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How to Build Your Practice


With the restricted panel approach and other circumstances making it difficult to win new patients, there must be something more effective than putting an announcement of availability in the Yellow Pages.

Business types call this marketing, but docs almost instinctively shy away from the term because it connotes hucksterism. Marketing is commonly accepted in the business community as identifying what your target population's needs are and then meeting them. But self promotion of any kind has been traditionally frowned upon in the profession as there is almost a feeling that "They come to us, we don't go to them."

Whether this is arrogance (demand for medical services being traditionally greater than supply) or a subconscious, savvy understanding of increasing our desirability, I will leave for you to decide.

Claims and comparisons about and among docs have always been difficult to substantiate, so medical organizations have historically prohibited all such unproven statements to the public as unethical. Medicine struggles with expanding science and a recent awareness of the importance of the separate service issue while the traditional art of medicine remains opaque to investigation. Evaluations could be very helpful to the public and to the profession if they could have a rational, reproducible and transparent basis. So far that process remains only a work in progress.

I was on my county medical society committee that made a change allowing an "announcement of availability' to be placed in the Yellow Pages. This was a breathtaking change at the time, as reasonable as it sounds today, even though subsequent events proved that the cat was really out of the bag. Some docs picked up the ball and ran with it going into direct advertising and even so far as testimonials by celebrities. Court decisions have also declared some restrictions by medical organizations, well intentioned or otherwise, except for fraud, to be "in restraint of trade." Ergo, were stuck with marketing - some of it embarrassing, some of it useful.

The other trend in medical economics that impacts the kind of activity docs who want to build or maintain their practices have to use, is the restricted panel approach heralded by the HMO movement. A doc could jump through the financial hoops to open an office, as I discussed in an earlier column, but if your area is dominated by insurances that have closed panels, you aren't going to see many patients unless you can get included on those lists. Even then, you still have an uphill battle for new patients.

Why? Well, the only patients available at first to a doc new to a panel are the disgruntled, the drug seekers, and the trickle that come into coverage between the open eligibility periods. It's kind of a zero sum game among patients with insurance and the available number of docs, especially among certain specialties in demand. Because the patient population is finite, your gain has to be another doc's loss.

Open enrollment periods are potentially a free-for-all where entire practice populations may shift. If there is a dominant employer in your area whose HR department gets talked into shifting from one "preferred" carrier to another, and you are not on the new panel, even your loyal patients will be forced to switch docs overnight and your practice could be decimated. I've seen it happen.

And I want to digress for a moment because I almost wrote "provider" instead of doc. I am adamantly opposed, both personally and professionally, to the term "provider." We are Doctors of Medicine, a hard won title which, aside from the value to our own tender feelings, has considerable value, identifying us as repositories of pertinent knowledge and possessors of final responsibility for the health of the community, according to multiple studies. I think that the use of this term "provider" is a significant step down a slippery slope, reducing not just the medical community’s clout on healthcare matters with the government and business world, but potentially threatening the population's very well-being.

I also feel that FNPs, Pas, and the rest have earned the right to their titles and should also not be denigrated to the moniker of "provider." There has been some laziness involved in choosing one enveloping term instead of multiple ones to describe the professional disciplines in the healthcare arena. And maintaining the respect of officialdom as well as the public is a key to building a practice that people will want to utilize. I hope you agree with me. If not, let me know your perspective and we'll talk about it.

So, you've got 4 approaches to building a practice; appealing to people limited to a specific panel of which you are a part, going directly to the community for medical services not covered by insurance, and currying favor with other docs for referrals and internal practice marketing, which is applicable to patients derived from all sources.

I'll get into the specifics next time as we have now framed the context and boundaries that describe building a practice.

Remember when it used to be just a variation of, "If you build it, they will come"?

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice