistic infrastructure for services;
translation: illegal aliens
* Page 95: The Government will pay ACORN and Americorps to sign up individuals
for Government-run Health Care plan.
* Page 102: Those eligible for Medicaid will be automatically enrolled: you have
no choice in the matter.
* Page 124: No company can sue the government for price-fixing. No “judicial
review” is permitted against the government monopoly. Put simply, private
insurers will be crushed.
* Page 127: The AMA sold doctors out: the government will set wages.
* Page 145: An employer MUST auto-enroll employees into the government-run
public plan. No alternatives.
* Page 126: Employers MUST pay healthcare bills for part-time employees AND
their families.
* Page 149: Any employer with a payroll of $400K or more, who does not offer the
public option, pays an 8% tax on payroll <>BR * Page 150: Any employer with a
payroll of $250K-400K or more, who does not offer the public option, pays a 2 to
6% tax on payroll
* Page 167: Any individual who doesn’t’ have acceptable healthcare (according to
the government)20will be taxed 2.5% of income.
* Page 170: Any NON-RESIDENT alien is exempt from individual taxes
(Americans will pay for them). THIS ALREADY HAPPENS
* Page 195: Officers and employees of Government Healthcare Bureaucracy will
have access to ALL American financial and personal records.
* Page 203: “The tax imposed under this section shall not be treated as tax.”
Yes, it really says that.=2 0
* Page 239: Bill will reduce physician services for Medicaid. Seniors and the
poor most affected.”
* Page 241: Doctors: no matter what specialty you have, you’ll all be paid the
same (thanks, AMA!)
* Page 253: Government sets value of doctors’ time, their professional judgment,
etc. BTW, they do this to an extent now.
* Page 265: Government mandates and controls productivity for private healthcare
* Page 268: Government regulates rental and purchase of power-driven
* Page 272: Cancer patients: welcome to the wonderful world of rationing!
* Page 280: Hospitals will be penalized for what the government deems
preventable re-admissions.
* Page 298: Doctors: if you treat a patient during an initial admission that
results=2 0in a readmission, you will be penalized by the government.
* Page 317: Doctors: you are now prohibited for owning and investing in
healthcare companies!
* Page 318: Prohibition on hospital expansion. Hospitals cannot expand without
government approval.
* Page 321: Hospital expansion
hinges on “community” input: in other words, yet
another payoff for ACORN.
* Page 335: Government mandates establishment of outcome-based measures: i.e.,
* Page 341: Government has authority to disqualify Medicare Advantage Plans,
HMOs, etc.
* Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by
* Page 469: Community-based Home Medical Services: more payoffs for ACORN.
* Page 472: Payments to Community-based organizations: more payoffs=2 0for
* Page 489: Government will cover marriage and family therapy. Government
intervenes in your marriage.
* Page 494: Government will cover mental health services: defining, creating and
rationing those services.

The best of the best:

* Page 30: A government committee will decide what treatments and benefits you
get (and, unlike an insurer, there will be no appeals process).


* Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
Can’t wait for them to decide only blue-eyed and blond haired people deserve
* Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens,
assisted suicide, euthanasia?
* Page 425: Government will instruct and consult regarding living wills, durable
powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of
* Page 425: Government provides approved list of end-of-life resources, gui
you in death.
* Page 427: Government mandates program that orders end-of-life treatment;
government dictates how your life ends.
* Page 429: Advance Care Planning Consult will be used to dictate treatment as
patient’s health deteriorates. This can include an ORDER for end-of-life plans.
* Page 430: Government will decide what level of treatments you may have at

Blueberries, vegetables and exercise, or cigars, sex and coffee…

The Secret of self-actualized life- is it blueberries, vegetables and exercise, or cigars, sex and coffee…

This past weekend, I finally got to wind down after our months long SuperConference build-up. It was a great event; most docs were ecstatic with the content and opportunities, despite the very harsh realities of private practice today. It was great to be with all my special friends who helped make this event so powerful.

In any event, another very special friend Dennis invited me on the water all day Friday and Patti and I to his Yacht Club Friday night. (Turns out, we’ll be joining!)

Friday morning, the fishing was great again, just off the Boston Harbor hotels, and airport runways. It’s a fabulous place, with tons of revolutionary war (and before) history, forts, burial grounds, etc.

Friday night, the four of us cruised the inner harbor, back on land for a couple drinks then had a fabulous dinner back at the club and tons of laughs together.

Then, Dennis asked me if I wanted to smoke a cigar with him. I must have had one hell of an expression, because he immediately began to tell me about studies on cigar smoking and longevity???

Huh? I read research every morning, but I missed that one!

So Dennis says “Its stress that kills us. Those that socialize, and have fun, maybe smoke a cigar and sip Scotch together, laugh and stay engaged, live longer, happier and healthier lives”.

So don’t you know it, look up the studies on centenarians in Cuba, and other countries too?

My take after reading these studies? They live simply, stay engaged in life fully for the moment only, and have moderate habits, nothing to excess. Interestingly, in Cuba, they smoke cigars, drink coffee, and still enjoy sex.

But most of all, they ENJOY all of life. Especially simple pleasures, friends and family. Most every day.

And thats it.

Boy, can we screw this one up, big time.

Look at the craziness some of us see everyday, people stressed out, never disengaged, or never shut off the cell phones and TV, bitch about everything, live sedentary, not outside enough.

Or some Docs that continually stress, never disengage long enough to really figure out who’s in charge of their life and practice, who they care or work for. No good systems or organization that really serves them, and their goals and dreams.

What a mess we are capable of creating!

But, there is an antidote. And it’s the very first step I often end up taking with new clients.

That is, to develop and work on and truly develop the essence of Practice by Design ™.

But if it’s really this simple, why do so many of us as very intelligent docs especially every practice day struggle with it?

I’m not really sure, but I can tell you a few things.

First, YOU have got to have complete design control in practice. This is really the most valuable part for me personally while working with my docs.

Next, staff needs firm, but still fun environments and goals. Very easy systems that still work (by design) when we all have those “no brain” days. And the government has made this one harder.

Three, patients need guidance, and the choice to accept or reject advice. When you can see them, what your game rules are. This must of course include finances. And, if they choose to reject your advice, why would you ever keep them under your care?

And you know what, it can be as simple as these three basic

But you must have the certainty, intestinal fortitude and underlying tools to pull this all off.

To that end, as Mr. Spock admonished me 40+ years ago, “live long, and prosper.”