Right-Sized and Outsourced

By John Hanks, DC

I walked into the treatment room with my new associate doctor. "Mrs. Kopopkins, this is Dr. Wang. He will be performing your adjustment today, and I'll be supervising. He is from Shanghai and is well-trained. I will be sitting here doing paperwork. Of course, if you have any questions, I'll try to answer them."

Outsourcing is the rule of the era. American businesses no longer own anything, repair anything or hire anyone. They simply contract with outside vendors who do it all. When discussing this topic with a chiropractor friend of mine, he lamented that it was a shame outsourcing could not be done in a chiropractic office. His shoulders are killing him, and he is tired of the staff problems. So, on a bet with my friend, I decided to show him it could be done.

I've been working on this outsourcing thing, and I think I've almost got it right. Dr. Wang has been a great set of hands to have around. Now I can sit and chat with the patients, tell jokes and stories, and finish my paperwork, while he does all the heavy work. Plus, I don't have to pay him as much as I paid Dr. Jobim, the graduate from that new chiropractic school in Brazil. If he had lived with 12 other people in a one-room apartment, like Dr. Wang does, Dr. Jobim also could have made ends meet working for the minimum wage I was paying him!

I have read that the fundamentals of outsourcing often advise against owning anything. I now lease my building and equipment, and also use a temporary agency to staff my office. After all, the receptionist doesn't do much. The office is mostly automated now, with patients making appointments on a computerized system in the reception area, which also can be accessed on the Internet. They swipe their own credit and insurance cards at a kiosk at the front desk. The funds are automatically deposited into my bank account. I use an outside billing service, so if patients have questions, the receptionist just hands them the phone and dials the number. If patients pay with cash, I come to the front desk and put it in my pocket. (Actually, this is not a new procedure.)

I use a paperless system now. I contract with a company that stores all the patient files in its database, and we pull them up on the encrypted Internet. I dictate the notes on DragonSpeak, and they are typed automatically. We also take a picture of each patient, because I have never been good with names.

There is a lovely couple - newly married, I think - who cleans my office. I say "I think" because they are from Guatemala and speak only Spanish, so communication is difficult. At first, I thought they might be here illegally, but their documents seemed in order. Their Social Security cards read "Schlomo Epstein" and "Shannon O'Rourke," which seems strange since they look more Mayan in appearance than Jewish or Irish.

My accountant is in India. But I hate to talk with him, because he always sounds terse and has no sense of humor. He is very bright, but unfortunately, there are some cultural differences that interfere with timely business. He is Hindu and apparently they have many holidays, including April 15th.

I have my X-rays done at a lab, but to save on X-ray interpretation costs, I have them read by radiologists in Jamaica who were trained in London. The images, of course, are digitalized and can be read by any radiologist in the world. I use the Jamaicans because they always send the reports back with a reggae music tag that brightens up the day. Previously, I used a Nigerian group, but the reports always had an addendum claiming that the chief radiologist was actually the prince and heir of a fortune, and if only I could forward some money, blah, blah, blah ... so I had enough.

One of the best outsourcing decisions I have made is the "virtual office manager" service from a company in Hong Kong. It is a computerized personal "secretary" that pays my bills, renews my magazine subscriptions, organizes luncheon dates and makes sure roses are sent to my wife on Valentine's Day. It's been a great help, but there have been some glitches. For instance, there was that Friday when 50 anchovy pizzas were delivered to the office.

I'm thinking about downsizing my office even further and laying myself off. But there may be economic consequences, since I can't collect unemployment payments. I guess I could claim that I, too, was a victim of "outsourcing."


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