“Psst! Send me some referrals. I can’t pay you directly, so I’ll pay your spouse.”

The medical group that I was going to see was under pressure. One of its former members had jumped ship and aligned with a competitor. The hospital issued an RFP. The competitor became the golden haired group.

Could you smell it in Cleveland, Carson City or Cape Cod? The stench filled the air in Paris, as taxi drivers burned tires to protest Uber.

Have you imposed an expiration date on your career, on your business?

The right question regarding the uncertain future, is to ask is what underlies your profession, your specialty, or its role. What’s the motivating desire or overriding function?

What are you doing to get attention for your practice or business? Attention from your referral sources, from your patients, from hospitals?

Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.

If I can make you a dollar by cutting your costs, can I keep 50 cents?

That, in a nutshell, is what’s described as “gainsharing” in the context of arrangements between medical groups and hospitals.

How many times and for how long do you think a Broadway actor prepares for his first performance, or even for subsequent performances?

Corporations exist to make a profit. There’s nothing wrong with that. It’s a fact of life.