[Joon] The medical license is considered a “gold license” by the public. However, many people tend to think that this profession is “enviable” or “looks like it has a lot of money,” but surprisingly, many people do not know what it really is. Among them, the reality of local clinics, their career paths, and their pocketbooks are not well known.
In fact, some general practitioners may be tempted to say, “Oh, I don’t envy you at all…! There are actually some general practitioners whose circumstances make one want to say, “Oh, I’m not envious at all…!
Dr. Tomoaki Takei, who graduated from Keio University School of Medicine in 2002 and is currently the director of the Tsubasa Clinic in Takazashibuya, explains the unknown reality of general practitioners.
According to the Ministry of Health, Labour and Welfare’s “21st Survey on the Actual State of Medical Economy” (2017), the average annual income of hospital doctors (national, public, medical corporations, etc.) is 14.88 million, while the average annual income of general practitioners (overall figure including individuals, medical corporations, etc.) is 27.48 million, a difference of about two times.
Although at one time it was said that general practitioners could “almost make a profit if they opened a clinic,” in fact, the new coronavirus epidemic and the recent opening of numerous clinics have increased the number of cases where they are forced to close their clinics from a business perspective. Nowadays, being a general practitioner is not a “job that everyone envies.
In this article, we present one case in which a patient was forced to close his practice.
After graduating from X Medical University, Mr. A (male, 40 years old at the time of opening his practice) joined the department of internal medicine at the same X University.
After six years of rotation in the university medical department, he obtained his specialist certification, but he was fed up with the trouble with patients caused by his poor communication skills, as well as the four times a month he had to work on duty and other strenuous work.
Thinking about his future life plan, Mr. A decided, “Such a low monthly salary and few days off are not worth it! The work environment is not good enough,” he decided. In his eighth year as a doctor, he left the medical personnel office and took a job at a private hospital of his own volition.
After that, Mr. A had many similar problems at his new job. Because of the emphasis on profitability at private hospitals, he found himself repeatedly having to leave his job for short periods of time due to a decrease in patients (and a decrease in hospital revenue) caused by poor patient care.
Even in such a situation, Mr. A never thought that “this happened because of me.” He said, “I cannot do the work I want to do because my wishes are not met. If that was the case, I should start my own business. It would be more profitable,” and decided to become a general practitioner.
In fact, this is an escape pattern called “demo-sika,” which is a typical example of a failed attempt to open a practice. In the world of doctors, it is said that a medical practitioner cannot succeed without a clear intention and track record, but this must not have fallen on Mr. A’s deaf ears. In the end, he quit his job at a private hospital and opened a paratrooper practice in a local city.
However, he stumbled badly from the start. It took a tremendous amount of money to open the clinic.
He had only 10 million yen of his own funds, but he took the word of the opening consultant and installed a detached house and advanced medical equipment such as a CT scanner, so the initial cost was about 150 million yen. We were suddenly out of pocket.
Also, when you become a general practitioner, you have to handle miscellaneous tasks yourself that were previously handled by office staff.
A medical practitioner’s work includes a wide range of tasks such as creating a financial plan for the clinic, dealing with the government, negotiating loans, dealing with taxes, hiring staff, and human resources for educational work.
Still, as long as the business was profitable, it might have been manageable. However, that point is not going well either.
The clinic’s monthly medical business expenditures are approximately 1.2 million yen for mortgage costs and utilities. Personnel and benefit costs are approximately 3.2 million yen. Approximately 500,000 yen for drugs and materials. Laboratory fees and other expenses amounted to approximately 500,000 yen. Other expenses totaled about 600,000 yen, for a total of about 6 million yen.
What about income? Assuming that the clinic operates 20 days a month and charges 6,000 yen per treatment, the break-even point is 50 patients per day. Now, was he able to meet his “quota”?
The day before the opening, Mr. A held a preview with much fanfare. The patient waiting room was luxurious and gorgeous, reminiscent of a foreign luxury resort hotel, and he proudly showed off the many advanced medical equipment, including CT scans.
Then came the opening day. Perhaps the many medical departments, the proud waiting room, and the rarity of the advanced medical equipment were successful, and the first month of business was off to a relatively good start, with about 30 to 40 patients seen per day. However, ……
I thought to myself, “Oh, opening a business is pretty easy. Yeah, I’m a winner in life!”
This arrogant attitude was not good. With the confidence that “I can do anything well,” I performed many unnecessary examinations and developed unfounded medical practices outside my specialty.
In the second month of his practice, he did not show up at 9:00 a.m., the opening time of the clinic, and it became common for him to be 30 to 45 minutes late. They lacked common sense as members of society. The lack of standardization in patient care, ambiguous decisions by doctors, and policies that changed according to their good or bad moods often caused the staff to move to the right or left.
In addition to this, the clinic gradually lost credibility due to the accelerating trend of “looking only at the electronic medical record instead of at the patient’s face during consultations,” “extreme reluctance to ask questions,” and “excessive drug prescriptions forcing patients to go to the clinic.
Finally, negative reviews began to appear on the Internet, such as, “You should avoid this clinic,” and “The director’s capriciousness and lack of medical knowledge, as well as his personality, are questionable. Within six months of opening, the average number of patients seen per day had dropped to the single digits, and the deficit exceeded 2 million yen per month. The bottom of “working capital,” the lifeline of clinic management, began to appear.
The director, however, did not reflect on his actions, but shouted at his staff, “We are losing patients because of your poor performance and attitude,” and “We will not pay you a bonus for this, and you will take a pay cut,” and the staff quit one by one.
Although he was backed into a corner, the power of his medical license was tremendous. The bank provided him with an additional working capital loan of 10 million yen to prolong his life.
But once patients leave, it is not so easy to get their hearts and minds back. Negative word-of-mouth comments continued to grow: “It is always crowded,” “The luxuriousness of the waiting room is inversely proportional to the human qualities of the doctors,” and “They give you unnecessary prescriptions and tests and make you a sucker to collect their funds.
I am sure you have all noticed that this clinic is now at the end of its life. The director is engaged in clinic care five days a week, but in order to make up the deficit and pay the staff’s salaries, he began working day and night shifts (8 times a month for 800,000 yen) at emergency hospitals and other facilities, which has left him in a state of physical and mental disarray.
As a result of his busy schedule, the quality of communication with patients and staff, which was already inadequate, deteriorated further, and he began to receive a lot of flak.
As a result of the drastic decrease in patients, patient care was reduced to about 15 minutes out of the seven hours of clinic time per day. In the remaining 6 hours and 45 minutes, I called patients directly and asked, “How are you doing these days?” but it did not seem to have any effect.
I wanted to finish paying off my debt as soon as possible, hire a part-time doctor, and live a comfortable doctor’s life. I wanted to enjoy my life with memberships to resorts and golf courses and luxury foreign cars.
His wish came true, but within a year of opening the clinic, he ran out of money and quietly closed it. Now, he is working as an internist while trying to pay off his debt of 100 million yen.
A good doctor should be able to communicate appropriately with patients, taking into account not only their medical conditions but also their social and family backgrounds, explain their conditions properly, and encourage them.
The shortcut to success in hospital management is to hone one’s humanity, ethics, communication skills, and economic sense, rather than medical knowledge and skills.
Text： Tomoaki Takei