January 19, 2018
Area(s) of Interest: Orthopaedic Surgery Physician Leadership
||Alan Pierrot, M.D.
It's more and more common to hear about physicians leaving their medical practice for other careers — mostly citing burnout. A Mayo Clinic-funded survey of nearly 7,000 physicians in 2014 found 54 percent reporting at least one serious symptom of burnout and an increasing dissatisfaction with work-life balance — up significantly from a survey done in 2011. Websites now abound offering career-change coaching for MDs. And DropOutClub.com, a social networking site, is where nearly 40,500 doctors commiserate and talk about the taboos of leaving the profession they worked years to enter.
But when Alan Pierrot, M.D., made the change, it wasn't because of burnout. He was just following his curious nature into new realms.
Entrepreneur is part of the doctor DNA
"I was fascinated by the notion that someone with an idea could write up that idea and get others to agree with it and then fund it," said Alan Pierrot M.D., a former orthopedic surgeon, explaining how he became the founding partner of Fresno Surgery Center, which eventually became Fresno Surgical Hospital.
Pierrot — he insists folks call him 'Alan" these days and drop the "Dr. Pierrot" formality — never set out to be an entrepreneur or to pioneer a new surgical delivery model. "I picked my profession when I was in seventh grade. I loved biology and I had a pretty strong bent toward public service” said Pierrot. "That was it and I never questioned the choice. I just loved it."
He loved medicine through his military training during Vietnam, through his first week in a new Fresno practice when he did three operations, and a decade later when his practice was thriving. But he also became captivated by the world of business investing.
“In those days doctors were the targets of investment schemes. We had money to invest and we were fairly unsophisticated,” Pierrot said. He wanted to learn more. "That connected with me and intrigued me. I thought it was wonderful that you didn't have to be part of General Motors to pursue an interesting new idea. I started fiddling around with putting groups of people together for investing in office space.”
Pierrot said he got lucky. The health care environment in the early 1980s was the perfect petri dish to create a new model for elective surgeries.
“There was a confluence of two ideas," he explained. The California state legislature was the first to encourage a more competitive approach to health care by eliminating the requirement for a Certificate of Need. At the same time surgeons in Arizona were discharging patients after minor elective surgery on the same day, rather than keeping them overnight — and having good results.
“So the idea that people could have outpatient surgery was coupled with the idea that anybody could build anything in health care if the market would support it, allowed physicians to pursue the development of surgery centers," Pierrot said. Investment dabbling had been unknowingly prepping Pierrot for the skills he needed to take advantage of those two ideas. In 1984, he led 76 physician investors in opening the 12,000-square-foot Fresno Surgery Center — the first outpatient-only surgery center in the nation. It wasn't long before the center needed to expand and add hospital beds to provide more complex surgeries requiring longer recoveries. In two years the group successfully pursued legislation to add 20 beds, the nation's first ever surgery center with beds.
He wrote in a 2003 Outpatient Surgery Magazine article about how once again the doctor group became pioneers, by overcoming. In 1986 they overcame California Hospital Association opposition to get state laws changed to permit surgery centers to add hospital beds. Only six outpatient facilities were approved for the change and only for up to 20 beds with patients limited to a 72-hour stay.
Although their investor group had expanded to 96 doctors, they couldn't muster the $5 million it was going to take to add on to the Fresno Surgery Center.
"Lenders didn't want to take the risk without some kind of operating model, and there was no other surgical hospital in existence on which to base this,” Pierrot wrote in his article. “At the time, the building trades were suffering in a weak economy and looking for opportunities to stimulate construction. Our investor group found a willing ear in the Carpenter's Union Pension Fund, which loaned the money on the stipulation that union labor would be contracted.”
By 1988, Fresno Surgery Center was again first in the nation, this time to provide overnight post-surgical care in a non-hospital setting.
Pursuing excellence obsessively
During his business building years, Pierrot said, he was unable to keep up with the demands a full time orthopedic practice and also be the kind of general partner investors needed. "I had the sole responsibility of looking out for the money, looking out for the interests of the patients and interests of surgeons," Pierrot recounted. He began seeing fewer patients and reading more business books to learn a new trade.
The book that became his business bible was "In Search of Excellence: Lessons from America's Best-Run Companies" by Robert H. Waterman Jr. and Thomas J. Peters. "It was inspirational," Pierrot said. "It made sense to me that companies needed to focus on customer service to succeed ... and it was inspirational," Pierrot said. "It made sense to me that companies needed to focus on customer service to succeed ... and it was obvious to me that health care didn't do it. Health care was only committed to technical excellence in those days."
Again, Pierrot became a pioneer, focusing on customer service a decade before the HCHAPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient experience surveys were instituted to require hospitals to pay attention to how patients felt about their stay. The Fresno Surgical Hospital also surveyed their patients before it was a requirement, adjusting based on the feedback.
"The patient appreciation was measurable," Pierrot enthused. The surgical hospital surveyed its patients long before it became routine, and it was getting 50 percent to fill out the hard copy surveys. "Patients wrote on the margins and they went on and on about the wonderful experiences and how grateful they were. I began to realize people were really angry at the arrogance of health care, doctors and hospitals — particularly hospitals. We all became zealots about customer service and everyone read the book — doctors, nurses and housekeepers."
Pierrot said while insurance payers and Medicare were slow to see the value of surgical centers with attached overnight beds, he could see it was "a superior model for delivering elective surgical services:' By 1992, after 19 years as a surgeon, Pierrot quit his practice and became a consultant to help others create outpatient surgery centers in other parts of the country.
It wasn't a difficult transition, he said: "I went from something I loved doing to something else I also loved doing. I took on another challenge that was important to me and that I cared about.” Market forces convened and changes in payment mechanisms aborted Pierrot's dream of taking the surgical centers to the rest of the country. He sold his business in 2006 and at age 65.
A constant search for 'interesting and meaningful'
"There I was trying to figure out how to make my life interesting and meaningful. I think that's the question you're in all the time," Pierrot said. "I did explore building Alzheimer's facilities. It just didn't connect with me. I was a surgeon and really loved figuring out how to deliver surgical services.” It was a book that again piqued his fascination and provided something new to learn and a new passion to follow: painting. Pierrot's still life and realist paintings are showing these days at Sense of Place Gallery and he's selling his work through his website www.alanpeirrot.com.
By Erin M. Kennedy
This article was exerpted from the fall 2017 issue of Central Valley Physicians Magazine, published by the Fresno Madera Medical Society.