Opportunities and Entrepreneurism

© Springer International Publishing Switzerland 2016
Lewis A. Hassell, Michael L. Talbert and Jane Pine Wood (eds.)Pathology Practice Management10.1007/978-3-319-22954-6_21

21. Opportunities and Entrepreneurism

Lewis A. Hassell  and Michael L. Talbert 

Department of Pathology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd., BMSB 451, 73104 Oklahoma City, OK, USA



Lewis A. Hassell (Corresponding author)


Michael L. Talbert

EntrepreneurismRiskLeadershipVisionProblem-solvingBusiness plan

Case: Taking Out and Centralizing Histology

The Regional Pathology Group not only contracts with eight hospitals to provide pathology services but also serves much of the region’s physician office outpatient market. While the eight hospitals comprise two hospital systems and two independent hospitals, all are amenable to allowing the pathologists to create a regional histology and cytology lab as a means of controlling histology costs and sending out immunohistochemistry tests. The pathologists’ consultant showed convincingly that the pathologists could achieve economies of scale, greatly increase the available immunohistochemistry menu, and create a positive margin while charging back to the eight hospitals total annual amounts that would essentially equal the current cost of operation of each of the smaller histology and cytology operations. The consultant also believed that the pathologists and hospitals would further benefit from the increasing expertise of the pathologists and faster turnaround time for difficult cases requiring additional studies.

How might this histology lab be achieved?

How could the shares be valued?

How could buy-ins and buyouts be structured?

Discussion: Obviously this not only represents an opportunity but also a challenge that the group must assess from financial, operational, and structural standpoints. Acquiring equipment and staff from existing operations would be a natural first proposal, but even before that can be done, some sort of operating entity must be created. Doing this within the structure of the practice might be possible, but would likely change the nature of their corporation or partnership. So, a new structure would need to be capitalized before space and equipment, much less employees, could be brought in. If the pathologists become the owners, as they are likely the source for the capital and operating experience in this case, they need to identify and think through possible future events, such as the addition of new partners and the departure of existing owners very carefully, and preferably with wise counsel. For small closely held companies such as the lab described here, valuation is difficult and can be costly to ascertain. Book, or liquidation, value usually underestimates the value, while revenue-based valuations may mistakenly overestimate the value by failing to consider various forms of market risk.

The Entrepreneurial Pathologist

Pathologists are inherently problem-solvers . They look at a patient’s biopsy or surgical specimen and relish the challenge of providing the answer to the puzzle. They consider aberrant coagulation results and devote their understanding of pathways, genetics, chemistry, testing platforms, and kinetics to making a diagnosis and predicting future consequences and potential treatment. The reward is in finding the solution and solving the clinician’s dilemma. But another common trait is a reluctance to expose themselves or the patients they serve to risk, primarily the risk of a misdiagnosis, since they are keenly aware of how small features, such as lymphovascular invasion or extension to a serosal surface, can alter perceived prognosis and chosen therapy for a patient .

Both of these characteristics need to be appropriately balanced for a pathologist or group to engage in entrepreneurial ventures. There are certain other key characteristics that may help practices successfully use their talents in new endeavors. One of these is the ability to “see” differently. An entrepreneur sees opportunities where others may see only obstacles or hardship. Entrepreneurs see their resources differently as well, often both in themselves and in others around them. This optimism can be a temptation to get out ahead of the group tolerance and capabilities, so would-be entrepreneurs are wise to temper their enthusiasm with the balance of more risk-averse colleagues, without always being totally shot down by expressions of risk aversion or fears of failure .

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Oct 29, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Opportunities and Entrepreneurism
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