If you want my business, answer your phone!

I need my microscope serviced and I need it serviced in the next week or so. Since I have a contact at Olympus, where I bought the scope, I called him for a recommendation. He gave me a name of a "great guy" named, ironically Guy, who works or owns a Massapequa Long Island microscope company. I was given the name of his company and told to look it up in the book. I never use the book, but I am typically preferential to "great guys", so I set to look up Guy's company on the web. No web site, no real web presence to speak of, but he does have a listing in some non-yellow book, non-yellow pages yellow page. I called it, and got a busy tone. I re-dialed, and now I got an answering machine. I called again, same result.

To hell with Guy!

Guy, if you want my business, answer your phone. It is really that simple.

So here's what I did. I Googled "microscope repair long island" and found ~10 listings on the side-bar, the paid listings. I chose one in the middle of the page that caught my eye because it said the word "service" in it. I clicked on the link and was taken to a nice website. On the index page of the site, I saw the phone number and location of the business, which was somewhat nearby to my office in Smithtown. I dialed the number and low and behold they answered…immediately. Suffice it to say that several minutes later I had an appointment scheduled for an in-office service by a guy named Raul and I was given Raul's pager number. The price was reasonable, though I'm sure that Guy would have done it for less, but he did not answer his phone.

I only do business with people that answer their phones before they have my money. If they don't answer when they want the sale, they will certainly not answer after they've made it.

If you want to compete and thrive, start by answering the phone and being reachable. It is really that simple.

The No-Show-ers

I have become somewhat obsessed with no-show-ers. Who are they and why? Are they rude or just forgetful? Do they think it is no big deal or do they know it's wrong & just don't give a crap? I think that no-show-ers can be placed into several categories and you can almost tell who will no show by examining the details surrounding the appointment booking.

Most—if not all--people who claim to be in pain, yet don't want to be seen that day, will no show. I don't understand this one, but it's true.

No show rates for vasectomies or infertility consults seem to double if the wife, rather than the husband, makes the appointment.

Self-pay patients no show more frequently than do insurance patients, unless it is an uninsured man who sees something on his penis. They always show up.

I have never seen a racial difference, but there is definitely a socio-economic difference; the very poor and the very wealthy no-show equally.

Young people no show more than the elderly. When an elderly patient of mine no shows, I start calling the hospitals!

Working people only no-show on Saturdays or in the evenings. . .or on holidays.

Retired people never no-show.

People who refuse to leave us their cell phone number typically no show.

People whose phone goes right to voicemail no show much more than do people who answer their phones.

People who return your calls never no show.

People that try to get a free consult over the phone while they are making the appointment will almost always no-show.

100% of people who ask for a free vas reversal consult will ultimately no show.

I noticed a trend, p value <0.05, that people who find me via the organic google rankings no show more than those who find me via paid listings.

Requiring intensive directions to my office predicts future no-showage. (And I'm on a major road in a big, well marked and well lit building)

Oh, I have a patient now. Thanks.

Geeze, I'd have figured that he would have no-showed. Oh well.

The IU.

 

My slowing blog post frequency

My favorite reader, SeaSpray, has asked several times why I have been posting with less frequency in recent weeks. Well, there are a variety of reasons for this, but basically, I write less because I feel there is less need for me to write.
When I first began to write the Independent Urologist blog, my experience with start-up was fresh and raw. Every day brought something new that needed to be published. For me, publishing was therapeutic, like a form a counseling I suppose. It helped me to collect my thoughts and to process the daily peaks and valleys that must occur in every start-up business and that certainly happened in my own business, big time! For me, my first 1 to 1 1/2 years as a solo practice urologist was the most exciting period of my life, far and away. I simply had to write about it or I felt I might explode. The fact that I had an audience made blogging that much more fun.
Fortunately, my practice is doing well now and I have settled into somewhat of a nice routine. It is not boring. Far from it. I just am no longer surprised when I get several new patients in a given day nor am I devastated when I don't. I have a schedule that is relatively constant from week to week. I have my typical busy days, slow days, late nights,and early mornings, and I drive my 3 1/2 year old to and from school 2 days per week, in between patient sessions.
Many of the challenges that I faced early on, such as getting my lab accredited and my office functional, I have overcome. I do a variety of in-office procedures, such a cystoscopies, vasectomies, and prostate biopsies, and I have developed such easy routines for preparing and doing these procedures, that they no longer cause me any stress, any heartache. Even scheduling patients for in-hospital procedures has become routine, automated, easy. Nothing more to blog about there, which is good.
From a staffing perspective, I have 2 people who have been with me from the beginning and a medical assistant, who I trained a few months ago, who are all excellent and loyal employees and they all plan to remain in their current positions indefinitely. As far as I know! So while I no longer have blog topics on staffing issues, I have stability, and that is better than blogging.
My homegrown EMR was a good source of blog topics for a while, but even that is just performing silently and bug-free in the background, as any good EMR should. I just don't feel the need to write about it any longer. With regard to digital back-up, I no longer need to expend mental energy on it, because I finally seemed to have come up with solutions that work for me automatically and effortlessly. It only took 21 months, but with regard to back-up, I have finally started sleeping at night, my infant not-withstanding.
Attracting new patient business, marketing, and practice building were a great source of blog post topics for a long while. Here, however, I have stopped writing for 2 reasons. One, I've become very adept at attracting new patient business economically and I no longer "need" to write about it from a therapeutic perspective. And two, I don't wish to share such valuable information with my competitors. It is that simple.
Medical malpractice is a favorite blog topic of many bloggers, but I never really got into that one. I guess that personal views on that topic are best kept personal. Just ask Flea. Enough said.
I do have much left to do in my still young practice and I plan to continue writing about it. But hopefully, I wont feel the need to write about it. I want stability and yes, even boredom. Those are 2 signs of a mature business, one with a future and in this regard, I feel that I have arrived.
Thanks for listening.
The IU.

On Making Decisions

Perhaps I made a mistake on VONAGE. Perhaps. Only when I Look back 21 months later, with the benefit of hindsight, am I not so sure that I would use this company again. But then again, 21 months ago I was in a bind and VONAGE was the perfect solution at the time. I had just left my old group and I wanted to capitalize on retaining any former patients of mine into my new, fledgling practice. I had no office and was unsure how long it would take me to get an office. Every day that I went without an office was lost money and missed opportunities. I was desperate to get new patients and was unwilling to miss a single one. With VONAGE, I was able to set up shop in my home and function as a business well before I had an office or an exam room or a staff. For me, back then, VONAGE was a key ingredient in my early success.

Some say that VOIP is not reliable for mission critical functions related to business. I disagree. Many businesses use this technology and it works very well. I have friends in the financial service industries—on Wall Street—whose firms have switched to VOIP. What is more mission critical than high finance? The problem has not been VOIP, but customer service at VONAGE. Their technology is fine. It is their service that fails.

It is very easy for people to criticize and second guess the decisions of others. It happens every day. What the critics fail to realize is that we make decisions with the circumstances and the best available information at the time, not years later. I believe the ability to have vision and then use it to analyze a situation, cull the data, and be decisive given incomplete information is what separates successful doctors, lawyers, politicians, and police officers, among others, from unsuccessful ones. Teddy Roosevelt understood this:

"It is not the critic who counts: not the man who points out how
the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself for a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat."

Critics will always be out there in the ether doing what they do. My advice to another person who finds themselves solo and unsure of what to do: analyze and think, but don't be afraid to make the hard decisions. And to hell with the critics!

Thanks for listening,

The IU.

VONAGE bites me in the ass!

Several months ago I switched from VONAGE to my local VOIP phone provider due to reliability issues. I ported the number and everything seemed to work out well. I did test to see if the port worked by simply calling the number and voila', it rang in my office, call hunted, etc. Beautiful.
Yesterday I received an email from a former patient of mine. "Dr Schoor, are you still in business? Your phone number has been disconnected for weeks" went the email.
What? The phone had been working fine and was ringing off the hook that very morning. I called him.
Apparently he has a VONAGE system himself and when he called from his cell phone or any other non-VONAGE phone, the call placed successfully. But from a VONAGE phone, the caller would always receive a disconnected message. I called VONAGE.
"Oops, sorry, our bad. We forgot to release the number from our system. I'll do that now. It'll take 24 hours. Sorry for the inconvenience."
Holy shit!!! For 3-4 months, anyone that tried to contact me from a VONAGE phone would not have been able to do so. Un-!@#$%-believable.
Think of the missed opportunity costs. I estimate that I probably missed 3-5 prospective new patients who called, got the message, and went to the next urologist on the list. Being that new patients are worth, over the course of a year ~$400, I can estimate a loss of up to $2000, maybe higher.
Yeh, I'm pissed!
My recommendation: if you are a business, do not get started with VONAGE. Their customer support is just not adequate for a business's needs.

Goals for -08

My 5 Areas of focus, (not in order of imortance)

Process Sreamlining ---Revenue Generation---Cost Containment---Safety---Payer Shift

At the beginning of a new year I like to take stock in what I have accomplished and to focus on goals for the next year. The cycle above represents the 5 major areas that I will focus on most. All are interrelated and of equal importance. For example, streamlining processes will result in increased patient safety and efficiency and help to decrease costs. Revenue generation will follow based on an increase in word of mouth referrals and through acquiring patients with better paying plans and cash pay.
Wish me luck.
The IU.