Thursday, May 31, 2007

The Flea saga and WOM

I want to throw my hat into the whole Flea thing. From the perspective of a solo practitioner in the start-up, practice building phase, who depends on positive word of mouth for his own survival, Flea's saga is a public relations disaster. First, he was sued for wrongful death and that law suit became, because of his actions and his actions alone, a very, very, very public matter. Isn't it enough to get sued and have to defend yourself in court. Do you have to announce it to the entire world and give the Boston Globe or NY Times a story? Now everyone of his patients, their families, friends, and referring docs knows that he had a wrongful death. Not the kind of thing you want to actively publicise.

Second, as Eric Turkewics pointed out, he and the defense were caught trying to manipulate the jury. Now this may happen all the time, I don't know. But from a public relations perspective, it doesn't look good for Flea. People don't like to be manipulated and you don't want patients, their families, and referring doctors to think of you as a callous manipulator. Just my opinion.

Third, his entire chronicle of his lawsuit experience was just plain reckless, stupid, and disrespectful and suggests that Flea himself possesses those qualities. He may be a nice guy. I'm sure he is. But only several hundred people, at most, know him as the nice guy-good doc, while several million now know him as the big mouth, reckless, manipulating blogger. And thanks to the Boston Globe, and KevinMD, they know his name.

Word of mouth marketing is the most powerful form of marketing, and when positive, can really help build a practice. When negative, it can kill. I bet Flea's cost him the limits of his liability policy, and probably his practice.

I wish him luck, I really do. And if you are reading this blog, Flea, give me call and I'll help you start over in your new solo practice in your new locale.

Best of luck.

The IU.

Wednesday, May 30, 2007


Well, here comes the summer. For most people that means a nice time to kick-back, slow down, and enjoy the weather. For me, it means "summer hours." Unlike many businesses, however, I actually expand my hours in the summer--or at least adjust them--so I can help provide transportation to my daughters' day camps. In the summer, I start my days at ~7AM, take a mid-day break, and start up again in the late afternoon.

My 2 current employees, who have been with me from the beginning, cannot work that early or that late. So I have to hire an additional person. Always a joy! Here's how it went.

I posted a job ad on Craig's List for general office worker, and described the position, the location of the job, the pay, and the essential skills needed. Within 20 minutes of posting the ad, I had ~100 responses, which became 200 by the time I was able to read any of them. Of the 200 respondents, I was able to knock off 180 because they simply lived too far away or lacked transportation. One person said he was from Saratoga, which happens to be 9 hours by car from Smithtown. Maybe he has a plane. Others were from Brooklyn and lacked private transportation. Smithtown is suburban and we really don't have adequate public transportation. Brooklyn by car can take 1 1/2 hours. By public transport; 4 hours.

Twenty applicants were local and thus possible contenders. 4-5 did not attach or post resumes, so I excluded them immediately. One applicant used a computer program to publish her resume that I did not have and I was unable to open the attachment. I suppose I could have purchased the software that she used, but instead I axed her. That left 13 0r 14 resumes to review. Several people had obnoxious or annoying email names, like lovekitten69 or anglestar, so I axed them. I did not want my wife to know that I hired lovekitten69. One person's email address was--I kid you not--2good4U. I thought that was a bit presumptuous, so, by-by.

That left approximately 10 people to call. The phone is an amazing device. Not only is it the life's blood of any business, it is the best, safest, and easiest facilitator of first impressions. So I like to call the applicants personally; get a feel for their "phone voice" and personalties, etc. For 1 or 2 people, I was sent to voicemail. OK, not great, but OK. 1 person had an annoying song on their voicemail greeting. NEXT. I left a message on the other person's and they called back promptly. She seemed OK and had a nice voice and demeanor. I asked her some preliminary questions, she answered them well and I asked her to come in for an interview. Ultimately I called 8 people and brought in 6.

One candidate had 6 jobs in 18 months. Sorry, I won't be number 7.

One candidate was really intense and was, I'm sorry to say, too qualified. There would have
been no way I could have kept her happy, financially, and retained her. Sorry. Good luck.

One candidate said she could only work 2 days a week, after 1PM. Hey, whose hiring who?

One candidate said she could work any hours for the pay I was providing and was flexible in terms of number of hours per week. Not bad. She made round 3.

One candidate said she was flexible with hours but upon further questioning, she would need the schedule a month in advance, because her other job "at the hospital" took precedent.

One candidate could work the hours for the pay and was flexible with the schedule, and spoke Spanish to boot. Therefore, on to round 3.

So I am now in round 3, and round 3 is a secret. But I will say to all the candidates who applied for work in Dr Schoor's office, thanks for applying. Just, in the future, try not to stand out in such a negative way. Especially U, 2good.


The IU.

Wednesday, May 23, 2007

Great Customer Service!

I just experienced an absolutely marvelous customer service encounter that I had to share with you. It happened at my local CVS pharmacy, on Terry Road in Smithtown NY. It was a marvelous experience--in its absolute ridiculousness. Here is how it went.

I was # 2 in line behind a woman who was trying to pay the cashier, an 18 year old or so woman, with 20 dollar bill. The cashier took the bill, and then began to speak on the phone.

"I'd like to order a soft shell taco, extra spicy" she said.

"That's right, soft shell."

"What, no no no, spicy."

"My address, I'm at the CVS on Terry."

"No, Terry."

"What's my car?"

"You'll notice it. I have the green car."

"No that's a soft shell taco."


And then to the woman ahead of me, "That will be $18.50."

"Well, you have my 20."

"OK, have a nice day," and she handed the woman her change.

Unbelievable! And it does get even better. The manager was standing next to her watching, and otherwise doing nothing. A third worker, in a short white coat in the camera area, was nearby, doing something unrelated to customer care. He glanced over then turned his back to us. During the interchange 2 additional people came in line after me. I have seen poor customer service, but never quite like this. I really did not know what to make of it, accept that if my receptionist kept a patient waiting in this fashion, she would lose her job.

And what were the other 2 workers doing? The manager and the man in the short white coat near the film area. Were their fingers and mouths broken? They couldn't help out? It would have been easy to do and prevented me from posting this blog. When my receptionist is busy, someone else, including me, jumps in to assist the patient who is waiting.

Again, a marvelous experience. If you have your own business, don't do it this way.

The IU.

Monday, May 21, 2007

Need new patients? Put your money where the mouth is.

When it comes to marketing and marketing dollars, there seems to be no limit to the possibilities or the costs. Professional marketers will tell you that marketing "should" cost you nothing. By this, they mean that if done correctly, 1 marketing dollar should yield 3-5 in return.

Oh that it is was that easy!

After 14 months on my own, I have come to the conclusion that only one type of marketing works for physicians, with the exception of plastic and LASIK surgeons.

Word of mouth.
Word of mouth is, and has always been, the best form of marketing for any business, but for doctors it is perhaps the only form of effective marketing. Far from a passive endeavor, word of mouth marketing is an active and continuous process. WOM, I have come to realize, is the most active form of marketing and while it may cost the least in terms of money, it costs the most in terms of effort and time.

There actually is a science behind word of mouth marketing and methods exist that allow marketers to enhance and maximize the effectiveness of the program and to track, scientifically, results.

So there you have it. Put your money where the mouth is!

The IU.

Saturday, May 19, 2007

Going solo? Stay away from the crepe hangers

"Stay away from the crepe hangers." This is something my dad used to always tell me. And life is full of them. What is a crepe hanger? Crepe hangers are, among other things, pessimistic people. They always see the downside, the problems, the negative forecasts. They are real downers and they are poison. Stay away.

The term "crepe hanger" is an historic term and comes from a period in history when people used to drape all the mirrors and windows of their homes with black crepe following the death of a loved one.

Medicine is full of crepe hangers. These are the physicians who speak about nothing other than rising costs and falling reimbursements. They speak only of the problems, never the solutions, and are always negative. They are all over the hospital.

I saw one the other day. Nice person. Good doc. I bumped into him in the physician lounge and said, "hey, how's it going?" He replied, "Ahh, you know. Now I'm paying $160K per year in insurance, next year it's going to be $180K. I don't know."

Crepe hanger. He ruined my day. Got me thinking about my problems and made my mood negative.

Crepe hangers. Stay away! They are poison.


Friday, May 18, 2007

Need new patients? Write a book.

I always wondered how colleagues of mine were able to publish books on such seemingly boring topics in medicine. I know of an oncologist out here, in the stix, who has published several books. Just talk to him for a minute and he'll tell you about his books, and he'll give you a copy. Now I know how he did it.
The other day I received a letter from a publisher asking me if I wanted to author a book on male infertility. Actually, the publisher was not given my name and it was not a personal invitation, but a form letter from a mailing list. In any case, I have always wanted to write a book, so I emailed the publisher. He responded immediately and wrote that he would send to me a "packet" in the mail. It came today.
Here is how it works. I sign a contract and then professional writers, with my help, write the the book. My total time commitment would be 15 to 20 hours. All costs for layout, artwork, distribution, etc would be paid by the publishers. And I get royalties. Sounds great! What is the catch?
I have to purchase 1000 books. List price, $14.95 per book. I don't know what the discounted rate would be, probably $10.00 per book.
So there you have it. For $10,000 you too can be an author of a book.
Now the better question: why would I do that? Actually, it is not a bad idea, and the price tag may be reasonable. Being an author of a book, any book, is seen by patients and colleagues as a major accomplishment and helps in the "branding" of you and your medical practice. It helps in "word-of-mouth" marketing--the best type of marketing. It makes you be a true expert. Also, giving out copies to patients can be an effective form of marketing as well.
I'll think about, plug the numbers into Bayes Theorem, and decide.
The IU.

Wednesday, May 16, 2007

Going Solo? Have a fire drill.

Unexpected things happen, well, unexpectedly. If you want the least amount of disruption and damage to your practice, drill for these unexpected occurrences. Here are some "fire drills" you may want to do in your office.

1: A fire drill: Do you know where the fire extinguisher is? Is the pin still in it? Has it been used already? To where does the 911 call get routed, an issue with VOIP. To find out, tell your staff you are going to have a fire drill and have one.

2: Computer crash drill: What are you going to do if your computers go down? Simulate it and find out. You'll be surprised regarding the strengths and weaknesses of your systems. What have you backed up and where? Do you know where key passwords are kept? Do you keep key phone numbers on paper. Can you run the office on paper for at least a short time?

3: Phone down drill: The phone is the life-line of the practice and being without one even for a few hours can kill. Does your phone system have back-up call forwarding? Can patients get through no matter what?

4: Patient collapse drill: With VOIP, 911 may, or may not, go to the nearest emergency station. Where does yours go? Try it out, just make sure you tell the operator it is a drill. Also, do have oxygen? An crash cart? Aspirin? Maybe you do or maybe you don't, but you should know what you have and where it is kept.

5: Angry patient drill: Unfortunately, some patients get angry and can make a scene in your office. very disruptive. Roll play different scenarios to figure what works for you and your office in a variety of situations.

That's it. Hope this may come in handy one day.

The IU.

Thursday, May 10, 2007

Need new patients? Go to talks.

I have written posts on the positive aspect of giving talks to groups of people, but there is an even easier way. Simply go to a talk. Choose a talk on a topic in which you have interest and t one that will be given by a speaker you like, or know personally, or who can "pack'em in." Then simply go to the talk with a smile, some small talk, and some business cards. It makes for an easy way to get some face to face time with other doctors and nurse practitioners; any one who may be in a position to refer. It does not cost anything, though it does take time away from family. I do it 2-3 times per year and have picked up a few new patients as a result. Nothing spectacular, but "not nothin neither."

Hope I helped someone with this post.

The IU

Monday, May 07, 2007

Need new patients? Beat their expectations.

When you first go solo, obviously, you do not have an established practice to build upon. This takes time. However, whenever this happens, you can use your existing patients to build your reputation and, hence, your new patient business by providing stellar, beat-their-expectations-service. Here are some tips.

  • Call back when you said you would

  • Run on time

  • Call when they don't expect you it

  • Open "special" hours, just for them

  • Book a referral, such as for a CT scan, for them

  • If they are having a problem, squeeze them in today or tomorrow, no matter what

  • Have copies of articles you authored and awards in the waiting room

  • Keep a copy of of CME certificates in a nicely bound book in the waiting room

Good luck and enjoy the growth.

The IU.

Wednesday, May 02, 2007

Similarities between physicians and body shops

A few months ago, a sign post unexpectadedly came out of nowhere and dented the entire passenger side of my honda. I won't say who was driving. In any case, my wife and I did not want to put the repair through insurance, fearing, as most of us do, our insurance company. So I took the car to a few body shops for estimates. Most were in the 3-4 grand range since this was cash pay, and thus full price. In addition, these body shops did not contract with our auto-insurance carrier. In the end, fearing run-away costs, I contacted our insurance company and put the claim through the insurance. I had the car fixed for a fraction of the self-pay estimates (total cost, including deductible) and it was fixed just fine. So that got me thinking about body shops and doctors and the similarities between the 2 occupations. Here are some:

  • Most people cannot afford auto body work as a cash pay. Most people can't afford health care as a cash pay.

  • Most people use body shops that contract with their insurance company to save money. Most people choose doctors in their plan, to save money.

  • Some people have collision insurance that allows them to use any body shop, but the deductibles can vary. Some patients have "out-of-network" benefits, though the co-pays can vary.

  • Mechanics in the "out-of-network" shops promised me that they would accept my deductible and not balance bill me for any "extra" charges not covered by the insurance. My hand surgeon did this exact same thing. He promised not to balance bill me for the difference between his fee and the 30% of "usual and customary."

  • Auto body shops don't waive deductibles. Doctors don't (or should not) wave co-pays.

  • Auto body shops wait for the reimbursement checks. So do we.

  • The car insurance company publishes a list of sanctioned auto body shops in my vicinity. The health insurance companies do this as well.

  • The car insurance company pays the auto body shop a lower rate in exchange for the promise of higher volume and thus more money. Same in medicine.

  • Auto body shops need to fix lots of cars in a short time period to make money. Doctors need to see lots of patients in a short time period to make money.

  • Auto body shops use expensive tools to help them align parts and ensure that the repair is adequate. Doctors use expensive tools to diagnose and treat disease.

  • Some people are not happy with the result of the auto repair. Some patients are not happy with their outcomes either.

  • Auto body shops have manuals with standardized parts and labor reimbursement rates. Doctors have CPT and ICD-9 books.

  • Contracted auto body shops can't balance bill you. In-network doctors can't balance-bill either.

  • Auto body shops that cater to Porches and Ferraris can charge a lot more than typical auto body shops. Plastic surgeons in Beverly Hills can charge a lot more than a general urologist can in Suffolk County NY.

So there they are. It sucks too admit it, but it is true. We are really just glorified auto body shops with $200,000 in education debt and $30,000 plus per year in malpractice insurance premiums. Don't get me wrong. I love what I do and I treat every patient to my utmost ability and effort. I just understand my place in the grand scheme of things.

Sorry if I offended and I hope you enjoyed the post.

The IU.

Tuesday, May 01, 2007

Need new patients? Look to your existing patients.

You want new patients, right? So do I. New patient business means everything--growth, success, stability, the future. But don't ignore your existing patients for they are your best source of new patient business. All you need to do is to figure out how to harness the power of your existing patients to generate new patient business. Here are some things you can do and some things you must do.

  • Keep your existing patients happy (A Must!)

  • Mail fliers periodically with new procedures you wish to promote

  • Send them business cards or magnets periodically

  • Publish a news letter quarterly

  • Ask them to "tell-a-friend"

  • Direct patients to your blog and tell them to refer others to it.


The IU.