The Fundamental Reason Why a Left Behind Doctor Was Able to Achieve “500 Million in Annual Sales” in Hospital Management
As shown in the first part ( “I’m a winner too!” (The End of an Arrogant General Practitioner with a 6 Million Yen Monthly Loan)), while there are doctors who fail to run their hospitals and end up with large debts, there are also doctors who aim to become “your ideal family doctor” that is truly needed in society and actually become so.
Dr. Tomoaki Takei, who graduated from Keio University School of Medicine in 2002 and currently serves as the director of the Takaza Shibuya Tsubasa Clinic, explains the unknown reality of medical practitioners.
What is it that separates success and failure, heaven and hell, as a doctor? Is it skill? Is it connections? In this issue, we will introduce a case of a general practitioner who is successful in management and well-liked, and who could be called a “heavenly doctor. Through this case, we hope to show readers what makes a successful doctor different.
Internal medicine physician Mr. B (male, 42 years old when he started his practice) graduated from the Faculty of Medicine at the University of Z and joined the department of internal medicine at the same university.
He was steadily gaining experience, but in his third year as a physician, he made a major mistake at Alpha Hospital, where he was working, that almost resulted in a medical lawsuit. The university saw this as a problem and ordered Mr. B to be transferred to a medical institution (hospital β) 80 km away from the university, which is called a “leftward shift” in the medical department’s personnel affairs.
He said, “Oh, I’ve fallen off the high road of a career in the medical department. How am I going to spend my long life as a doctor in such a remote medical institution?
Mr. B was thinking like this when he received a shock at the beta hospital to which he was transferred.
The only doctor who came to Beta Hospital from the medical department of University Z was an internist. Other departments were staffed by doctors from other universities. Furthermore, the director and vice-director of the hospital advocated and practiced primary care that transcended departments and treated patients of any age, body or mind, based on the belief that “I would be ashamed to be a supervising physician if I did not examine not only my own department but also other departments thoroughly.
The common practice at that time was to develop expertise in one field and to become able to treat patients as a physician in a specialized field. However, when Mr. B was transferred to this hospital, he was shocked as if he had been shot in the head: “There are doctors who want to be able to treat patients as a human being and to be able to go beyond their own department. He decided to become a “primary care physician” who could see anything and consult with patients, which was unthinkable at the time.
Working here, he had a vague idea of the kind of doctor he wanted to be.
I want to become a doctor who can provide health consultation on any matter” and “I want to create a clinic that will be loved by the community someday”-this was the image of a doctor that Mr. B had begun to envision. If he had stayed at his original hospital, he would never have thought of this, but his encounters and experiences at Beta Hospital changed him.
His motivation accelerated, and he worked hard every day, treating patients with sincerity and devotion.
The hospital executives were heartened by his efforts, and the deputy director encouraged him by saying, “There is a gamma clinic that has been a model of primary care in the community for many years, so you should use your vacation time to work there part-time and learn its know-how, including its management. The director and medical director also encouraged me to actively participate in obstetrics and gynecology, pediatrics, and other departments as well.
As a clinical resident supervisor, I not only taught the younger generation, but also learned and experienced other departments and acquired management sense, and in my 12th year as a doctor, I decided to open a clinic in April.
Mr. B finally opened his clinic. Under the slogan, “No matter what age or what kind of disease, I will treat patients well as a primary care physician,” he carefully examined patients and actively communicated with them.
Although there were 15 patients on the first day, the hospitality of the staff and doctors, as well as the heartwarming clinic atmosphere and interior design, have resulted in good Internet and real word-of-mouth reviews. Moreover, that word of mouth was “It is very busy now. However, the staff and doctors go above and beyond what you expect, making it a relaxing place where you can truly trust them” and “Good quality care and low wait times. It is a hole in the ground now. It will surely get crowded.” All of these statements were full of hope for the future. However, the number of patients did not increase, and Mr. B was painfully aware of the difficulty of attracting patients.
Then an incident occurred. In July, after the rainy season had ended, the weather turned hot and humid. In July, when the rainy season ended and the weather turned hotter than usual, a salmonella outbreak broke out at a nearby nursery school.
Mr. B used his own knowledge from his years as a working doctor to provide prompt patient care, and also sincerely did things that did not yield a penny, such as responding to the public health center and advising nursery schools.
These actions were highly appreciated, and word of mouth spread rapidly among the local community of mothers, resulting in a rapid increase in the number of consultations for vaccinations and health checkups.
The clinic’s monthly medical business expenditure was approximately 800,000 yen for mortgage and utilities, 2,000,000 yen for personnel and welfare, 500,000 yen for drugs and materials, 400,000 yen for outsourced testing, and 300,000 yen for other expenses, for a total of 4,000,000 yen, which is within the reasonable range compared to the clinic in the previous “hell section. The total cost was 4,000,000 yen, which was within the reasonable range compared to the previous “hell” clinic.
Operating 18 days a month (4.5 days a week), the clinic’s unit cost was 6,500 yen and the break-even number of patients was 34 per day. In the fall, the number of patients increased to 40 per day, and in the winter to 50 per day, easily exceeding the break-even point.
Opening a business is a piece of cake. Unlike Mr. A, who exclaimed, “I’m a winner in life, too,” Mr. B, who still wanted to meet the needs of the community even in his second year of business, was engaged in local infant checkups and school doctor work for the medical association, and also went to the community comprehensive support center.
At that time, he heard from a home nursing station that there were not enough needs for home medical care, so he did not slack off on his days off, but engaged in home visits to Beta Hospital, which had been a great help to him, to learn its know-how.
In the second year of business, although the clinic had a surplus of 24 million yen in ordinary income, fatigue of Mr. B and his staff due to a greater-than-expected increase in the number of patients also became a problem.
In response to this, in the third year, based on the concept of valuing the staff more than ever and contributing to the community for a long time, the company introduced the “Oiribukuro,” which is given on days when the number of patients visiting the clinic exceeds a certain number, as well as “incentives” based on the amount of surplus by revealing the monthly balance, and also introduced a membership as part of the benefits package In addition, as part of the welfare program, a resort membership was purchased and staff members’ families were invited to stay at the resort for overnight stays. Thanks in part to these measures, only one employee left the company in three years.
The hospital’s management had been going well up to this point, but in the fourth year of operation, a new coronavirus outbreak caused a temporary shortage of medical examinations. Undeterred, however, the hospital developed medical services that met the needs of the times, such as outpatient fever clinics, vaccination against the new coronavirus, and online medical services.
One day, Mr. B also contracted the new coronavirus, and although he had to suspend his practice for 10 days, he was able to minimize the damage with the help of his staff, whom he had nurtured.
It would be bad enough if I had to close my clinic and not be able to function,” he thought. Mr. B thought so and opened two clinics in the neighborhood, helping each other when the other’s clinic was closed, thereby contributing to the community.
Various media, including TV stations, took notice of Mr. B’s activities, and he appeared in interviews and other media. Each time he appeared, he received encouraging comments from patients, such as “I saw you on TV,” which eventually led him to plan a self-publishing project.
As the saying goes, “like attracts like,” and it seems that good doctors make connections with good doctors. Mr. B was invited to a luxurious party by the person in charge of membership resort memberships, who invited him to a members’ social gathering.
There, he met Mr. C, a surgeon with a passion to teach the skills he learned at a local hospital on his days off, as well as performing day surgeries at his clinic; Mr. D, an internist who has established several group homes in the community and provides general and visiting medical services; and Mr. E, a “former” pediatrician who, like Mr. B, treats 100 patients a day, from newborn babies to 103 year olds. There were wonderful doctors in various fields, such as Mr. E, a “former” pediatrician who, like Mr. B, treats 100 patients a day, from newborns to 103-year-olds.
By exchanging information, they shared their own stories of hardships they had faced in the past. By absorbing the good aspects of each doctor and bringing them back to their respective areas, they were able to further develop medical care in their respective regions.
Thanks to you, I feel safe. Thank you.”
These words are the best reward for Mr. B. The sales of the three clinics have grown to 450 million yen per year, but Mr. B. has decided not to expand any further, saying, “I can only take care of up to three clinics. Still, there is no doubt that he is a “heavenly doctor” who has achieved “satisfaction of his own mind,” “satisfaction of his patients,” and satisfaction in terms of management.
Of course, being a doctor is a special kind of job that can only be done with a license. However, the difference between success and failure, between heaven and hell, is the state of mind of the doctor. As long as he keeps his “for you” spirit, he will continue to be “your ideal family doctor” who is truly needed in society.
Written by： Tomoaki Takei