I was invited to participate last night in a roundtable discussion with MBA students, from all the bigger Los Angeles schools, who were interested in entrepreneurship.

I represented the category of entrepreneurship and healthcare, and was pleasantly surprised to discover that several of the students were interested in learning more about healthcare opportunities, despite the siren call of much sexier sounding businesses like sports companies, fashion business and the liquor industry!

What stirred my juices was a question from a young man who, as a pharmaceutical sales rep now completing his MBA, had whiled away many hours in doctors' offices waiting to talk about his products. Instead of, as he put it, "reading Vogue or Sunset magazine -- the People magazines had invariably been stolen", or staring at the patients, he had chosen to strike up conversations with the office staff.

In doing so, he had become aware of many of the challenges faced by physicians in private practice, as well as some of the good, and less-well performed business practices.

He wondered out aloud whether there was a viable business opportunity - figuring out ways to help physician practices reduce waste, increase efficiency and generally run more like great boutique or even larger service businesses.

It was his next observation that got me.

"Why are doctors so cheap?" he asked. I gathered he was expressing concern that doctors wouldn't pay for the services he was considering offering.

I've heard this asked or remarked upon many times before, and I must have just dropped any pursuit of the question, perhaps because I didn't have an audience to blog about it to. Now I do - and you're it!

In trying to formulate a response, I realize that the questions behind this question need to be answered first.

Did he really mean: Why don't physicians understand that making an upfront investment in something can sometimes make them way more money later on? i.e. What do they know about Return on Investment?

Or, was he really asking: Why do doctors handle money so poorly?

Or perhaps: Why are doctors so arrogant about knowing it all and not paying for good help or advice?

Or, could it actually be: Why are doctors so miserly?

In his book "The E-Myth Physician", Michael Gerber has a chapter he calls "On the Subject of Money", where he describes the four factors of money:

1. Income: what the doctor takes home as an employee of the practice or business
2. Profit: what is left over after the practice has done its job efficiently and effectively
3. Flow: how much money is there when you need it
4. Equity: the financial value placed upon your practice or business by a prospective buyer of your practice or business.

This is, of course, a bit of an aside to my original question (just thought I'd take a moment to give you something meaty to think about!).

What Gerber says, and perhaps this is at least part of the real answer to our young man's question, is:

• Doctors have studied medicine and NOT the economics and finances of practicing medicine - they lack knowledge
• Doctors are really busy people, under a lot of pressure (getting worse all the time - my comment) - they lack the time to get educated about money
• Doctors, for the most part, don't like dealing with money - they have an emotional reaction to money
• Doctors don't think of themselves as business owners with responsibilities to teach all their staff to think like practice owners - they just want to be left alone to be a doctor and let the money take care of itself.

My reply to the ambitious and concerned sales rep MBA student was:

"Figure out what stresses the doctors most. Show them that you understand their headaches and their challenges - empathize from a sincere place of wanting to help.

Use the power of story to illustrate the ways in which your services could alleviate some or all of their most tedious headaches. Make it simple - no MBA jargon!

Intentionally design an experience that you want your customers - the doctors - to have of you and your business. Don't leave it to chance.

Share your knowledge - educate, without patronizing, because these are incredibly smart people.

And, do this with love in your heart, because it's a tough job running a practice or business in a low-reimbursement environment. By doing so, you will have created Meaning for your work - you'll be impacting not only the lives of many good doctors but also the thousands of their employees and patients.

Once you have accomplished this, I believe you will discover that physicians are not cheap - they are merely cautious. They want to trust you, because their work is, in many ways, a sacred cause. And you must earn their trust!"

Was I correct? What do YOU think?