The IU has a new partner!

I am proud to announce that I have hired a new, young gun hotshot to join me. Born yesterday, 7-16-07, he is 6lbs, 8oz, and does not yet have a name.
I call him dude.
The IU.

Myth #6

Almost a year ago I wrote a post that dealt with some of solo vs group practice myths. That post had 5 myths regarding call issues, economies of scale, etc. Here is a sixth myth.

Myth #6: A specialist depends on professional referrals to grow.

If that was true, I'd be out of business. Professional referrals, while important, are no longer an essential for practice growth. Patients come from a variety of sources, and only one is the referring doctor. I recently analyzed from where my patients were coming. Here it is, not necessarily in order.

• Internet insurance lists--this is the modern age equivalent of the insurance book, only it is on the internet. It accounts for ~35% in my practice. Recently patients have found me on Cigna's site, Aetna's site, and even Medicare's. I did not know Medicare's site even had a physician search feature. Live and learn.
  
• Internet Search Engines--this has been a growing segment of my patient population, with the overwhelming majority coming from Google. Prospective patients type in any number of search terms, but "urologist smithtown" or "vasectomy doctor smithown" predominate. Male infertility patients will often find one of my other blogs, then hyperlink to Dr Schoor.com. I always ask people what keywords they used and which search engine. ~15%, but growing. And I have not even really started to web-market!
  
• Word of mouth: this is my one of my best sources of new patient business. And the best things about it is, one, it's free, and 2, WOM self-perpetuates. As the practice grows, more mouths talk, and more patients come to see me. Off course, so long as I remain a good urologist with good outcomes. About 30%, and growing.
  
• Professional referrals: when I first opened in April 2006, I concentrated most of my efforts on the cultivation of a cadre' of doctors who would refer to me often. While I have done well in this regard and now have several docs that send repeat referral business, the truth is that referrals even from these docs come infrequently and sporadically at best, and if I had no other sources of new patients, I'd be up the creek sans paddle. I'd say that professional referrals account for about 15%. Interestingly, WOM is the best way to cultivate professional referrals. When your happy patient tells their primary about you, that has more positive impact than a brochure and a box of coffee for the staff. In addition, doctors talk also and a "I use Schoor for infertility" said to a colleague is worth thousands of dollars to me, not to mention the personal satisfaction of peer recognition.
  
• Yellow Book and Yellow Pages: Less than 5%. Not even worth mentioning. Just get the free or cheapest listing, or better yet, none at all.
• Print ads: 1 patient, and his check bounced, twice. Money spent on ads into the thousands. Worse than worthless.
  
• In office free seminars: I held 2 on ED. 10 people came overall. I got one patient out of it, and he turned out to have a bogus Medicare card.

I have found enormous satisfaction from my success in the absence of a large professional referral base. It means that I am truly independent and beholden to no one for my next meal. It also portends well for me, since the professional referrals will come with time, and then imagine how busy I'll get. Until then, I'll focus my efforts on internet marketing and WOM referrals.

Thanks for listening, and send me some patients.

The IU.

WOW! That's some bad WOM.

This is an example of some terrible, negative word of mouth marketing. In case you don't read the link, a stewardess for Continental Express Airlines kicked a mother and her chatty toddler off of a flight because the toddler was being annoying. The stewardess asked the mom to give the toddler a sedative, apparently.
Unbelievable. In fact, I'm not sure I believe it. But it is bad word of mouth for this airline.

The IU.

. . .and continues

I had the phone techs here for 2 hours yesterday re-routing lines and checking connections. When they left, my 2 Optimum voice lines worked, only the call hunt feature was not working. I called optimum voice support, who remotely accessed the modem, made some changes, and then it worked. For the rest of the day everything went smoothly. And we booked 4 new patients.
My credit card processor was on a dead line. The techs were able to re-connect the line, though the credit card processor was unable to connect to the carecredit site. We tried a number of maneuvers, such as powering up and down, connecting the processor to the router itself, and connecting the processor to the modem itself. The processor only worked if connected directly to the source jack, which was in the closet, close to the ceiling. No problem. I'd just have to make my staff climb a ladder in the closet 20 times a day.
That works for me. Yeh right!
Finally I sent home the install techs and decided to call Vonage, since the credit card processor was on one of the remaining Vonage lines. As I was on hold with Vonage tech support, which is actually pretty good support, "firewall" popped into my head. Yes, the firewall, you knucklehead. All routers have built in firewalls that are distinct from the firewall that are installed in your computers, you know the ones you buy from Semantec, etc. These router firewalls need to be set and adjusted to allow for 2-way traffic. When the credit card processor transmits to the processing company, it also receives signals. The firewall was preventing that incoming signal from reaching the unit. The Vonage guy fixed it in several seconds. Now it works.
So everything is now good, right?
No.
This morning I came into work, un-did the forwarding feature so that calls would come into the office phone. Call one worked fine. Call two came while I was on with call one, and . . dropped. WHAT THE F---!!!!!!!!!!!!!!!!!!!
Optimum voice, my local, Long Island, VOIP provider is having difficulties and call hunt on their end is temporarily disabled. Calls that come into a busy line 1 go immediately to voice mail. "We're sorry for the inconvenience," said the tech. INCONVENIENCE! An inconvenience is getting a BLT when you ordered tuna. I'm losing money, lots o'it.
I really just want this fixed.
On a good note, I got 3 new patients this morning.
Thanks, the IU.

The phone saga continues. . .

Seaspray asked me why I felt loyal to VONAGE. The answer is that I don't. But I do know that fixing one problem will create 5 others that need to be fixed before things begin to run smoothly again. This is exactly what has happened to me since last Friday, when I changed phone service providers.

• My dedicated fax line is no longer working.


• My credit card processor is no longer able to connect and we can't use it.


• The data line in my office is on the fritz--it intermittently goes out--making it impossible for me to connect to my server from my workstation.


• Today, lines one and two on my Optimum voice phone are dead.


• My remaining VONAGE lines, 326-6035 and the other in the hunt sequence, are the only working phone lines, though calls still drop.
• My cell phone, thankfully, still works.

As I have said before, phone systems are like urethras. If they cause you pain, you got a problem.

Thanks for listening.

The IU.

An alternative way to book an appointment

My dad sees a urologist in NJ. This urologist, who happens to be a good friend of mine from medical school, is in one of these mega-urology groups--30-40 urologists. My mom says that she is never able to get through by phone without at least 10 minutes of hold time. No doubt that this is a sign of a thriving practice--or really bad phones--but it is somewhat of a pain for patients, new and follow-up alike. I'm sure this group already employes these techniques, but here are some things I do to give patients access to schedule appointments without tying up phone lines.

• Fax an appointment request
• Email the practice administrator that you wish to make an appointment and that you are an established patient of the group.
• Voicemail--just make sure you check. I have not yet employed voice mail.
• Text-message--I had one patient contact me this way. In general, I am not very good at the MMS lingo, but I got him in the door. "OMG, I g hsv. n2cu." Translation: Oh my God, I have herpes. I need to see you.

The moral of the story is that the phone is but one avenue to reach the scheduler in the office. Personally, I think fax is the best. We check the fax on our free time and contact the patient when our phones are not ringing off the hook.

Thanks,

The IU.

On credit card processors

We take credit cards. I know that seems trivial, but for a while, over a year, I did not take plastic. I did have a good rationale for not accepting credit cards, namely because of the transaction fees. But then something started to happen that pushed me over the edge. Patients at an increasing number were not carrying around cash and could not pay the co-pays. They would ultimately pay upon receiving the mailed statement, but they were not paying at the time of service. So I evolved.

In order to accept credit cards in your practice, you must have a credit card processing unit and a merchant account with one of the processing companies. I happen to use care credit, but many people I know and trust, use ACCPC. Setting up an account is easy. All you do is call their toll free numbers, purchase a processor (typically in the $300 to $500 range, and negotiable), fill out the application, send them a voided bank check for direct deposit, and voila, you're up and running. You will need a separate phone line dedicated just for the processor, despite what others may tell you. Processors don't function well over a splitter.

The processing companies take transaction fees, which is how they make their money. Transaction fees range from 1.5% to 3% and vary for a number of reasons. Some companies are just more expensive than others, but some credit cards exact higher transaction fees than others. Have you ever wondered from where the money comes to fund rewards for purchases or for college 529 plan cards? The merchants--me, you, the pizza guy--we fund those rewards programs via higher tranaction fees. VISA and Mastercard have variable rate fees. AMEX always charges a flat 3%. Sounds like a scam, right.

Well, yes and no. When I have to send my biller to collect on un-paid co-pays via repeated mail and phone call attempts, I pay much more than 3% of the value of the co-pay. I pay $18 per hour, not including taxes, plus postage and envelopes. In addition, un-collected co-pays adds to accounts receivable, and negatively impacts cash-flow.

Since I have started using credit cards, my cash flow has improved and my ability to collect co-pays, some of which are in the $50 range, has improved. Live and learn, but I wish I took the cards from the beginning. Who knew?

Thanks for listening.

The IU.

An overheard converstion.

During lunch today, I overheard a conversation from some people seated near me. The Chinese Buffet, in Smithtown NY, was nearly empty at 3PM, when I finally had a break for lunch and a bank-run. 3 college students, seated 2 tables from me, were involved in what seemed like a nice discussion. As I gazed in their direction and stared intently at their moving lips, I really could not help but listen in on their conversation.

One of the students, I'll call him Alex P Keaten, was telling the others of his career plans. He wanted to be a doctor and he seemed to have a pretty good business sense. His plan was to do something in the primary care field, but with a complementary and alternative medicine bent. In addition, he wanted to incorporate chiropractic into his practice as well. His business plan was to start patient treatments using an alternative medicine and/or chiropractic model, but then switch to an allopathic approach should the patient not respond as desired. He would then prescribe medication, which he would sell from his office, via his staff pharmacist.

Really not a bad plan. I was impressed. But let's dissect it a bit, for fun, to see if we can find some wholes in it. First, in NY at least, physicians can't sell drugs, only pharmacists can. Alex gets around this by employing a pharmacist. While I can see a conflict of interest that I find bothersome, it may be legal, depending on how he structures it from a corporate perspective. Perhaps he'll make his practice a PC, with him and the pharmacists as employees of the corporation. I think this may work, legally. I know of some big groups that do this, though certainly no smaller groups do it. I suppose that having to stock such high volumes of drugs requires a huge capital outlay and could impact cash flow negatively. In addition, unsold drugs that expire would become financial losses. Plus, pharmacies have very low profit margins and rely on volume. Thus smaller groups can't support the pharmacy. I don't know if Alex has considered these problems.

Now lets discuss drug stocking issues as they relate to the insurers. Most insurers have 3 tiers of drug coverage; generics, formulary, and non-formulary. What this means is that some plans will pay for, let's say Nexium, though others will only authorize prevacid. Of course, like many things in medicine, patients, if given a reasonable alternative, only choose the least costly option. I guess Alex's pharmacy will just have to stock all the drugs, but that would be very expensive. In addition, is he going to stock herbal remedies that are so popular in eastern medicine. These are expensive for Alex as well as for his patients and they are never covered by insurance. This is good for Alex, unless he has a predominantly insurance-only allopathic clientele, because this population doesn't go out-of network. I'd be surprised if Alex considered these problems as he slurped on his chicken corn soup.

Finally, Alex planned to incorporate western medicine with alternative medicine and even chiropractic. I think this is a great idea, as do many other practitioners. In theory at least, the allopathic practice can complement and build the eastern medicine and chiropractic practice, and vice versa. But here's the rub. Insurance does not really pay for eastern medicine and people don't really pay for allopathic medicine, other than via there insurance policies. So does Alex plan to participate with insurance or not? Participation is the fastest way to build a practice, but you pay the price of filling your practice with patients that only value YOU if you accept their insurance. Moreover, these types of patients don't do anything that insurance does not cover. I mean they don't do anything not covered. These types of patients don't pay out of pocket for alternative medicine. This is certainly how it is in Suffolk County Long Island, where I practice.

In addition, I think the allopathic pharmacy business will suffer in an eastern medicine practice. Eastern medicine devotees don't want big pharma drugs and western medicine types don't trust herbal remedies, unless they are covered by insurance plans, which they never are. So I guess Alex will have to stock both types. But that gets back to expense, not to mention conflict of interest, credentialing, and licensing problems. Oh, brother!

Perhaps Alex will not accept insurance. Excellent! I commend him on his bravery and I hope he can pay his bills in the early years. He will ultimately grow via his alternative medicine practice, but patients who want alternative medicine are often suspicious and un-wanting of western medicine and this aspect of his practice may flail. So how is he going to reconcile this dichotomy? I don't have a clue, but I know there are practices that successfully do it. I recommend that he put down the egg roll and visit one of these successful practices.

I certainly don't mean to pick on Alex and belittle him. To the contrary! I was extremely impressed by his savvy. When I was his age, I wanted to be doctor. Why? To help people. How was I going to make money as a doctor? I was going to get paid. Naivety. Or schmuck. You decide.

I think medical school does a great disservice to its students--you know, the ones that pay the school's tuition--by not teaching some of the business side of medicine. Actually, I think in today's environment, medical practice management ought to be required teaching and students should select schools that offer these types of courses. Maybe times are changing in this regard. But I don't think so.

Alex, I hope you apply to med school, and if you do, pick one that offers curriculum in business. And if you want a letter of recommendation, come find me at the Chinese Buffet. I'll be the guy eavesdropping.

Thanks, the IU.

THAT'S IT, I'M DONE!!!

I finally decided that enough is enough with VONAGE and have decided to phase it out slowly. Here is my plan.

I desperately do not want to lose my phone number or have a major disruption in service. So, I am going to add 2 additional optimum voice lines for a total of 3 lines in a call hunt grouping. Call hunt, for those who don't know, allows incoming calls to jump from busy line 1 to busy line 2 then to open line 3. I now have 3 VONAGE lines. The main line, 631-326-6035, will jump to line 2 when busy. I actually do not know the phone number for line 2. My 3rd VONAGE line is at home, and I use this line to make and receive patient related phone calls after hours. This line is not part of my call hunt sequence, but after hours, calls made to 631-326-6035, my VONAGE line 1, will forward to this home line. Interestingly, this phone line has never dropped a call, though it's call volume is negligible.

I have one Optimum voice line, which I use as a private line for outgoing calls and as a fax line for outgoing faxes. Incoming faxes come in via EFAX. This line has been very reliable, though again, with a lower volume of calls, so who can really say? For some reason, this line's phone number is listed in the yellow pages--the free listing. Why do I mention that? Because, in April and May of 2006, when former patients of mine tried to look me up in the book, they found my listing and called the Optimum voice number, which rang and rang and rang. Fortunately, my patients are my greatest assets and they told me about the problem, which I corrected by forwarding Optimum Voice line 1 to VONAGE line 1. Voila, solved. Crisis averted.

So here is what I plan to do now that VONAGE has caused my hairline to recede to the apex of my skull. I am going to keep VONAGE line 1, but forward it to optimum voice line 1. Optimum voice line 1 will then call hunt to lines 2 and 3. VONAGE line 2, the number I don't know, I plan to use as a back line and outgoing fax line. VONAGE line 3, the one in my house, I will keep as is. If after several months, everything is working fine, I'll probably start to pear back the system, and screw everything up.

Now I just need to figure out which phone jacks receive their signals from which phone number. And for this, I need to go pro, at $85 per man per hour, not including parts.

Did you ever think a phone could be so complicated. Well they can be. Any suggestions from the 'sphere.

Thanks, the IU.

Why I won't be getting an Iphone.

I want an Iphone. I really, really want an Iphone. They look cool. They look fun. They all kinds of cool features. It looks like a really fun toy.

TOY!!!

I don't purchase toys for my practice. If I had a need to surf the web on my phone while seeing patients, I'd buy an Iphone. If I became lost in my 1100 square foot office, and needed GPS, I'd buy an Iphone. If I became bored when consulting with a patient and felt like listening to some music, I'd buy an Iphone.

But there is one thing I could use te Iphone for: email. Of course, I don't need an Iphone to do mobile email. But perhaps that is a good enough reason to justify the purchase. . .

Vonage: A Biopsy Story

You know I have a love-hate relationship with VONAGE, my VOIP phone service provider. Well, the other day I was in the process of telling a patient about his biopsy results. Here's how it went.

"Hi, it's Dr Schoor. I'm calling with your biopsy results."
"Oh, thanks doc, I'm really stressing over this."
"OK, the biopsy was" click.

Dropped call.

Somehow, I don't think that that'll end up in one of their commercials. Though I still, on the balance, have liked VONAGE.

Thanks, The IU

The 4 types of urologists

I was having a discussion this weekend about the nature of private practice vs academic practice on my way back from the city and I'd like to share my thoughts with all 4 of my readers, plus mom.

As I see it, there are 4 types of urologist--or any physician for that matter. The 4 types may be classified as follows:

1: The academic hot-shot: this is the superstar academic physician. This doctor has NIH money as well as pharma dollars and is a consultant for many companies, either pharma or medical device or both. This doctor does very well financially and has a very secure future, since he or she can take their credentials with them wherever they go. These docs are the leaders of the specialty and influence, for better or worse, how the rest of us practice.

2: The typical academic physician: this physician sees the patients in an academic urology practice. They can get some pharma dollars or serve as consultants to medical device companies, but this is really not a significant source of income for them. These doctors are the worker bees of the academic practice, and to an extent, support the galavanting superstars. This type of typical academic physician serves at the whim of the chairman and/or board of governors and can be canned quite easily and mercilessly. These doctors grumble quite a bit.

3: The typical private practitioner: The most common type of urologist. Very hard working and very competent, these doctors roll with the punches and constantly adapt to the changing market place. They will always do well, yet they never feel in control, and complain quite often. The react to changes in the medical marketplace, though some react faster than others. Many, someplace along the line, lose their passion for the field and consider their specialty as a job. Que' lastima!

4: The private practice superstar: This is the go to guy, the urologist's urologist. This doctor sees only people on an out-of-network basis and commands high fees, yet has high volume as well. This type of urologist/doctor has extraordinary vision, foresight and business saavy. They have the ability to develop a practice that seems impervious the problems that plague the rest of us. These docs do very, very well.

5: The doc who thinks he/she is the superstar and yet is not. Of course, this is the largest of the categories.

Just some food for thought.

Thanks.

How to ask for the co-pay...and how not to.

Getting co-pays is critical for your practice. Your cash flow depends on it. In general, patients have no problem ponying up the co-pay. They do it gladly. However, there are certain methods of asking for the co-pay that can increase--and decrease--whether or not you get it that day. Here is how to ask for co-pays if you DON'T want to collect them the day of the visit:

• "Would you like to pay your co-pay now or later?" 5/5 will say, "later."


• "Would you like to pay your co-pay now, or should we bill you later." 4/5, in my experience-->"bill later."
• "How would you like to pay your co-pay?" Too open ended. Open ended questions are great during a medical history, but not when you are trying to collect money.
• And of course the worst way is to see the patient first and then say, "Ok thanks" and then just send the bill for the co-pay. Oh, yes, this happens in many offices because the staff is just too busy and does not understand the importance of the co-pay.

Here is how to ask for a co-pay:

• "I see that your co-pay is x-dollars. Will that be cash or check today." And of course, it is collected BEFORE the patient is seen.

That is the best way.

Of course, we don't deny people service because they can't pay the co-pay right then and there, but it does serve to let the patients know that we take co-pays seriously and that they will receive a bill in the mail, and that they will be expected to pay it.

Thanks,

The IU.

PS: How would you like to pay for this practice management tip, bank check or credit card?

Email and the solo doc

Email is a great way for a doctor to communicate with patients, despite it's drawbacks. In my practice, patients have been using email more and more frequently, and I think it is a good thing and welcome it. It makes me more accessible to my patients and is less intrusive on my own life. For example, in Father's Day, 2 patients had quick questions for non-emergent conditions and sent me emails. Since I have a habit of hitting "send/receive" every time I pass my MAC, i got the messages promptly and replied. No biggy. As I said, I like communication with email.

Here is how I deal with emails.

Patients are given the option to communicate by email, but they must sign an email consent form first. The consent discusses all the possible negative consequences of email communication and If you'd like mine, just shoot me an email.

When patients send me emails, I reply, then I save the initial question and my reply in the patients folder under correspondence. I save the email as a text file and date the file as well.

And that is it. Nothing fancy. Totally simple.

Thanks,

The IU.

More on EMR's

I have been having discussions recently, with knowledgeable people, on one of my favorite topics: the EMR. One person, a patient of mine, was an EMR purchaser for a major hospital, so I think she may know something. Here are some salient points we came up with that you may want to consider before committing to an EMR.

• Up-front cost: Of course this is important and obviously so, yet people still get mesmerized by the bells and whistles of a system and the vendor's claims of "ROI." Here's the real deal. If you are a primary care physician who makes, on average, $35 per encounter, you will need to see an additional 4285.7 patient visits to offset the cost of the $150,000 EMR featured in this NYTimes article. In other words, a primary care doc will need to see 12 additional patients per day x 7 days per week just to pay for the initial EMR cost.



• Up-grade costs: Have you ever wondered why Windows keeps changing it's perfectly good operating system, for example from XP to Vista, every couple of years. Windows does this to make money. Of course, when you have a personal computer, you are under no obligation or professional stress to up-grade, plus, as a consumer, the up-grades are relatively inexpensive. Now consider your EMR that you purchased for $5000 to $150,000, up-front. Every 6 to 12 months, without question, the vendor will hit you for an upgrade. Perhaps upgrades in the first year or 2 will be free, but they won't be free forever. Sooner or later, they'll get you for possibly thousands per year in upgrade costs. And what are you going to do; not pay it and let your system crash? Will you switch to another vendor and start again? I don't think so. You will be held hostage!



• Service contracts: Have you ever called, for example Dell Computers. If you don't have a service contract, they can charge $100 per 15 minutes. Dell has great customer service and their setrvice contracts are cheap: ~$250 per 3 years. Now consider this; have you ever seen anything "for medical use" be cheap? Absolutely not! Service contracts for EMR's typically start in the $500 per 6 month range and go upwards. I know of one that costs $12,000 per year. That is more than some docs pay for liability insurance. And you have to pay this because the systems break down--even the "good" ones.



• Reliability: I'm actually talking about the vendors now. EMR sales are expected to skyrocket in the next 6-7 years, so we are in a sort of gold rush, with the EMR vendors being analogous to the prospectors of 1848. Many vendors, in fact most, will not survive. Now I want you to imagine that you select an EMR for $5000--cheap for EMR's--and the software comes with free upgrades and service for 12 months. You convert everything to electronic after hours and hours of effort and money, and then the company stops answering their phones when you need them. Now what do you do? You have all this critical information that may or may not be transferable to another EMR program. In other words, choose your vendor carefully and if possible, get psychic powers.



• Ownership: Some companies are promoting use of their own EMR online services. These services are cheaper as there is no expensive software or hardware to purchase upfront, and there are no installation costs, but I have some concerns. One major concern is: who owns the records; me, the patients, or the vendor? You better read that contract carefully, or better yet, get a lawyer to read it. You may surprised. Medical charts--paper ones--that were stored in Iron Mountain Storage after a California HMO implosion in the early 1990's cost millions to retrieve, and some charts were lost forever. Personally, I don't see a difference between electronic vs paper storage. Storage is storage and physical possession is everything.


• Work-flow: Most EMR's that I have used or demo'd force the user to alter their own typical work-flow routine to fit that of the computer program, rather than vice-versa. Now this may not be a bad thing, but I know many very excellent physicians who can crank out patient visits and still leave the office on-time, with charts completed at the end of the day. For these docs, which I believe are the silent majority, EMR's would actually add inefficiency.

There, I have said my peace. And I am a staunch believer in EMR's. But they are just too expensive and if they are supposed to benefit the payers, as Senator Clinton points out, then let the payers purchase them for us. Until that happens, proceed with caution.

Hope you enjoyed the post.

The IU.

PS: Thanks SeaSpray for the Father's Day Wish.

EMR: Toys vs Tools

In an earlier post I wrote about the difference between toys and tools. I recently came across an article in the NYTimes regarding a 3 physician group who purchased a $140K dollar EMR with $50K in service contracts. In the article, the doctors state that the advantages of their system gave been largely non-economic: they have been able to downsize staff by 3 and have saved somewhat on transcription costs, but otherwise it has been a loss.

I can understand why. They spent too much and must not have really run the numbers. I think they purchased a very expensive toy, rather than a tool.

When buying an EMR, running the numbers and doing the analysis is everything.

More later/

Going solo? Have phone drills.

I overheard 3 recent phone call encounters. Here's how they went:

• "Hello, Dr Schoor's office. Our address? Sure. 285 Middle Country Rd. OK, by."


• "Hello, Dr Schoor's office. No, went don't take credit cards. OK, by."


• "Hello, Dr Schoor's office. OK. By."

So my question was, what the hell was going on? I decided to ask the receptionist, one of the new hires, what the phone calls were about.

• Call 1 was from someone who asked for our address, but she did not enquire as to who was calling or for what purpose.


• Call 2 was from a person who asked if we take credit cards, but my receptionist did not know who called or why they wanted to know whether or not we take credit cards.


• Call 3 was from a person who wanted their records sent to someone, only the receptionist did not ask for the patient's name or to whom they wanted the records sent or why.

Well, that is certainly not how I want my phones answered, and I could get angry at her, but the anger should really be directed at me. See, one can not assume that someone would or could know how you want the phones answered and what information they need to get from the caller. Some training was needed and I dropped the ball. No doubt in my mind, call #2 was from a new patient, so I lost some potential income. Serves me right!

Since the phone is the life's blood of a practice and the first, and perhaps most important, encounter that people have with you and your practice, phone training is essential for new hires. I knew that, and didn't do it. Now we drill the new hires with a variety of phone scenarios. As a mystery caller, I call my own office and ask the following questions.

• "Hi, is this Dr Kim's office?"


• Is this Suffolk Urology Associates?"


• "What is your address?


• "Do you accept United Health Care?"


• "Do you do vasectomies?"


• etc

The answers to the above questions are not simply yes or no. Instead, I have trained my staff answer those questions with questions and to try to elicit from the callers their names and the reason for the call and if it turns out that the caller is a new patient, to get them in the front door.

Poor phone skills can cost money. Lots of it. Phone training is critical!

Thanks,

The IU.

Another reason to answer the phone: word of mouth

I answer my phones after hours. Other doctors say I'm nuts to do this and tell me that one should never give out personal cell phone, home numbers, etc, to patients because the patients will abuse it.
Wrong, wrong, wrong!
I have been doing exactly that for 15 months and not one patient has ever abused it. What has happened is that word of mouth regarding my availability to speak on the phone and my reach-ability has spread like wild fire and my practice has grown. Patients and their families consistently say things like, "I've never seen any other doctor be so reachable." And then they volunteer, "I'm going to refer you to my friends."
Music to my ears!
Maybe one day I'll get tired of it, but I doubt it because it really is no big deal, patients like it, and not only does it cost nothing, it makes me money. Placing less barriers between you and your patients, while counter intuitive, is actually better for everybody; patients, referring docs, and you.
Thanks,
The IU.

ps: the above picture was taken by me at Robert Moses State Park, about 15 miles from Smithtown.

Minimize phone lines-Maximize phone power.

The phones are your practices life's blood. You must keep the phone lines open for callers, yet your staff must be on the phones for a variety of important reasons, such as to confirm patient appointments or call insurance companies regarding claims. Thanks to VOIP and PC calling, you can have relatively few expensive phone lines, such as from Verizon or ATT, etc, but have a several PC phones on every computer. I use a service called SKYPE. SKYPE used to be free--100% free--but due to its popularity, it began to charge a whopping $29 per year--YEAR!!!--for unlimited PC to phone calls anywhere in the USA and Canada. SKYPE to SKYPE, anywhere in the world, is still free, and will always be free. I use SKYPE in my office frequently and have it on each computer. My staff and I use SKYPE to make all outgoing calls to insurance companies and doctors offices, any place where you may be placed on hold for a long time.

Just a little pearl of wisdom from the IU to U.

More on answering the phone after-hours.

I know I risk sounding like a broken record, but it seems that 2-3 times a week I am rewarded just for answering the phone. Here are 2 of the latests successes:

• Last night a woman called at 7:45 PM to enquire about getting her husband an appointment for a vasectomy. The call was forwarded to my vonage line at home, which I anwered while trying to put my girls to bed, and booked the patient.
• A patient was given the numbers of 2 urologists for a vasectomy, me and another, established urologist. The patient called the established urologist first, but they did not answer the phone. He then called me, we answered, and I did the vasectomy yesterday. Not only that, he had such a good experience in my office, he let me know that he would tell others to come to me.

Answer the phones. It is really that important.

The IU.

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.

Hiring

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.

Thanks,

The IU.

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."

"Thanks."

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.

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.

W.O.M.

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.

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.

Thanks

The IU

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.
Thanks,
The IU.

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.

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

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.

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.

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.

Thanks.

The IU.

Need new patients? Get a website.

Let me just start out by saying that I think websites for doctors are highly over-rated. Just having one does not increase the likelihood that you'll attract patients. In order for this to happen, you must have a nice looking, informative website and you must try to get your website noticed using SEO--search engine optimization. Even then, the website is just another tool for prospective patients to find you with, not a money-maker in its own right.

Let's start first with the site itself. I believe your website should reflect you, and be unique, like you. I therefore, don't feel that standard template websites, like those available on GoDaddy or 1And1.com or the UrologyChannel.com are any good and any prospective patient that goes to one of those sites will see "business as usual" as their first impression. Almost anyone with any computer experience can design a great looking, unique site using 1 of these 3 programs: Dream Weaver, FrontPage or iWeb. I use iWeb for mine, host on .mac and have my domain name, http://www.drschoor.com/ point to the .mac site. Total cost $57 per year.

Now lets talk about SEO. This stands for search engine optimization. This is how your site will be found amongst the billions of sites already out there when people, for example, Google vasectomy. The easy way is to pay people to do it for you. This type of service can range from several thousand dollars to 10's of thousands of dollars. I finally caved in and began to use a service called http://www.vasectomy.com/ to direct potential vasectomy patients to my site, http://www.drschoor.com/. So far, it has worked quite well. Another way is to blog, provide good content on your blog, and link your blog to your site. If your blog content is good, people will notice it, and they will start to link to the blog and tell other about it as well. Thanks, Seaspray! All these incoming links will prop-up your blog, and ultimately your website, in the search engine rankings. There are other ways to do it--raise you site's ranking--such as adding meta-tags, and key words, and word density, etc, but I find that the best approach is with good content and a couple of good incoming links. And it is free. Since I started blogging in March 2006, I have added several thousand dollars to my bottom line.

The website can also be a good tool to educate your own patients plus prospective ones, and give patients an alternative method by which to contact you and make an appointment. Again, these types of services can range in complexity and cost but actually are quite simple. I have a blog on blogger and iWeb for my urology specific posts. Cost: zilch. I provide ample email links on my website and blogs for prospectives to reach me by, and I give my phone number and fax, as well. I have had a handful of new patients request appointments via this method.

The moral of this post. DO NOT SPEND BIG BUCKS ON YOUR SITE. One, it ain't worth it. Two, it is unnecessary. Three, it is more fun to DIY.

Hope you enjoyed this post.

The IU.

Need new patients? Take a contrarian approach.

I like being contrarian. I always have. A contrarian is someone who goes against the grain, not because he or she is being difficult, but because they see opportunity. In a new medical practice, taking a contrarian approach can really pay off. If your competition does not have Saturday hours, see patients on Saturdays. If you are told to go with an answering service, answer your own phones after hours. If everyone has strict office hours, make your hours flexible. This way you can adapt and grow and capture patients that think like you and can't just conform to another's convenience. You'll find that you will pick up a surprising number of new patients that you may not have otherwise obtained. Plus, you'll do it your own way. And you'll have fun. I've always been one to question everything, think for myself, and do my own thing. And now I have found a way to make it pay off with new patient business and overhead reduction.
Try it out.

Why shouldn't doctors be second guessed? Everybody else is.

I am doctor and I get second guessed. It is simply part of life. It doesn't bother me. It keeps me on my toes. I expect it and am never surprised by it. I also give every patient my best effort, I suppose, like most of us. So go ahead, do it.

Other professions get second guessed even worse than doctors. Governor Corzine's State Trooper driver is being criticized for the way he drove. He'll probably lose his job. The Governor himself is being criticized for his lack of seat belt use. When he returns to office, no doubt that every single one of his gubernatorial decisions will be second guessed.

Any politician gets second guessed as a matter of business. No, they don't get sued personally or professionally, as we doctors do, but they get voted out of office and have to find new employment. Especially the President. And you think it is good to be an unpopular ex-president? Just talk to LBJ, Nixon, and Bush 1. They all spent their post-office days in a sort of exile. Though, on the balance, doctors have it worse than ex-presidents.

Cops have it worse than doctors. They have high pressure jobs, have to make split second decisions, and can make mistakes that have disastrous consequences. Just like doctors. In addition to doctors, the police face constant second guessing from internal affairs, politicians, and citizen's rights groups. And they can get sued, civilly, as well. In NYC, the police make < $40K per year. Yeah, cops have it worse than doctors.

How about teachers? They have it rough as well. They get tortured by administrators, parents, and politicians. They can lose their jobs, get passed over for promotions, and, yes, be physically injured. They do get their summers off. Otherwise, teachers have it worse than doctors.

How about ad-executives? Seems glamorous, if you watch the movies. I don't think it is. High pressure, dead-lines, and results oriented. They won't get sued, they'll get canned.

So basically, everyone has got it rough. Suck it up and move'on!

The IU.

My real fear.

I have never writen about med-mal, nor will I. I do think that doctors fear law suits more than they fear cancer.
If you want to know where your priorities and fears ought to be, click here on the Pulitzer Prize winner for photography.
Thanks to Kevin MD for the link.
The IU.

Need new patients? Donn the bow tie.

One day I just got bored wearing the same old thing day-in/day-out. But I do believe in professional dress and showing patients respect with, among other things, the clothing you wear. So one day, I went to Brooks Brothers, bought a bow tie and got a lesson on how to tie it. After 1 week and 10 unsuccessful attempts, I began wearing bow ties.
The response was actually unbelievable. Somebody commented on the bow tie each and every day for 1 solid year. Patients who I saw in the hospital would call my office to request to be seen and would say, "I can't recall his name, but I want to see the young doctor in the bow tie."
Though I did not do it as a marketing gimmick, it turned out to be one of the best marketing tools I have ever used.
Yes I still wear a bow tie. Yes I hand tie it. Wouldn't do it any other way.
Donn the bow tie.
The IU.

A tale of two ureter stones.

An election year must be coming because universal health care is back in the news. . .and the bloggers are having a field day. I believe I have written on single payor universal health care before, so my views are probably known, but I am going to write here, right now, about 2 real patients that I saw this week in an affluent part of Long Island, both with kidney stones. One has insurance, one does not. Both are tax paying, US citizens. These 2 cases epitomize the good and the bad in our system.

Patient 1 (with insurance): She came to me with severe left flank pain x 5 days, tenderness in the flank, and blood in the urine. She had not been able to keep anything down by mouth. I sent her for a CT scan, and since this is the good'ole USA, she was able to get one that morning. The CT showed a stone in the middle of the ureter that was approximately 8mm in size. Again, because this is the good'ole USA, we were able to send her that day for a lithotripsy (non-invasive stone procedure), and she was stone free and pain free 6 hours later. Her out of pocket costs: $20.00. She had NY States insurance plan that government officials and police get. That, I believe, represents the best health care in the world, no doubt.

Patient 2 (no insurance): He came to me after 10 days of severe flank pain. He was referred from an urgent care center, which he went to twice ($300 for the 2 visits). He had a CT scan, done the day it was ordered (good'ole USA) that showed a 6mm stone in the upper ureter. The CT scan set him back $800. Then he came to me, only without the ability to pay. Now here are his treatment options. He can, A: wait it out. Cost $0.00, except for lost wages and possibly lost job. B: Go to the ER and get pain meds, and maybe, if he is lucky, a urologist will see him (probably not). Cost, $3500 for ER visit. Up to $15000 if he needs urologic intervention such as a stent or ureteroscopy or lithotripsy in the hospital. Option C: He can have a lithotripsy electively as an outpatient. Cost $5500 (we negotiated this one for him.)

Now here is the kicker, he is out of money, having spent it on the CT scan and the urgent care center. He is SOL. So here are his real options. He can lose his job, because he can't work through the pain or the narcotics. He can go to the ER, get admitted, and stented, and then have the hospital place a lien on his personal assets (yes, this happens every day in the good'ole USA) as they try to get paid. Or he can place the $5500 on a credit card and go hopelessly into credit card debt (happens every day in the good'ole USA). Of course, he can wait it out and if he is lucky, he won't do irreparable harm to his kidney.

So these 2 cases are illustrative in that they really represent the best and the worst that US health care has to offer. Had he been English, Canadian, Cuban, German, French, Dutch, Greek, Israeli, or Japanese he would have been treated without risk of personal financial ruin. Our Canadian bashing friends are always quick to note that in Canada he would need to wait months for treatment. Not true. Just ask any of my Canadian urologist friends, and I have a few. Anyway, as I see the increased frequency of anti-health reform blogging, I thought I would just add my own personal experience with our system. Not myth. Not exaggerated. Just how it is in my little corner of the world.

Need new patients? Go with a post-it.

You know what a post-it is right? You know; those ubiquitous yellow pads that everyone uses to jot down what ever needs jotting.
I had some made with my practice name, logo, and phone number printed on them. Cost me $40 for 20 pads, each with 50 sheets, and I gave them out to doctors’ offices whose business I was courting.
No fan-fare; just dropped’em off with a business card, a Babka, and a thank you.
The goal: keep me in mind.
Does it work? Sure.

The pharma reps do this type of stuff, and they have companies that pay millions to marketing firms that tell them to leave behind post-it notes and pens.

Cheap and easy.

Thanks,

The IU.

Need new patients? Give a talk.

You don't need to be good at public speaking to give an effective talk that will result in new patient business. Often, a talk to 2 or 3 people can result in new patients. A well respected, reconstructive urologist I know used to say that he would get more business from taking out and speaking to 3 doctors than when speaking at a national meeting. I don't know about that. I think the more, the better.
My chiropractor friend has found success speaking on health food store symposiums to as few as 5 people. I have given many talks and have not had great success with increasing new patient business, though I have had some success. I still do it because there really is little downside to doing public speaking, other than my time and some pride.
Here are some good venues:
--Support Group Meetings
--Grand Rounds
--In Office Seminars
--Local Medical Society Meetings

Need new patients? Be available.

I have a friend in start-up. He is chiropractor and he works banker’s hours. He takes Thursdays off and seldom works on weekends. He feels he “should” get to work what ever hours he wants and patients can wait; even if they are in pain. I wonder what the founder of 7-Eleven would think of this approach to convenience and availability.

In my view, he has not grown as fast as he could or “should” have.

Now contrast that to STAT Health, a start-up urgent care center in Smithtown NY. They have been open for as long as my friend has. They are open from 8AM to 8PM, 7 days per week. It is owned by 2 guys, and they are always—I mean always—there. And they are mobbed.

I know comparing a chiropractor to an urgent care center is probably not a fair comparison, but the point stands. Be available.

Everybody is busy. Everybody has a job. Everybody has family. Everybody has prior obligations. If you want to grow, be the one who accommodates. If your patient base commutes into the city, have early morning or evening hours or weekend hours. If your patient base is retirees, have mid-day hours. Nothing wrong with working on Saturdays if that is what it takes. My Dad saw patients every Saturday for 30 years in his dental practice. It never bothered me. In fact, I admired it. Your family will understand also.

If you want to grow, be available when others will not be.

Thanks.

The IU.

Need new patients? Hit the pavement.

Nothing works quite so well or has as much bang for the buck as dropping by a referring source's office and saying hello. Rather than being on annoyance, it is seen as a sign of respect. It is actually quite easy, not very time consuming, and aside for gas and perhaps some donuts, costs nothing. In my experience, one in ten visits results in immediate new patient referrals. Whenever things slow down, the first thing I do is start to visit my referring doctors.

Caveat: Never demand to see the doctor. I typically will bring coffee for the staff and say" don't bother Dr Smith, just enjoy the coffee and give him my card." Never be pushy.

Easy. Effective. Inexpensive.

The IU.

Need new patients? Answer the phone.

This is the first in a series of posts relating to practice building.

And as I have said before, if you want your practice to grow with constant new patient business, answer the phones. I just can't emphasize this enough. Just the fact that the patient selected your name is incredible and is the goal of all your other marketing efforts. But if they can't get through on the phone, it is all for naught.

Answer the phones during the day, in the morning, in the evening. Make it easy for new patients to speak to a live voice. If you must have a call service or an auto-attendant, make sure you have an option that allows patients to immediately reach a live voice, most preferrably you. Trust me, you won't be annoyed. It is all for you.

Thanks,

The IU.

Patients like the solo guy.

I have written in the past about the advantages of solo practice from the perspective of the provider. Well, here are some advantages for the patient.

1: A stronger doctor-patient relationship: Solo docs develop very strong bonds with their patients. Perhaps we view a patient's business as a privilege instead of a chore.

2: Better care: Solo practitioners control every aspect of the practice, and this makes for better outcomes.

3: Happier patients: When patients have a problem, they want to see "their" doctor, not Dr Whoseinwhat that is covering for him/her.

4: A more pleasant environment: Staff and patient alike enjoy the predictability that only a solo practitioner can provide and that translates into a more pleasant experience for the patient.

Of course, you can get lucky with a doctor that is in a group, but the odds of this happening are better with the solo doc.

What do you think?

Great News!

Wow!! That IS great news. New attendent options. Jeeze-Louise! Awesome.

I just can't seem to wipe the smile off of my FUCKING FACE!

New phone attendant options. Now that really takes the sting out of tracking down dead claims.

Gimme-a-break.

The IU.

When it gets slow, look inward.

It must be because of the holiday week, but despite 5 "rocking" weeks, my volume has dropped by 40%.
No need to panic. Instead, go to the "No worrries log", find out who has been non-compliant, call them, and get them back in. Next week is already looking good.
I guess that is one reason why being "established" has its benefits.
The IU.

The Record Request: A Simple and Fast Way.

A patient called me today requesting that his records get sent to an IVF group that his wife will be seeing. I offered to have them faxed, but instead wanted the records mailed to him.

Simple: Burn record onto a CD-R.

Total time of phone call to completed burn: 60 seconds.

Critical: CD must be R, not RW, to prevent any possibility of the patient's altering the record.

Any questions or comments?

The IU.

I miss working for someone else.

I have been on my own now for exactly one year and I must admit, I miss being an employee. Here what i miss.

1: I miss being told when I have to get to the office and when I can leave.
2: I miss being told which days I can take off.
3: I miss my yearly "performance" evaluations.
4: I miss the mind numbing routine.
5: I miss taking call on Holidays.
6: I miss having to request time off.
7: I miss that feeling of anxiety when one of my partners was in a bad mood.
8: I miss being on employee.

Happy April Fools Day.