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.