Have dream ... will prevail.

Susan Reynolds, MD, PhD, a skilled and well-trained emergency and critical care physician had been in practice only a year when, in 1982, she realized that she had to become an entrepreneur.

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While she loved medicine and caring for patients, her professional life lacked passion--"a real commitment to doing something that ignited my life that provided an extra creative input, in order for me to feel satisfied," as she puts it.

Her idea was to open a freestanding emergency room in Malibu, Calif., a beach community in Los Angeles County that was, and still is, surprisingly under-served by hospitals.

She was well prepared for her role. She was good at working with others and had experience in building a team. She was also blessed with sufficient self-awareness to recognize how much she enjoyed leadership, as well as the "people politics" that accompanied much of medical staff committee work. These insights gave her the energy to overcome any inner resistance and fear she felt.

A recent poll of over 2,000 physicians revealed that many desire to develop a clinical or non-clinical business, learn business skills or bring a new product or service to market. However, less than a quarter felt highly confident that they had a good working knowledge of how to start up and operate a business or bring a new product or service to market.

Like the poll respondents, Reynolds harbored the desire to become a business owner. However, she felt clueless. Very little in her education had prepared her for business. Very little that is, except for a favorite course that was offered in her residency at UCLA by an accounting firm, on "How to set up your own office."

She dug up her old notes on how to create a financial proforma, bought a book on starting a business, hired a business advisor, an attorney, an accountant, a banker and an insurance broker and got to work.

Open for business

The Malibu Emergency Room began life in the summer of 1982 as two beds on the back porch of a family physician's office, with a wooden bench for a waiting room, and it rapidly filled up with sick or injured locals and beach-going tourists.

As independent professionals, many of us are accustomed to joining or starting medical practices with a view toward working for ourselves as physicians. As Michael Gerber writes in The E-Myth Physician: Why Most Medical Practices Don't Work and What to Do About It, we are, in effect, creating jobs for ourselves that enable us to ply our hard-earned skills.

However, very few of us are taught how to relate to the business of medicine, or any other clinical or non-clinical business we choose to engage in. According to Gerber, most physicians in private practice are suffering from an "entrepreneurial seizure."

This was potentially true for Reynolds. She loved being able to practice medicine in a business of her own creation. But despite its early success, the Malibu Emergency Room's viability was threatened by a projected annual shortfall as the summer hordes departed, leaving behind a smaller community of local residents.

Reynolds crunched numbers with her business advisor and had her first taste of real fear when she faced the risky decision of forging ahead instead of abandoning her dream. She needed financial support to keep the Malibu Emergency Room's doors open. Fortunately, the town needed her.

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In a creative partnership, the town leaders stepped in to help find the necessary funding. At their instigation, Reynolds formed a non-profit entity with a sole function of supporting the annual administrative shortfall of the emergency room. She and the town collaborated to raise the funds hosting celebrity rock concerts and other charity events--to the tune of over $100,000 annually!

Too often, we are deterred from germinating our "dream" entrepreneurial business or seeing it to fruition because of fear and uncertainty, insufficient funding and lack of exposure to sound business principles and practices. Upon reflection, Reynolds attributes the early success of her first business to:

* Recognizing her strengths, as well as knowing which complementary skills and traits she needed to seek from other sources for her business

* Having a truthful sounding board of key professionals she chose to surround herself with

* Following her passion to provide a service that was valued by others who were willing to help her fund her venture when she hit a barrier

* Being able to continue working as a clinician while she "wet her feet" as a entrepreneur, which was important to her at the time

Like many entrepreneurial tales, her story takes a twist after 11 successful years in business. Malibu proved to be a town hit by natural disasters on a regular basis and within 12 months in her twelfth year, the Malibu Emergency Room experienced substantial physical and economic losses from flooding, fire, mudslides, and a major earthquake.

Reynolds had to re-evaluate the sanity of pouring funds into restoring function to the crippled emergency room after each disaster. After the fourth event in one year, she was forced to close her business.

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Changing course

Most physicians enjoy the actual practice of medicine to the extent that, for many of us, our personal identities become entwined with that of being a doctor.

It is daunting to picture walking away from the huge investment of time and money we have made in our careers, despite the many pressures we face as practitioners today. It is even more disturbing to imagine the feeling of no longer being a "real MD."

But for the restless physicians who yearn for something more, these feelings of loss are counterbalanced by the stronger urge to create something, shape a new adventure and build a path toward the expression of both a professional and a personal lifestyle.

For Reynolds, it was the coincidence of both business and personal challenges that necessitated her taking stock of her life. She paused long enough to recognize that she was finally ready to give up clinical practice and take advantage of a new opportunity that had arisen--to develop a national physician executive practice for an international executive search firm. She had reached a point of no return in her professional journey to entrepreneurship!

During the seven years of working as an independent physician executive search consultant under the auspices of a large firm, Reynolds once again suffered a "passion drought."

Her work was interesting, but not enough to give her the deep professional satisfaction she sought. However, what she did discover early in her new role as a recruiter was her talent and a love for coaching physician executives and educating them about the leadership roles they were seeking.

Fueled by her own experiences, some on-the-job-training in coaching and extensive reading on leadership, she responded to her longing to experience career passion again by exploring an idea for a business focused on physician leadership development.

She began by examining her needs. Being a seasoned self-evaluator by this time, she heeded her own lifestyle desire to be a "hands-on" single parent and to limit the demands for business travel, as well as her delight in going to nice resorts in wonderful locations.

She formed the Institute for Medical Leadership at the beginning of 2002, an executive coaching and physician leadership training company. She developed the curriculum and recruited a prestigious faculty for her medical society leadership development programs as well as for "chief of staff boot camps," which are held in nice resorts. Her business is thriving and so is she.

What do you really want?

The place to begin tackling the decision to go into business for ourselves begins with a hard and honest look at what personal and professional lifestyles we really want for ourselves, what we are capable of (far more than most of us can imagine) and what sacrifices we are willing to make.

Reynolds' experiences reinforced three key insights for a business start-up:

1. Have an exit strategy before you even launch your business. Create options for how to get out of your business if and when you desire or need to. Plan to sell the business, partner with someone, shut it down and walk away with sufficient savings set aside for that "rainy day" to enable you to start again, or keep working on the business until it dies its natural death. Reynolds now has such a plan for her current business, something she learned the hard way when her emergency room venture failed as a result of the unanticipated natural disasters.

2. Take time to clear out the cobwebs of inadequacy or negative self-talk, be still with yourself for a while, and search your soul until you are able to discover your passion. That passion will provide the fierce drive and the devotion to your business's and life's purpose and keep you going over the long haul.

3. Take calculated risks; don't just jump off the diving board and hope they remembered to fill the pool. Create a well-thought-out plan with input and support from others. But don't let the fear of failure or of not knowing something become your justification for not venturing into new territory.

Reynolds is an entrepreneurial success story. She not only articulated her dream but dared to go after it. She persevered and learned from failure. She responded to a deep calling to live a life that allowed for passion. And she began with the end in mind--the life she wanted to live both personally and professionally that she designed and then figured out how to attain.

Philippa Kennealy, MD, MPH, CPCC, is a certified physician coach and president of Oya Consulting. She coaches aspiring and actual physician entrepreneurs, and can he reached at philippa@entrepreneurial MD.com or www.entrepreneurialMD.com

RELATED ARTICLE: Do You Really Need a Business Plan?

The prospect of writing a business plan intimidates some would-be entrepreneurs. Some simply open a new practice, or service business, or create a Web site and begin selling.

In fact, a well-written concise business plan is an elegant communication tool, used perhaps just to elucidate one's own ideas or to arouse sufficient interest to fund a $3 million venture. Key elements include:

* Executive summary

* Business mission statement

* Product/service description and differentiator(s)

* Market description

* Proforma, projecting revenues and expenses for 2-5 years

* Competitive analysis

* Management biographies

* Funding and next steps

Susan Reynolds, MD, PhD, admits to initially having no formal business plan for the Malibu Emergency Room she built in the 1980s. She relied instead on guidance from a now out-of-print business-building advice book. Following the book's counsel, she wrote a proforma, a projection of anticipated revenues and expenses.

Her first "three-month summer version" was modeled on a population of 400,000, including summer beachgoers. Opening the ER under these conditions made financial sense. However, she knew the year-round population was only 12,000; and she was wary.

With a business advisor, she created a second proforma for the first few years that told a different story. The ER would lose $90,000 a year. Yet a competitive analysis revealed no comparable service for 150 square miles and the community was crying out for the facility.

Without formal market planning, Reynolds set to work. In retrospect, she recognizes she undertook many typical marketing plan activities by:

* Forming a strategic alliance (the Chamber of Commerce and key town leaders)

* Forming an advisory board for her 501[c] 3 fund-raising charity

* Contacting newspapers and writing articles (her "PR plan")

* Speaking in multiple venues

* Giving away promotional items such as First Aid Tip Sheets to local restaurants

* Participating in community activities like teaching CPR courses

Reynolds received on-the-job business training the hard way, and it speaks volumes that she started her current company with a formal business plan.

--Philippa Kennealy, MD, MPH

By Philippa Kennealy, MD, MPH