Dr. James Leavitt: How to Grow Your Private Practice

You also need to build great teams that share your vision, mission, and care and lead by example. You need to always remember there can be no leadership without a team.

As a part of my interview series with prominent medical professionals about “How to Grow Your Private Practice,” I had the pleasure of interviewing Dr. James Leavitt.

James Leavitt, M.D., FACG, is the current President and Chief Clinical Officer of Gastro Health, a leading Gastroenterology platform company with more than 250 providers currently located in 4 states and the first GI company to partner with a Private Equity firm back in June 2016. He is a past President of the Florida Gastroenterologic Society, served as the ACG Governor for South Florida for 6 years, and has served on numerous committees for the ACG and ASGE. He was named by Becker’s Review as one of the 75 gastroenterologists to know in the United States.

Thank you so much for joining us! Can you tell our readers a bit about your backstory?

I grew up in the Northeast — I went to high school, college, and medical school throughout the region. My entire family is from Boston, where I lived until the fifth grade. So, obviously I was a hardcore Red Sox fan. In the fifth grade, I moved to New York and I was surrounded by Yankee fans. By the seventh grade, I was converted to a Yankee fan, which created significant problems with the rest of my family.

After medical school, I decided that I wanted to live somewhere else for a few years before moving back to the Northeast. After training in Miami for three years, I decided there was no way I was moving back to the Northeast winters. That’s how I ended up living in Miami, sort of just by chance.

What made you want to start your own practice? Can you tell us the story of how you started it?

I didn’t start my own practice. I joined a practice that was founded in 1969. When I joined in 1980, I was the fourth person to start working there. However, the story about how I joined the practice shows that life is full of random moments that can profoundly shape your journey.

At the time, I was finishing my GI training in Miami and I had intended to stay a part of the university faculty. In April, of the last year of my fellowship, it became apparent that there were a lot of politics going on in the division. So, I decided to look for other last-minute alternatives.

Coincidently, we used to have a meeting with private GI practitioners in the Miami area every couple of months for an interesting case conference put on by the university. There were always three gastroenterologists from a particular practice that seemed incredibly interesting, liked by everyone, and were clearly the smartest people in the room. I went to my chief to inquire who these physicians were, and later cold-called them. I informed them that they needed a fourth person, which they refuted, saying that they were moving into a new office in a few months and could not afford another physician.

I asked them if we could meet in person — telling them how I could add value to their practice because I did advanced endoscopic procedures that they did not do at that time. Still, they persisted, explaining that they could not afford a fourth physician.

Then I made them an offer they couldn’t refuse!

I told them that they’d just have to pay me what I would make as a fellow. If the practice did well, then I’d want to do well. The risk was essentially zero; I just wanted to prove myself. So, I made them an offer they couldn’t refuse, and they didn’t. It all worked out; I’ve been with the same practice since 1980.

Managing being a provider and a business owner can often be exhausting. Can you elaborate on how you manage(d) both roles?

It’s a challenge — there’s no question about it. We are no longer a small business. We employ more than 1,500 people, more than 250 doctors, and have over 100 sites in four states.

We built a great team, so I don’t need to worry about the day-to-day operations in our practice. Therefore, I can deal primarily with important non-urgent things that I can schedule well out in advance. Obviously, sometimes you need to be flexible to deal with urgent matters, but hopefully if we planned well, these should be fewer and fewer over time.

I’m a big believer that if you fail to plan, you plan to fail. I have the luxury of having a great team on both sides of the equation, which helps me manage both roles.

As a business owner, how do you know when to stop working IN your business (maybe see a full patient load) and shift to working ON your business?

It’s one of the biggest challenges I face. Delivering healthcare and the business of healthcare are different in many ways. In healthcare, seeing and caring for patients is immediate and intense, but at the end of the day, I’m done. The business part isn’t as immediately intense, but it never goes away; you’re always thinking about it.

You’re never quite certain when to shift between working in your business and working on your business. If you properly schedule and keep urgent matters to a minimum with the support of your team, it’s manageable.

From completing your degree to opening a clinic and becoming a business owner, the path was obviously full of many hurdles. Is there a specific hurdle that sticks out to you?

That’s not how I approach situations. Instead, I focus on how we are moving forward. What do we want to accomplish, and what are the issues that we want to tackle right now and in the future? It’s a never-ending battle for improvement, and the hurdle is to never be satisfied, always strive to do better, and accomplish more.

How did you build up resilience to rebound from failures?

Several years ago, I took part in a six-month leadership program in which we had individual coaches.

“Tell me about a time that you failed,” said my coach.

“I don’t think I have ever failed; I have just not succeeded yet,” I answered.

You should try new things and not be afraid of failure — you’re not going to get it perfect the first time. It is the continuous process improvement cycle. What creates failure is basically Einstein’s definition of insanity, which is doing the same thing over and over and expecting a different result. Instead, you must stay flexible, move forward, and strive for improvement.

What are your “5 Things You Need to Know to Grow Your Private Practice” and why? (Please share a story or example for each.)

When I first started at the practice, I was told there were three things that were important: availability, affability, and ability. Ability is a minimum requirement you need as a physician; you must be great at what you do. As a physician, you establish relationships with your patients and referring doctors, and you must be available and affable.

Secondly, you must really care, and people must easily recognize that you do. We have a poster up in our break room that says, “People don’t care how much you know until they know how much you care.” That’s an important and powerful thing to remember.

Thirdly, you’ve got to be mission-driven and not margin-driven. If you follow and achieve your mission, then the money, success, and reputation will follow.

You also need to build great teams that share your vision, mission, and care and lead by example. You need to always remember there can be no leadership without a team.

Lastly, you must embrace and be able to master technology, the internet, and reputation management. To do this, you must find a way to strategically manage technology without losing the personal touch or quality of care. You must also be resilient, and technology can support that mission. For example, during the COVID-19 pandemic the physicians at Gastro Health have been able to leverage eClinicalWorks’ healow Telehealth and other common solutions to continue to provide care for our patients. We’ve learned that we can connect remotely, safely and effectively with them and still maintain great patient satisfaction. In Florida alone, we were doing 6,000 televisits a week after just a 10 day roll out of our multifaceted televisit program. From a business prospective, this provided us with a critical ongoing revenue stream. It has become clear that telehealth is the right solution. Big picture — eClinicalWorks’ solutions and other technologies have helped and will continue to help our practice deliver high-quality, comprehensive care and results.

As my practice continues to leverage eClinicalWorks’ EHR platform, we are now building out our business and clinical intelligence solutions. Assuming that reimbursements for telehealth remain reasonable, I believe that the telehealth genie will not and cannot be put back in the bottle. I predict that at least 25–30% of our routine visits will stay virtual in the future — and this is something that benefits patients as well as the overall practice allowing us to be more efficient with resource utilization.

Many healthcare providers struggle with the idea of “monetization”. How did you overcome that mental block?

At our core, we are mission-driven not margin-driven, and I am incredibly proud of what we do. Every day, we do great things. We improve people’s lives by measuring quality. Our adenoma detection rates are well above the national average for screening colonoscopies. We have been able to significantly reduce our overall cost of care for colonoscopies and upper endoscopy. We are between 75 to 85 percent of average cost for a gastroenterologist in the state of Florida, for example.

And we get paid for this work. Private practices are for-profit companies. As long as you remain mission driven and provide great results for your patients and customers, then you have something to be proud of. Our primary mission is to provide outstanding medical care and an exceptional healthcare experience. So, as long we remain true to our mission, I have no mental block about “monetization.”

What do you do when you feel unfocused or overwhelmed?

I stop what I’m doing and do something else. Sometimes it’s essential to take a break, whether that means a vacation, reading a book, working out, or just stopping for a few moments and doing some relaxation techniques. Then I can come back feeling reenergized and start again.

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?

We have countless mentors throughout our lives. You should learn from as many people as you can. However, my biggest mentor has to be my parents. Parents instill your basic core values: what is right, what is wrong, which hopefully persists through the rest of your life and everything you do.

What resources did you use (blogs, webinars, conferences, coaching, etc.) that helped jumpstart you in the beginning of your business? Can you explain why they were helpful?

One of my favorite personality traits is that I’m a curious person. I like to learn. One of the great things about being a physician is that I’m always learning. When you’re younger, life tends to get into a pattern of change. You go to high school for four years, college for four years, medical school for four years, post-graduate training for four or five years, and then you go into practice. And after four or five years, you’re still there, there’s not a change; it was shocking.

Being the curious person that I am, I decided to continue learning new things in the delivery of healthcare and the business of healthcare. I got involved with the hospital as the chairman of the performance improvement committee. We were transitioning from quality review to quality improvement, which was a more forward-looking concept.

During this time, we got involved with the Institute of Health Improvement (IHI) led by Donald Berwick. I also got involved with learning the classic Japanese business improvement concepts. As we tried to apply these techniques to the hospital, it became obvious that we needed different tools to engage the physicians and to make real change. I came to understand that we have to use technology to accomplish our goals of quality improvement. So, I became interested in technology around Electronic Health Records. We were early adopters of an EHR in 2003. It became clear that we were going to have to use technology to accomplish our goals.

Additionally, I have taken many courses and read many books on finance, marketing, and executive leadership. One thing leads to another when you’re curious.

In interviews like this one, people often ask about the best advice that one was given. I’d like to flip the script. What’s the worst piece of advice or recommendation you’ve ever received? Can you share a story about that? Was there a lesson or take away from that story?

You receive advice from a variety of individuals throughout your life. Generally, people do not give advice with malicious intent. Thus, I take everything with a grain of salt and evaluate their advice through the lens of my value systems and knowledge.

Please recommend one book that’s made the biggest impact on you. Can you explain why that resonated so much with you?

It’s got to be Clayton Christensen’s book on disruptive innovation. Christensen talks about being an innovator and disruptive innovation in healthcare; I think that had a big influence on me. He discusses the fact that a transformation in healthcare must be created by a new institution rather than trying to transform an existing institution designed for other purposes.

Christensen says that when we try to preserve outmoded institutions, great companies disappear. There are often disruptive innovations that they can’t adapt to. The history of disruption tells us that these institutions will be replaced with institutions whose business models are appropriate for the new technologies in the market. I’ve always been a forward thinker, and that’s why I have always been interested in technology, whether it’s information systems, artificial intelligence, or predictive analytics. And that’s why we were the first GI group to partner with a private equity firm in 2016, to help us create this new institution.

In 2019, our company saw more than 370,000 patients and conducted 680,000 visits; that is a lot of data. We want to structure that data to be used for predictive analytics, and data mining, so we can care for our patients in ways that we never thought possible. We need to look at future technologies and innovations that are going to be disruptive, adapt them into our workflows, and then use them to our fullest advantage.

How can our readers follow you online?

Our company has an online presence, including a website, Twitter, Facebook, and Instagram. People can follow these accounts; however, I personally don’t have an online presence.

Thank you for these great insights!