B EYON D the DAYS of the G IANTS Solving the Crisis of Growth and Succession i n To d a y ' s C P A F i r m s Paul D Fisher B EYO N D the DAYS of the G IANTS Solving the Crisis of Growth and Succession i n To d a y ' s C P A F i r m s B EYO N D the DAYS of the G IANTS Solving the Crisis of Growth and Succession i n To d a y ' s C P A F i r m s Paul D Fisher Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business A PRODUCTIVITY PRESS BOOK CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2014 by Paul D Fisher CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S Government works Version Date: 20130822 International Standard Book Number-13: 978-1-4822-0357-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint Except as permitted under U.S Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers For permission to photocopy or use material electronically from this work, please access www.copyright.com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400 CCC is a not-for-profit organization that provides licenses and registration for a variety of users For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com For my dearest Colleen, who worked so hard while she waited for me to grow up I’m glad you got a glimpse of our shared legacy I promise to keep growing it for us Contents Foreword xi Acknowledgments xiii Introduction xv About the Author xix 1 The Days of the Giants .1 The Giants’ Laments Value Creation Commitment .4 Profit Management by Tradition Hope for the Return of the Business Cycle .5 Find Forms of Less Expensive Labor Find New Ancillary Services Decide to Merge The Keys or the Car? 2 Giants and Dinosaurs .13 Glory Days .14 The Extinction of the Finders 16 The Minders Follow the Finders .18 Enron and WorldCom 18 The Great Recession 18 And, Last, the Grinders 19 Opportunity and Security Diverge 20 The Clinical Analogy .22 3 Clash of the Titans 25 Flavor of the Month 26 I’ll Be the Judge of That! 28 Me and My Knee 29 vii viii ◾ Contents The Customer Is Always…Responsible 33 Client Choices: The Value of Doing Less 34 On to Commitment Number Three 35 4 Creating Missionary Resolve .37 Lots to Do, Little to Accomplish 38 The Disappearing Department 40 The Merger of Value Creation and Succession .41 It’s Not My Problem! 42 But We’re Tired! .44 Where Do We Start? 45 The Simple Case 46 Cooperating Specialists 48 5 The Efficiency Equation 51 Save Money—Live Better 52 Growth, Stagnation, or Contraction? .60 6 Building Your Efficiency Numerator 63 The Dreaded Fee Discussion 64 Painting the Picture 66 A Serious Value-Creation Problem 67 But Did We Win the War? 72 Oh, and by the Way 74 You’re Not Alone 75 7 Succession Is Everyone’s Crisis 77 The Minder’s Lament .78 The Merger of Value and Succession 79 Two Birds with One Stone 80 Happy Retirement! 82 One or the Other? 83 One, the Other, or Both? 84 Good, Better, Best 85 Mourning the Minders’ Demise .86 From Theory to Practice 87 8 Entrepreneurialism by Design 89 Think Big, Sort Of 91 Our Value-Management Model 93 Who’s Carrying Whose Water? 94 Contents ◾ ix With or without Mayo? .97 To Merge or Not to Merge .99 9 Build Your Own Mayo Clinic 101 From Giants to Standards of Care 102 Algorithms 103 People .104 Processes 104 Status and Professionalism .105 We the Practitioners 111 The Journey so Far 111 10 The Decision Engines .113 Uniformity vs Linearity 114 So Where Do We Start? 115 Assessment 116 Learn by Doing 117 Deja Vu, Revisited 119 Specialty Competence 120 Specialty Integration .120 Labor Leverage Factor 121 Value-Management Index 122 Referral to Nowhere .124 11 The New Minders 127 Melancon’s Undiscovered General Practitioner .128 The Lineage of the Giants 131 Exit the Finders 134 Exit the Minders .137 So Now What? 142 12 Your Primary-Care Teams 145 A Simple Measure 146 Cross-Organizational Teams 148 The VMI Challenge—Relationships or Evidence? 151 So What Now? 154 Bibliography 157 ...B EYO N D the DAYS of the G IANTS Solving the Crisis of Growth and Succession i n To d a y ' s C P A F i r m s B EYO N D the DAYS of the G IANTS Solving the Crisis of Growth and Succession i... explain a reference in that article to the Days of the Giants. ” Dr Ofri’s response was that it was an industry term -of- art describing the feelings of senior and retired doctors about themselves and. .. arrived at the beginning of 2012 The AICPA, in cooperation with the Chartered Institute of Management Accountants in the United Kingdom, began offering a credential to their memberships called the Chartered