Friday, November 10, 2006

Going Solo? The best advice that I received.

When you find yourself going solo, you will most likely experience what I did: people came out of the woodwork to give me advice. Most of these people had never and will never take the leap into solo practice, and their advice, though well intentioned, was often not helpful nor practical for my situation. But some people gave advice that was terrific; real pearls of wisdom. And I am going to pass some of it on, here and now.

1: Get Vonage
This advice was given to me by my friend Hugo, who went into solo practice neurosurgery 3 years ago. Vonage is a VOIP phone service provider that has a number of attractive features, but one feature in particular is most important for your start-up. When you sign up with Vonage, you get a router and the router itself contains your phone number. Where ever you plug in the router, that is where your phone is. So before you have an office, plug it in at your house or any other place that has access to a broadband conection. If you plug it in at home, your office phone will ring there, if you plug it in at your Dayton office, your phone will ring there, at the Cincinnati location, there, etc. This way, you'll have 1 permanent phone number for your patients and other important contacts to reach you by, no matter how many locations you have or how temporary these locations might be. For example,I left my old practice in February 2006, but did not have an office until April 1st. With my Vonage phone, I had an office phone number 6 weeks before I had an actual office and I started booking patients with it; my first 40 patients! Moreover, when I moved into my new office, I simply took the router with me and kept the phone number. No port charges, no connection fees, no disruption of service. It was easy. It took 2 seconds. Because of VOIP technology and Vonage, I was able to function and grow even before I had a physical space and as I have grown, the Vonage system has grown with me. I now have 4 VOIP and a IP fax line. The negative thing I have to say about VOIP phones is that, in my experience, calls drop more frequently than with traditional phones. But for me, the benefits far outweigh this sole drawback.

2: The Windows Folder Method
I knew I wanted electronic charts, but the price was, and still is, prohibitive. I had used EMR extensively in my training and knew what I liked and did not like about it and for the previous 5 years I had been tinkering with the folder (directory) system that is part of Windows OS (See EMR blog). I just was uncertain that it would function efficiently enough in fast paced medical practice. Then I read Christian Rainer's book on practice management and right in the book, he described his system, a system similar to mine. Voila, it would work! So I committed to the off the shelf, self-made Windows OS EMR, and on April 1st, 2006, my first day of seeing patients in my solo practice, I implemented it. That morning I saw 15 patients efficiently. And 300 new patients and 7 months later, I still use the system. I have been able to modify it and tweak it easily for my changing needs and this simple, custom system has grown beautifully with my practice. In addition, I have never had a single "down" minute. And I am not alone. The self-designed, custom, off the shelf EMR is used by other physicians like me. This advice was terrific, and it came from a book.

3: Fax the referral letter
Getting the referral letter to your referring physician is an extremely important aspect of private practice, both for optimal patient care and for good marketing purposes. When your letter arrives promptly and gives the referring doc the pertinent information in an efficient manner, your patient will get great care, you will look good and you will likely receive more patients from this doctor. Conversely, when the patient returns to the referring physician before your letter, the doctor will not have the information she needs for optimal patient care and will be upset. You will look bad. My problem in February 2006 was that I had no transcription service, no letterhead, and no good plan to perform this important detail of practice. Then I came across Neil Baum's book on medical practice marketing and he had already come-up with the perfect solution to this problem and published it in his book. He called it "the lazy letter" and to ensure that the letter arrives promptly, he faxes it to the referring doctor the same day he sees the patient. "The lazy letter" is a template that goes something like this: "Dear Dr A, I saw patient B for disease C and plan to do X, Y, and Z. . ." Then have your staff fax it. I actually fax it directly from my desktop with special internet fax software.
It is that simple, works like a charm, and has been uniformly praised by my referring docs. 'The lazy letter" was Dr Baum's pearl of wisdom that he passed to me via his excellent book. Thanks Neil!

4: Cultivate your sub-specialty
This may seem like a no-brainer, but I assure you it was not for me in February of 2006. At that time limiting the practice actually seemed counter-intuitive to me since I wanted to grow as fast as possible and to minimize what I thought would be tremendous financial losses in my first year of solo practice. But my father suggested otherwise, and he was right. I do have sub-specialty fellowship training in male infertility and microsurgery as well as significant andrology laboratory experience and my father, a retired solo practice periodontist of 30+ years, encouraged me to aggressively cultivate that aspect of my practice and market it. It turned out to be great advice and in doing so, I have been able to get a toe-hold in a medical community that is otherwise as hard as granite to break into. Moreover, as a general urologist, I was 1 of 50+, just in my county, and now I am 1 of 3 on all of Long Island that does male infertility and has an on-site CLIA andrology lab. Instead of competing with the mass of urologists in my community, they are now my potential referral sources! By focusing my practice I have, in essence, turned the tables in my favor and have been thriving. Thanks Padre'.

5: Blog
Like many people I first heard of blogging and bloggers during the Bush-Kerry Presidential election of 2004 but I certainly did not understand what blogging was and why bloggers did it. Now I do and it is because of advice from my good friend Steven Krein, an Web 1.0 and now 2.0 successful entrepreneur and founder of OrganizedWisdom. Steve set me up with a blog in March 2006 and told me to just start writing on topics on male infertility, ED, etc. My first blog went something like, "Dr Schoor, male infertility specialist, has moved to Smithtown." In May 2006, a prospective patient googled "male infertility specialist smithtown", got my blog, and called to make an appointment. And then I understood the power of blogging. Since then my blogging efforts have resulted in increase website ( traffic, search engine presence, and an increase in new patient business. In addition, I use my blog to educate patients about selected topics in male infertility, ED, and urology and to point them towards useful and pertinent articles that are written by others. Third, I enjoy blogging and despite concerns--legitimate and real concerns voiced by my attorney--I have continued to do it. I have come to feel that the benefits of blogging offset any potential risks, and isn't risk-benefit analysis what we doctors do everyday.

Thanks for listening and I hope you find this advice useful. Please feel free to comment on your own pearls of wisdom for small medical practice management or anything else you feel like commenting on.

The Independent Urologist.