Being willing to change and evolve is also critical, and I guess that’s my fourth suggestion. Practices that allow a “status quo” culture will not reach their potential. Medicine is constantly changing, and physician practices must respond to those changes and take advantage of new evidence and advancements that emerge. One way to demonstrate a willingness to change is to seize learning opportunities and not be afraid to make some mistakes.
As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Dr. Rohit R. Kashyap.
Dr. Rohit Kashyap is a family practice physician based in Northwest Houston. He is a founding partner in a very successful and well-respected family practice group servicing the medical needs of the local community through their two locations in Spring and The Woodlands. He practices full-time in the clinic, but also carves out time to train and supervise Nurse Practitioners and share in the administrative duties of running the practice along with his three partners. He is the Physician Champion for practice transformation in the practice, and his efforts, along with his practice transformation teams’, recently resulted in national recognition as a NCQA recognized patient centered medical home.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?
Sure. I was born in New York, but I spent my formative years in Toronto, where my extended family still lives. After graduating from college in Texas, I stayed. I met my wonderful wife in Houston. We have two beautiful children and have lived there for the past 20 years or so. My experiences with socialized medicine in Canada helped shape my perspectives about healthcare delivery and the importance of efficiency, defined protocols and evidence-based medicine.
I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?
My patients have been my biggest mentors, and I’ve probably learned as much from them as they have from me. I am continually impressed by people’s strength and resilience, as well as their willingness to be vulnerable. I’ve cried with my patients and celebrated with them, and they have helped me recognize the need to weave compassion, communication and hope into my practice. I remember seeing a 12-year-old girl who was losing hair. I met and talked with her, and in the clinical workup, we ended up finding juvenile diabetes. Her strength throughout the diagnosis and care planning process was inspiring, and it was gratifying to uncover her health issues and help her start to navigate them.
In addition to my patients, I’ve learned a lot from my parents. Both of my parents have tireless work ethics and incredible patience, characteristics that have served me well in setting up and expanding my practice. My dad taught me to listen and observe. He was a family practitioner and has now retired, but I remember when I was young, I used to go to his office, and he’d help me understand why he was treating patients and what he was doing. One thing he would always say was that in family practice, if you listen to the patients, they’ll tell you exactly what’s wrong, at least 50% of the time. You don’t necessarily have to order a bunch of tests and imaging, but you do have to listen and hear what’s actually going on. I think that’s one of the most valuable things he taught me.
My mother’s background includes a degree in English Literature. She instilled in me an appreciation and love of reading and literature. This has served me well in reinforcing the importance of enunciating words and pronouncing them correctly to ensure clear communication.
What made you want to start your own practice? Can you tell us the story of how you started it?
I founded IKP Family Medicine with two colleagues, Dr. Irvine and Dr. Palmeros-Irvine. At the time, we were all employed in the same physician practice, working for an older doctor. He was at a different stage in his career, and his interests were somewhat diverging from ours. He was considering slowing down, and we were young and hungry and wanted to innovate. We felt that opening our own practice afforded us greater autonomy and advancement opportunities while giving us room to grow personally and professionally.
When the practice owner indicated he wanted to make some changes, the timing seemed right to branch off and do our own thing. He had two offices, so he kept one and we bought the other, which was in the Red Oak area of Houston. Our goal was to meet community needs and practice medicine with greater continuity. We partnered with three hospitals, two long-term acute care hospitals, and two nursing homes, so we could follow patients along their entire course of care. We even did some hospice work for a while.
I think one of the reasons for our success to date is that the three of us have known each other since residency, and we have similar goals and ethics. We respect and value each other’s perspectives and appreciate our different strengths. Dr. Irvine has a strong business mind, and Dr. Palmeros is a great out-of-the-box thinker. I bring some computer-savvy to the table, so we have complementary skills.
Can you share the most interesting story that happened to you since you began your career?
A story that has had a profound impact on how I view medicine relates to my grandfather. When he was 90 years old, my mother went to visit him in India, and she noticed he was dipping his toast in water before eating it. She asked him why, thinking there might be something painful with his teeth. He told her that at his last medical appointment, his doctor said butter was not good for him, and he shouldn’t use it anymore. So, he was using water to moisten the bread instead.
You have to know that my grandfather was a vegetarian, never drank alcohol or smoked, and was quite active throughout his entire life. When my mom told me about his experience, I couldn’t help but think how ridiculous the situation was. I mean, the man was 90. A little butter on his morning toast was not going to make the difference between a healthy and unhealthy lifestyle. Quite frankly, if he wanted to start drinking and smoking, we could’ve probably let him. I try to remember this example, especially when I’m seeing my older patients. Even though evidence-based medicine is essential to consistent and high-quality care, we as physicians need to recognize when those recommendations are not fully relevant to the person sitting in front of us. What is realistic and beneficial for them? Is it necessary to force a 90-year-old man who is otherwise healthy into giving up his buttered toast just to move his cholesterol down a point? Patients are human beings who are complex and unique, not just conditions that require prescriptive interventions.
Because it is a “helping profession,” some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?
The most important thing is to treat patients the way you or your family would want to be treated. If you consistently show respect and compassion, success will find you. I also seek common ground with my patients whenever possible, because when I relate to them, I’m more likely to view them as a person and less likely as a condition or a vehicle for making money.
It’s also beneficial to implement strategies and solutions that help your practice run more efficiently and reliably, so you can work smarter and have more time for meaningful patient interactions. For example, one of our practice’s first initiatives was implementing an EMR to streamline care processes. Even though it took a little longer than we initially anticipated to see those efficiencies, we eventually got to a point where we improved our productivity and made care more consistent.
For those just starting out, or even those considering medicine, I recommend taking some business courses as part of your education. If I had the chance to do it all over again, I would take at least some basic courses to give me a rudimentary understanding of how a practice runs. It would’ve also been helpful to spend some time in the business office during residency, so I could have a better appreciation of the nuances. I feel fortunate that I’m partnered with Dr. Irvine, because he has such a great feel for that side of things, and he has a keen interest in it.
Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?
A team approach is key. Right from the beginning, we made sure we had the resources to guide and assist us. For example, we hired an administrator we could trust and found a good lawyer and accountant because those were functions we couldn’t do but knew we needed to do well. We also aim to continuously improve, so we’re focused on things that matter most to our patients and our business. We work with, CareAllies, an external partner that helps us identify, prioritize and activate transformational improvements. For example, we received our patient-centered medical home (PCMH) certification last year, and that was thanks to the work of our outside partner, as well as some of our nurse practitioners, administrators, and business office staff.
From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?
The journey has not been without pitfalls, but our practice has been fortunate due to our management team and the checks and balances we have in place. That said, there have been a few hiccups. I still get teased about one incident that happened about 15 years ago. Dr. Palmeros-Irvine was out of town, and Dr. Irvine and I decided we should buy a new photocopier. This charming fellow just happened to drop by with a great deal, and we spent a lot of money without doing our due diligence in researching him or the product. It turns out he was a scammer. When Dr. Palmeros-Irvine returned to the office, she discovered we’d spent quite a bit of money on a fictitious photocopier, and she was not pleased. We eventually did receive the machine, and it all worked out. But I have yet to live that down.
As I alluded to before, we also had a bit of a rocky start to our EMR implementation. We had researched several systems and narrowed the field to about five, which I demoed myself. We selected one and arranged for two days of training because we were told that would be sufficient to get up and running on the system. We flew in a trainer, completed the training and went live. After a few days, I thought we were going to go out of business because we went from seeing 35 patients a day to struggling to see 10. It was a crisis moment, for sure. Obviously, our performance improved with time and practice, but the experience was eye-opening. Looking back, there was a better way to approach the initiative, and we learned a valuable lesson about what not to do going forward.
Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why?
- I think the first thing to know is that in primary care, you are your own best referral source. So, it is essential to treat patients with respect and remember that they should be at the center of everything you do. If you lose sight of this, not only will it be difficult to attract and retain patients, but you also won’t find as much joy or satisfaction in your work.
- Next, you should have a clear understanding of your market and local demographics, so you know what the community needs and what services are already out there. Just like every patient is different, so is every community. Taking time to learn about your market’s nuances is critical as you plan how best to meet community needs and grow your business.
- The third thing I’d recommend is to cultivate a collaborative work environment where everyone feels they can contribute and learn from each other. Team members should feel their expertise is valued and be empowered to identify problems and recommend changes. To realize this type of environment you must surround yourself with people you respect but who may not always agree with you. Seek staff and external partners that push you to expand your thinking or view problems from a new perspective. You will not always be right, and you must be able to hear feedback, rely on others’ expertise, and learn.
- Being willing to change and evolve is also critical, and I guess that’s my fourth suggestion. Practices that allow a “status quo” culture will not reach their potential. Medicine is constantly changing, and physician practices must respond to those changes and take advantage of new evidence and advancements that emerge. One way to demonstrate a willingness to change is to seize learning opportunities and not be afraid to make some mistakes. I recall one time, for example, when our practice transformation partner asked, “Who wants to try out process mapping?” I raised my hand, even though I didn’t know much about the concept because I wanted to learn a new skill that could help me and the practice. Yes, my team saw me stumble through the exercise, but it was enlightening for me and for them. In my opinion, the best practice environments are the ones where people feel comfortable putting themselves out there and stretching their limits.
- And finally, it is wise to invest in practice improvement and transformation. Longevity requires agility, which in turn requires you to examine everything through the lens of continuous performance improvement. You must be able to deconstruct processes, examine them, spot failure modes, and reassemble the processes more efficiently. A key component of this is data, including quality, contract, operational, and patient satisfaction information. Solid, real-time data helps you understand where you are, where you could improve, and how you’re trending against your goals. Too often, practices make decisions based on subjective influences like how the team feels about a decision or what intervention team members believe will solve a problem. Without data, you don’t know whether you’re implementing the right solution and whether you’re actually making things better. For example, a short while ago, my team was struggling to handle the volume of phone calls coming into the practice. We thought we would probably need to hire another person to work the front desk, however our transformation partner encouraged us to evaluate the phone tree process a little differently. What was slowing things down? Was it possible to approach the problem in a new way? What if a phone conversation wasn’t necessary each time? Could some of the calls be avoided altogether? As it turned out, we looked at the data and reconstructed the process around incoming calls, which allowed us to reduce the volume and handle the ones that remained more efficiently without hiring additional staff.
As a business owner you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?
I struggle at times to achieve the appropriate balance, and it’s tempting to focus more on the patient care side and not on how to improve practice performance and sustainability. When I want to dig into the business side of things, I rely heavily on my teammates — and our key business partners such as CareAllies who supports our business transformation — and their knowledge and skills. I don’t pretend to be an authority on practice innovation and knowing that I have both internal and external colleagues who are experts at what they do helps me feel confident that we are taking the business in the right direction, which allows me to focus more on my patients.
I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?
My recommendations are similar to that of any leader in a high-stress job. You need to find balance, which may involve regular exercise, meditation, and/or pursuing a hobby about which you’re passionate. Taking a break once in a while and turning things off is a must. When I started out, I took my pager to Acapulco and my laptop to Hawaii. Those decisions prevented me from relaxing fully and truly enjoying those experiences. I don’t do that anymore, and I feel much more rested and rejuvenated when I get away, which allows me to be more focused and present when I am at work.
Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?
There are several quotes I would choose, but the one that seems most relevant for this article is “If life were predictable, it would cease to be life and would be without flavor.” This is a good reminder of the importance of welcoming all that the world has to offer, even if it initially seems hard or overwhelming. I have witnessed both heartache and happiness in the course of my practice, and unpredictability has certainly been a constant. This quote reminds me that I can choose to view the messiness of practice ownership as a frustration, or instead welcome it as something that adds to the richness of my life and benefits me and the people around me.
How can our readers further follow your work online?
Check out our website at https://ikpfm.com/
Thank you for these great insights! We wish you continued success and good health!