Thursday, July 24, 2008

Referral Pads or a Plate Full of Feces?

The following story is true.
It is in no way exaggerated.

I had some referral pads made up recently. I personally like referral pads. I use them in my own office and a good one can influence where I send my patients for referrals, tests, and studies. For me, a good pad fits easily on a corner of my desk, has just the tests that I want in check box format, room for the patients name and my name, and how I want the results reported. Several of the labs and imaging centers that I use have referral pads that fit these criteria and I admit that I send more than a fair share of patients to these centers, rather than other ones, because of the pad. Of course, these centers do quality work as well.

Because of my own use for referral pads, I had some made for Richard A Schoor MD PC. The pads met all my criteria and were professionally designed and printed. They costs me ~$1000, total. My plan was, and still is, to distribute them to referring docs and potential referring docs via a practice rep, ie Janet.

Yesterday, I had some slow time and I learned of a new doctor that recently started practicing in an office next door to mine. She is an OB and joined a doctor that I have excellent relations with and view as a friend. So I stopped by myself to see them both. Now I no longer typically do this because one, I'm too busy,and two, I don't like being mistaken for a Pharma rep. But on this day, why the hell not!

I went to the reception desk, said hello I'm Dr Schoor, is the new doc here, or something to that effect. The staff was very friendly and replied that the new doc was not there but that she would be in the next day.

So I left my calling card and then asked the receptionist if she had any use for a referral pad, as I slowly extended my arm with pad in hand.

The receptionist immediately recoiled. In one motion she rolled her chair back 2-3 inches, put both hands behind her back, turned her face to the left, and said "no we don't use those."

It was like I had handed her a plate of feces. Incredible really.

I had to look back at the pad to make sure nothing was on them, like urine, blood, etc. Of course, the pad was pristine, all white and blue.

I wonder what I did wrong here. . .

Friday, July 18, 2008

Wednesday, July 16, 2008

Doc vs World: How to Survive Long Term

The cost of running a medical practice has skyrocketed over the years. In this same time period, the reimbursement for our services has declined tremendously. While many of us may generate the same or more gross revenue than we did years ago, we have done so only by increasing our through-put; ie the number of patient encounters that we see per year. Clearly, this compensatory mechanism is limited, unsustainable and ultimately very costly to us doctors both personally and professionally. In addition, our patients pay a high price as well in terms of their declining satisfaction, decreasing access, and an increase in adverse outcomes. Like being on an desert island with a limited water supply, if you want live for many years to come, you better get off the island. If you are a doctor and want to be around and happy in years to come, get off the island while you still can.

My name is Richard A Schoor MD FACS and I am The Independent Urologist and a solo practice survivalist. I have been in some tough jams over the past few years and have come out stronger and more resilient than ever. Recently, I and many other doctors, survived a 10.6% Medicare pay cut. Of course the actual income loss, factoring in decreased reimbersements from private insurers that were sure to follow Medicare's lead, would have been closer to 20%. For many of us, that would have been death. What does this mean?

It means that the future is clear. It means that you best start building your raft and planning your escape.

How do you do escape? You plan.

You know what the future will bring if you stay the course, so that is not an option. But you probably know others who seem to have your "dream practice" and these doctors' practices can serve as templates for you to emulate. Simply call them and ask them "how'd you do it." More likely than not, they'll tell you, especially if you are not among their direct competitors. Ask them how they built their practice, which marketing vehicles were beneficial and which stunk, if they negotiated with payers or just took the cash-only plunge, how they dealt with referral sources; anything you can think to ask them. In my experience, these people are proud of their accomplishments, as they should be, and are glad to talk to about themselves. If you have a blog, offer them a guest post. If they don't have time to write, you offer to write about them and to provide their website with inbound links and a favorable web-plug.

When you have done your homework, then you must develop your own plan. And you must commit your plan to pen and paper. Once your plan is written down, it will take on a life of its own and become a reality. If nothing else, at least you'll feel like your fighting and not just being swept along, for whatever that is worth.

January 2010: a storm is coming. Will it kill you or will you be prepared?

Make the plan. Be prepared. Live. Thrive.


The IU.

Sunday, July 13, 2008

Reunited with an old friend

I was recently reunited with an old friend, a very good old friend in-fact, that I had lost touch with several years ago. I'll call him The Kid, and he was my college roommate. He stood at my wedding and I at his and we shared many terrific memories over many years. He was always a loyal friend and I know we both regret that we lost touch 5 years ago. In any case, water under the bridge.

I think that many people would say that I was good role model for the kid. I think that Kid's parents felt that way. Maybe I was. But I saw things differently. It was kid that was my role model.

Kid was our fraternity's social chairman, and he was the best one we had ever had. he approach the job with passion and zeal and a business plan. Yes that is correct: a business plan.

After graduation he went to work for his dad and then his dad sold the company and the kid found himself without a job. He moved home and into the bedroom of his youth, complete with twin bed and "Marc" on the door. Not a very glorified life for a college grad. But the kid was not phased. He got a separate phone line and he promptly started a business. It was called Marc Photo and Marc was the only employee. Kid would answer the phone that was next to his twin bed "studio." It was hysterical. When I drove with him in his car, he'd be playing audiobooks on business topics. While other friends of ours thought it was pathetic and would joke that Kid couldn't read, I thought it was terrific. I saw Kid as hungry, clever. He'd be on the road so much promoting his business, that he used the time as productively as possible, hence the audiobooks. It was brilliant,really. I never doubted that he'd be a success in business. Within 5 years Kid had transformed his bedroom company into a multimillion dollar commercial photography and design business.
Though far from Kid's multimillion dollar company, I have my own successful urology practice now and I've become very busy in my office and life. On top of work and an old house, I have 3 kids, i.e. children, of my own, and I have very little time or energy to read, whether it is for pleasure or business. What have a done? I have taken The Kid's lead and have turned to the audiobook. Phenomenal! I can download the books from the internet and listen to them on my desktop at work, on a iPod as I lay in bed with Emma and wait for her to fall asleep, and on CD while in my car. It has really been nice and in the past few weeks I have "read" 5 or 6 books and have learned some new things. Sure my wife makes fun of me because I'm not really reading, but I assure you I know how to read just fine.

Kiddo, it was great seeing this weekend and thanks for re-entering my life. I can learn a lot from a guy like you. You've been a huge success in business and many of the things I've done that have worked, I learned them from you.

Let's keep in touch buddy-boy.

Wednesday, July 09, 2008

Waiting with baited breath.

How will they vote?

Waiting for our leaders to lead. . .we will remember in November!

Tuesday, July 08, 2008

Doc vs World Episode 4: Risk Avoidance

If you don't parachute, your risk of dying in a sky diving accident is zero.
If you don't let your children swim unattended in a pool, you can minimize the risk of a drowning incident.
If you stay in your home between 11PM and 5AM, your risk of injury from an alcohol related incident can be significantly reduced.
If you perform surgeries that are well within your skill set, you can minimize your risk of an adverse event and resulting legal issues.

My name is Richard A Schoor MD FACS and I am urologist in solo practice in Long Island. As urologist and physician I am well versed in risk and each day that I awake, I face plenty O'it. But I don't take unnessesary risks.

While risk is unavoidable, unnecessary risk is avoidable.

If you are a urologist, for example, you can get into trouble during a surgical misadventure, an informed consent issue, missed diagnosis, or a failure to act on an abnormal lab. If you are a urologist, these problems are not completely avoidable, but they can be minimized. For example, many a urologist has had problems arising from failing to act on a positive lab test, such as a PSA or cytology, namely because they never saw the test. This type of error happens for several reasons:
  • the patient fails to go for test
  • the test result is never sent to the doctor
  • the test result is sent to the doctor and filed without the doctor's knowledge
  • the doctor sees the test and chooses to not act upon it for some reason, though never documents the rationale for that action
  • the doctor and patient have a discussion about the lab test, and that discussion is not documented
In a significant portion of the above instances, it is the patients themselves that fail to go for the test. The easiest way to eliminate this risk is simply to do the test in your office or to obtain the specimen in your office. If you want the patient to have a PSA, draw it yourself.

Risk minimized.

In today's environment of zero tolerance for medical errors and high liability rates for doctors, it is simply imperative that doctors avoid taking on any extra-risks. You can examine your own processes and identify areas in which you are assuming extra-risk that is simply unnecessary.

Get rid of it.

The IU.

Monday, July 07, 2008

A butcher without an advantage

My son is turning 1 and my wife and I are having party. Not anything fancy, mind you, just a barbecue by the pool with family. This weekend while driving on 25A in St James we noticed a new butcher that had opened next to our favorite pizza place. Looking for something unique for the party, we decided to stop in see what the butcher had.

He had what every local supermarket had to offer, hamburgers, hot dogs, steaks, chicken breast, ribs. Nothing different. Nothing unique.

How is this place supposed to survive?

What is his competitive advantage?

Perhaps if he had very high end cuts of meat that I could not get at the Stop & Shop. But he didn't.

Perhaps if he had unusual meats, like impala or a TurDucken, but he did not.

Perhaps if he specialized in free range, organic, or local only animals. But he does not.

How does he plan to compete? Beats me.

Maybe he should get a competitive edge.

Saturday, July 05, 2008

Location, Location, Location

A perfect night for fireworks.
A terrific view.

Blocked by the 59th Street Bridge. When it comes to real-estate, BPH, and now fireworks. . .it is all about location.
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Wednesday, July 02, 2008

The Medicare Cuts

Now everyone calm down. The sky is not falling in and the world is not ending. What has happened is that the Republicans, led by our fearless leader, has screwed us. But all is not bad. You know why?

Because if you can survive without Medicare then maybe you can become independent of Medicare. And then just maybe you can drop them on your own terms.

Just maybe this whole thing is a blessing in desguise.

Think about it. Plan for the next time. Transition your practice to be independent. You may not be able to fix the system, but perhaps you can fix your own lot.

Just thoughts.
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Even a solo guy can take some time off

A tail gate party and salza dancing at Sunken Meadow Park, Kings Park NY.
Fisnhing on the pier, Sunken Meadow Park
BobBob and The Beeshee boy. . .my little boy. It is good to get out, see the community, and gain some persective.
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