I try very hard not to lie to myself.  For instance, I never tell anyone I will meet them early in the morning because I know it won’t happen.  I have great willpower unless I’m trying to wake up early for anything besides work or a flight.  I know I’m not going to floss every day, so I get my teeth cleaned every three months.  I’m not going to drink more water – I like green tea and Coke Zero.  I’m nothing if not self-aware of my shortcomings.  Many things in my personal and professional life could use some work, but I don’t set New Year’s resolutions or make goals lightly.  I will only make a goal if I can commit to it.   

     So, when Heather wanted us to make a list of goals for 2024, I was a little hesitant.  The only thing worse than lying to myself would be to do it publicly.  Therefore, I have attempted to make a list of goals I intend to accomplish.  These goals will help me focus on what is most important in business and address a few personal foibles I have been unwilling or unable to change.   

     I tried to make these goals SMART:  Specific, Measurable, Achievable, Relevant, & Time-Bound.  Not every goal on this list lends itself to this method, so I used SMART only when I felt it was appropriate.  I’ll review how I did at the end of 2024.  

What Are Your Top 3 Business Goals For 2024?

1. Expand Urgent Care Company

     The area in which our urgent care company operates is geographically isolated.  We have 4 locations in 3 cities and a similarly branded family practice office in a 4th city.  While there might be an opportunity for further growth in two of these cities, the others are too small.  Additionally, no other cities are large enough to support an urgent care within two hours of our central office.  We tried to expand to a separate geographic location a few years ago, ultimately failing.  An article about this misadventure, How I Lost a Million Dollars, is coming soon.   

     My goal is to open at least one new clinic in 2024 or have a firm plan (geographic location and clinic site) to start a new clinic in 2025.  I have until the end of the year for this goal.  It takes time to identify an appropriate location.  This expansion can be from organic growth or through acquisition.  We have already been looking at an acquisition target and a new geographic market, so this goal is certainly achievable. 

However, negotiating to buy another company is never a sure thing until it actually closes, and building in a new market depends on many factors, mainly site availability and the pool of qualified employees.  It also takes a long time to close a deal and to build out a new location if the site chosen is an empty shell.  Opening a new location in August – October is preferable to be established by the winter season.  So, this is a goal I will have to focus on early to make it happen in the coming year.  

2. Grow BusinessIsTheBestMedicine.com

     One of my highlights of 2023 was starting this blog.  So far, our focus has been on producing quality posts, staying consistent with our aggressive release schedule, and improving our writing.  This has consumed a lot of time, but I believe we have succeeded in all three objectives.  However, we have yet to spend time trying to grow our readership.  I wanted to ensure that we could consistently produce quality articles before trying to publicize ourselves.  Truthfully, I also have a terrible aversion to any kind of personal spotlight.  It took several months for Heather to convince me to put my picture on this website.  We plan to continue with this focus until we have reached at least 50 articles on the site, of which we are proud.  At this point, we may relax our twice-per-week schedule to once a week to have time to grow the blog.  

     The goal in 2024 is to gain consistent readership, which I believe we can accomplish using two methods.  We need to market the site more and network with others in the space.  This blog has an important message that I believe would benefit all medical professionals at all stages of their careers.  So, while Heather and I will market the blog more aggressively, there are a few items that I would like to complete.  First, I want to write at least one guest post on another blog.  I will also attend at least one conference relevant to the blog’s content.  Finally, I will speak to at least two professional schools about the importance of understanding business and personal finance.  

3. Optimize All Businesses 

Traction goals

     I consider myself a big-picture guy.  If you have read Traction, I’m the visionary rather than the integrator.  I’ve got a hundred business ideas a year, a few of which are actually decent.  My problem is the implementation.  I’ve worked around this by surrounding myself with partners who are good with details.  However, I’m also very interested in numbers, finance, and math- the very definition of detailed work.  Therefore, in most of my businesses, I take on the de facto chief financial officer (CFO) role.  These two roles occasionally put me in a contradictory position.  The visionary in me wants to expand and start new service lines, new projects, and new businesses.  Some of these ideas work out spectacularly, such as when I made a million dollars in 8 months during the pandemic.  Other times, these ideas die on the vine and become a drag on my overall business portfolio.

     My goal in 2024 is to closely study the financials of all my disparate businesses and do some housecleaning.  We have started service lines that are not profitable.  The losses are minor, but these projects must be remedied or terminated.  Other ventures are cashflow positive but may not be worth the trouble it takes to keep them running.  Finally, other profitable projects need a refresh, refocus, or redirection to maximize their full potential.  I need to dedicate time each month to go through the financials of each business and optimize their returns.  

What Are Your Top 3 Financial Goals in 2024?

1. Open a Donor Advised Fund (DAF)

     I mentioned this in my charity auction post and want to complete it this coming year.  I have appreciated shares of stock in a taxable brokerage account that I can donate to the DAF.  This will save me money on capital gains taxes, and I can deduct the whole donation amount in 2024.  This works because I have unrealized gains in a taxable account, itemize my taxes, and am comfortable irrevocably donating a large sum.  This goal should be easy to meet, and I’ll document the process for the blog.  

2. Change My Retirement Plan to a Solo 401(k)

     This goal will take a little more work but is still straightforward.  I have worked as an independent contractor since I started my medical career.  I started a SEP IRA in 2006 to fund my retirement and save on taxes.  All the older doctors I worked with recommended it because they used it.  The Solo 401(k) was created in 2001, so I imagine none of my older colleagues had heard of it.  During the first part of my career, I focused on building wealth through working long hours and investing in real estate.  I maxed out my SEP each year simply to decrease my tax burden. 

Over the years, I have learned that the SEP has the disadvantage of precluding you from performing a backdoor Roth.  I have wanted to make the transition for several years but have never gotten around to doing it.  I plan to remedy this in 2024 and will let you know how it goes.  

     While it would have been great to have been investing in a Roth for the last 17 years, I don’t think it is too late to make a difference.  I don’t plan on working clinically forever, but it is possible that I may continue to work part-time for the next ten years.  During that time, I could amass an additional $78,000 in contributions and perhaps have $100,000+ at the end of a decade.  If that money doubles every 7-10 years, and I live to be 80, that could still be $400,000 of tax-free money.  My wife is younger, so she could live another ten years, achieve another doubling, and leave $800,000 tax-free to our heirs.  Considering our current net worth and the 40+ years of growth in question, this may not be material, but it’s probably worth the time it takes to make the change and the yearly conversion.  

3. Deploy Capital 

     I am currently sitting on a large amount of cash, above and beyond my emergency fund.  Since my career began, I have kept a larger-than-normal amount of cash despite knowing it is not mathematically optimal.  I like the security of having multiple years of my expenses readily available.  I also use boluses of cash at opportune times when I believe I can make outsized returns, such as to start a business, lend money privately, or buy real estate.  My cash horde has grown over the last few years as my companies have increased their cash flow, and I have sold a few rental properties. 

In the previous two years, I deployed much of that money into the stock market but have also increased my cash reserves.  The current interest rates of 5% have also influenced my decision.  However, I think I have overshot and currently have too much of my net worth in cash, roughly 10%.  I would be more comfortable at 5% and thus would like to deploy some of that capital in 2024.  I want to do this appropriately, of course.  I want a good return on my capital, but I haven’t looked hard enough over the past two years for those good deals.  I’ll keep you all informed if and when I find something.     

What Are Your Top 3 Personal Goals in 2024?

1. Work Less   

     When people ask what I do, I tell them I’m an ER doctor but only work about eight shifts per month.  That is how I think of myself: as someone who works part-time.  However, if you ask my wife, she’ll tell you that I work nonstop, from the time I wake up until after she goes to sleep, at home, and on vacation.  I guess it is a matter of perspective.  I do chart reviews, talk with my business partners, answer patient care questions from the UC, research and write articles for this blog, create lectures for our various practices, approve the schedule for our ER group, work on various special projects, and more. 

To me, none of it is work.  Typing, reading, thinking, working on spreadsheets, and talking on the phone don’t seem like work compared to a shift in the ER.  However, my wife correctly assesses that it takes time away from my family.  Since I stopped working so much clinically to have more time with them, that creates a problem.  

     I love business.  I love to create things.  I love to help, educate, and advise people.  I don’t want to stop doing these things.  However, I don’t want my business hobby to adversely affect my family time.  My goal in 2024 is to work less when it affects my family.  Unless they are patient care related, I won’t answer calls during dinner or protected family time.  I will be mindful of the time I spend working on the weekends and while on vacation.  I won’t stop working on things I enjoy; my goal is to be more efficient and aware of when I am working on them.  I am currently writing an article on my problem with time management, which I will link to here when finished.  

2. Be Consistent 

     I read something long ago that said multitasking was a myth.  We can only focus on one thing at a time, and those who are “good at multitasking,” like ER physicians, are really just good at switching focus from one thing to another.  Perhaps this is why I have a problem with consistency.  I tend to focus on one thing intently, to the detriment of others, and then move on to something else after some time.  If I am reading a book, I’ll go without sleep and postpone other work in order to finish the book.  Then, I may not pick up another book for a few weeks.  When I exercise, I’ll work out 5-7 days a week for several months, then stop exercising for a few months.    

     My goal in 2024 is to write and exercise more consistently.  Instead of marathon writing sessions, I want to write for an hour every day that I am at home (not traveling or working clinically).  I want to exercise 3 days a week for 48 weeks of the year.  I know there will be some weeks when travel or work will prevent this, so I’m giving myself a little grace.  I will keep track by marking on a calendar each day I accomplish these items in 2024.  

3. Be Honest

     I don’t have a 3rd personal goal, but not because I don’t have things to work on.  The truth is that I couldn’t come up with one that I felt I was ready to commit to, and there were so many to choose from.  In no particular order:  I need to be more social, talk less and listen more, keep in better touch with friends & family, be more patient, use my phone less, show gratitude more often, learn to relax, eat more vegetables, and spend more time in nature.  I plan to work on all these things, but I’m not sure I’m ready to commit to any SMART goals in 2024.  

How Do You Plan on Keeping Yourself Accountable?

    The most important way to keep myself accountable is by simply publishing this post.  By announcing my goals on this blog, I have committed to completing them to the best of my ability.  For those that have a definite end point, I will write about them when they are done.  For those that are more fluid, I will track them and summarize my results at the end of the year.  Additionally, Heather and I meet weekly so that I can put a recurring line item on our agenda so we can check in and keep each other accountable.  

     What are your goals for 2024?  Hopefully, one is reading this blog consistently.  You can be proactive by subscribing so you never miss a post.  Need some accountability?  Leave a comment or send us an email to state your goals publicly.  We’re in this together!  Happy New Year.