I recently finished reading The Executive Scalpel: Cutting Through the Business of Healthcare by Dr. Justin Sherfey and thought it was a valuable overview for younger surgeons and physicians interested in understanding what to expect when running a private practice.
One of the strengths of The Executive Scalpel is that it addresses the business side of medicine that is often missing from formal medical training. Dr. Sherfey walks through many of the practical realities physicians encounter when building and running a practice, including legal frameworks and business structures, negotiating with insurance companies, pricing and collections policies, structured appointments, and ancillary revenue opportunities.
We have worked with many new practices over the years, and this book touches on many of the same challenges and roadblocks we consistently see physicians navigating as they build and grow a practice. One of the biggest surprises for many younger physicians is how much operational planning needs to happen before the doors ever open.
Insurance credentialing, billing workflows, collections policies, appointment structure, front desk communication, patient processes, and documentation systems all need to be thoughtfully planned early on. We have also seen practices underestimate how important it is to properly structure insurance billing and submission processes from the beginning. It is far better to submit claims correctly the first time than deal with the frustration, delays, and cash flow disruption that come from rejected claims, rework, and resubmissions later.
Dr. Sherfey also emphasizes several important principles that many physicians overlook early in practice ownership:
As he reinforces throughout the book, even small adjustments matter over time.
One section I particularly appreciated focused on consulting opportunities as a way for physicians to extend their influence, build thought leadership, strengthen their practice, and create additional revenue opportunities outside of direct patient care.
Another message that strongly resonated with me was one of my own favorite mottos:
“If you don’t ask, the answer is a definite no.”
Dr. Sherfey also shares thoughtful warnings about the limitations and risks associated with hospital partnerships and venture capital involvement, particularly when it comes to physician autonomy and long-term control.
One of the clearest takeaways from the book:
Your time as a physician is valuable. Never work for free.
One area the book only briefly touches on is marketing and tracking marketing ROI. That’s understandable because the book covers a wide range of operational topics. But it also reinforces something I see every day: many excellent physicians still underestimate how much visibility, reputation, and patient trust now impact practice growth and long-term independence.
If you are a younger physician, practice owner, fellow, or resident interested in better understanding the operational and business realities of medicine, I think this book is worth adding to your reading list.
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