THE EVOLUTION OF SUCCESS<

by: Robert Anthony, Shelly K. Schwartz, and Bill Sonn

George Bernard Shaw once said, “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man.”

Old George was right. So we thought we’d introduce you to some of healthcare’s most unreasonable visionaries: Hal Teitelbaum didn't like the way physicians were being squeezed out of the equation in the new world of managed care, so 12 years ago he set out to build a new kind of healthcare delivery system. James Dove decided the best way to provide cardiac services in rural Illinois was to build one of the largest, and finest, heart care centers in the country. And Michael Janssen thought it would be fun, if revolutionary, to create a spinal care center that's a whole lot more.

Each concluded that in the new world of healthcare, the surest way to control your fate is to get big enough that you can't easily be pushed around. Each took big, but not foolish, risks, and each followed his passion.

Why tell you their stories? Because you could be next.

CRYSTAL RUN HEALTHCARE: GROWING FOR SURVIVAL

When Hal Teitelbaum started his solo hematology and oncology practice in Middletown, N.Y., in 1982, he had to borrow $100,000 just to finish and furnish the office space he rented. “It literally had a dirt floor and no partitions,” Teitelbaum remembers.

Hiring staff, buying equipment, and building a business all seemed like daunting tasks, and Teitelbaum worried about failing. “I asked my father what would happen if I didn’t meet [my financial] projections, and he said, ‘Well, you'll go bankrupt. But we won't let you starve.’”

Teitelbaum took the risk and didn’t go bankrupt. In fact, his practice, Crystal Run Healthcare, grew — to seven offices with a total of more than 200,000 square feet to finish and furnish. “We are to my knowledge the fastest growing medical practice in New York state, and probably one of the fastest in the country,” says Teitelbaum.

That wasn’t the idea when he started. Having worked at Memorial Sloan-Kettering Cancer Center and Albert Einstein College of Medicine, Teitelbaum never thought he would end up working in a large practice. “I think that many physicians are sort of independent; they’re not used to playing well in groups,” says Teitelbaum. “The typical thing that you’ll hear from physicians if they have a bias against larger group practices is, ‘I want control.’”

Tired of the bureaucracy and worried that an academic setting wouldn’t allow him as much freedom, Teitelbaum opened his own offices and was joined two years later by a former colleague from Sloan-Kettering. For the next decade they kept the practice small, with just two partners.

Ironically, the same desire for control pushed Teitelbaum to grow his practice. The rise of managed-care organizations and physician-management companies in the early 1990s convinced Teitelbaum that doctors were being squeezed out of medicine. External decision-makers were controlling how patients were treated, when they could be referred, and whom they could be referred to.

Teitelbaum wanted to be able to refer his patients to competent physicians — but even when he found them, he still had trouble scheduling appointments. “Many physicians then, and some still today, measure their success by [how long] it takes to get an appointment with them. I would argue that's a measure of their failure.”

NO MORE OUTSOURCING

With healthcare growing more bureaucratic and dominated by managed care, Teitelbaum felt he wasn't providing patients the best possible care. “It would be like BMW or Porsche saying, ‘We build the best cars in the world — but, by the way, we<

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