MARKETING

I knock on patients' doors

By focusing on customer service, bypassing insurers, and appealing directly to patients, this doctor developed a thriving urgent care clinic.

By Todd Coulter, MD
Internist/Ocean Springs, MS

When my solo practice, Midway Family Care Walk-in Clinic, opened on Dec. 7, 1999, I had eight patients. Exactly two years later, I had over 7,100. I did this by emulating the consumer-friendly model of successful retail businesses, and by energetically marketing the practice to the people of Ocean Springs, a middle-class resort community on Mississippi's Gulf Coast.

Medicine is rife with barriers to entry: Patients have to make an appointment. They need a referral. If someone doesn't have insurance, the implicit message is, "You probably can't afford to come here." Wal-Mart and McDonald's may not save lives, but they're accessible to their customers in ways that most medical practices aren't.

I addressed the accessibility issue by creating a clinic that, for its first two years of operation, was open seven days a week, from 8 am to 8 pm. No appointments or referrals required. All visits cost $40. We are not a bank; therefore we don't extend credit. Insurance isn't required, either. We do accept Medicare and Medicare with Medicaid, but not Medicaid alone. And if a patient has private insurance, we provide the information needed to file a claim, but it's the patient's responsibility to submit it to the third party. I see 25 to 40 patients per day, and no one complains about the way we do business. On average, we collect $900 to $1,300 dollars daily.

From Chicago med student to Mississippi entrepreneur

When I finished my internal medicine residency at Michael Reese Hospital in Chicago, there was a great need for doctors in Mississippi. I began a rural health rotation in Tylertown, in the southwestern part of the state, but after a few months, Singing River Hospital in Pascagoula, MS, made me an offer I couldn't refuse: They'd give me a handsome salary—and pay off my school loans—if I'd run a primary care practice there.

Unfortunately, the hospital had over-recruited. I was never busy for more than three or four days per week. I started moonlighting at a nearby urgent care clinic and realized I had found my niche: Urgent care offered good pay and plenty of work, minus the overhead and hassles. After about a year of working for another walk-in clinic, I opened my own place to take advantage of everything I had learned about running a primary care outpatient facility.

As a young physician from a lower income family (my mother was an LPN who later got her RN; my father was a bus driver), I'm a fiscal conservative by habit and necessity. So I keep Midway's staff to a minimum. My wife comes to the office three days a week to do the billing. Instead of an RN or LPN, we employ a medical assistant who is authorized to do things like take X-rays and draw blood. One front-office person works from 8 to 2, another from 2 to 8.

Going to patients so they'll come to you

To build my practice, I took a grassroots approach. I went to local homes, businesses, day care centers, churches, gas stations, restaurants, and—like the prophets of the Old Testament—spread the word. "Hi, I'm Dr. Coulter," I'd say. "I run the Midway Family Care Clinic. Do you know about us?" Most people expressed surprise and delight, because no physician had ever approached them and asked for their patronage or referrals.

Visibility makes a great difference. I also developed what I call a collateral support network of veterinarians, chiropractors, dentists, and subspecialty physicians. I put copies of my brochure in these practitioners' waiting rooms, and asked them to tell their patients about our low-cost after-hours clinic.

For the past two years, I have participated in the Adopt-a-School program sponsored by the Ocean Springs Chamber of Commerce. Every six months or so I go to a local school and have lunch with the faculty and staff. It's an excellent opportunity to get to know teachers and students, and to network with parents and community leaders.

I treat patients the way drug representatives treat me. I go to local businesses, sandwich shops, and crawfish places, and distribute $25 gift certificates as well as Midway Family Care pens, writing paper, and Post-It® Notes. In fact I've learned all my marketing from drug reps. They've made it easy.

This past January, with Midway still growing by seven or eight patients per day, we discontinued Sunday hours. Soon afterward, Saturday hours were dropped. Patients are amenable to us keeping the clinic open Mondays through Fridays, 12 hours a day. Occasionally, I hire a doctor to cover for me, but Midway remains a one-physician enterprise.

Patients who came in for brief episodic care often ask, "Doctor, can I stay with you?" and I reply, '"Sure." In fact, I tell patients that if they see me more frequently, they'll reduce their risk of hospitalization. A lot of patients choose me as their primary care doctor.

My home phone number is listed in the phone book, and I give patients my cell phone number. But because the clinic is open so many hours during the week, I rarely receive after-hours calls. Patients are instructed to go to the emergency room in the event of late night or evening emergencies. I maintain some hospital privileges, but I couldn't run Midway if I had to see five to 10 hospitalized patients a day, so I use hospitalist services.

Now that Midway is closed on weekends I have more time to market the practice. On Saturday mornings, I put on my backpack and walk one Ocean Springs subdivision at a time, meeting merchants and ringing maybe 50 doorbells. I say Hello and hand out our brochure. And I actively engage folks in conversation. It blows people away.

 

Todd Coulter. Marketing: I knock on patients' doors. Medical Economics 2002;15:47.