Physiatry Practice Management Resources

Marketing—it's not advertising Marketing and promotion require a more hands-on approach than simply buying ads, particularly for new practices. Among the tactics suggested by consultants and physicians: Speak to community groups, schools, and senior centers; set up a booth at a local health fair; offer to provide medical advice on a local TV or radio station, or to write a medical advice column for your local newspaper; do an elder care health presentation at a local assisted living facility or, with a slightly different slant, at a PTA meeting; sponsor a team in a local youth sports league.

"For the first few years of my practice, I used to do a lot of public speaking, sometimes several nights a week," recalls Patti Roy, a family physician in Muskegon, MI. "It was very effective, and I really enjoyed it. It doesn't cost anything, but it does take a lot of time away from your family.

"Another thing I did in those early days that cost nothing was canvas the neighborhood businesses: the local drug store, grocery store, bar, florist, movie theater, gas station, restaurants, and pizza joints. I'd introduce myself to the manager and the employees. Often they'd ask questions about themselves or a family member, which gave me a great opportunity to impress them with my knowledge and compassion. Some of those neighborhood people have been my patients for more than 20 years now."

Internist Todd Coulter also took to the streets when he opened his solo practice in Ocean Springs, MS. He went door-to-door visiting local businesses, churches, day care centers, and homeowners, handing out brochures and engaging people in conversation. That effort really worked, he says, producing several new patients per day.

Another inexpensive way to let the community know about your new office or satellite clinic is to hold an open house. Invite local physicians and other potential referral sources: hospital administrators, dentists, pharmacists, podiatrists, psychologists, clergy, and realtors. Send an invitation to the local paper's health affairs editor or reporter. You'll get the best turnout by holding the event mid-week, about 5 p.m., so people can drop by on the way home from work. The event should run only two to three hours, and your staff should all be present.

To many doctors, the most effective kind of marketing is simply word-of-mouth from existing patients. As Greg Hood, an internist in Lexington, KY, says, "The best way to advertise is to take good care of the patients you already have." Patti Roy agrees: "Satisfied patients stay, and they refer their family and friends." To encourage that process, Roy has signs at her front desk and in each exam room that read: "The highest compliment our patients can give us is the referral of their friends and family. Thank you for your trust."

There are several other no-cost ways to encourage more referrals. "One of the best is to send handwritten thankyou cards to every single person who refers a new patient," says Denning. "In fact, the first time you get a referral from a new source, you should call him with a message of gratitude. This method works better—and costs less—than almost any other form of advertising you can do."

Then there are marketing tricks like raffles, giveaways, and free first visits. "Those things may work for some doctors," says Patti Roy, "but they've never set right with me. There's something tasteless about them." Consultant Jeff Denning agrees: "Novelties like refrigerator magnets and ballpoint pens are too common to be effective, and in my opinion, they're not dignified enough for medical practices."

Internist Jeffrey Kagan in Newington, CT, has found that making house calls on bedridden patients can pay extra dividends: "They tell their friends," he says. "Every one of my house-call patients has led to at least two or more new office patients."

Charles Davant suggests keeping a few "loss-leader" patients around. "I remember asking my physician father why he kept one notorious deadbeat as a patient," he recalls. " 'Because he has an enormous family,' my father replied. 'They've all become my patients, and they all pay their bills.' "

Using a Web site as a marketing tool Medical practice Web sites are so common these days that they've become a standard marketing tool for attracting new patients as well as for communicating with existing ones. For physicians considering an Internet presence, the options range from simple homemade sites that cost little or nothing, to customized sites created by professional designers that can cost $500 or more, plus monthly maintenance fees for hosting and updating the site.

The good news is that as Internet use has grown, prices for Web software and designers have fallen sharply. When choosing a Web designer, however, don't shop only for price. Ask your friends or colleagues to recommend someone with experience in creating sites for medical practices. Then look at those sites to see if you like them.

Prepackaged sites are available at little or no cost through the American Medical Association, state and specialty societies, health plans, and hospitals. Using their templates, you can design your own format, fill in your practice information, and select patient-education articles and interactive patient forms.

Every Web site should contain such basic information as practice location, office hours, services you offer, office phone and fax numbers, e-mail address, and doctors' bios and photos. Include your Web address in your newspaper and Yellow Pages ads, your practice brochure, letterhead, and business cards. Have your staff tell your patients about your site. Hopefully they'll mention it to their family and friends.

Since many people search the Internet for information on their own medical problems your site should also include advice and information sources on such topics as disease prevention, nutrition, exercise, and weight-loss, plus any conditions you specialize in, like diabetes or chronic back pain.

Keith Borglum, a healthcare marketing consultant in Santa Rosa, CA, warns primary care doctors not to sink too much money into Web sites because they tend to be more successful for big-ticket specialists like plastic surgeons, whose patients are typically highly motivated in their search. As he explains, "Someone with a cold or a sore throat doesn't usually have as much interest in searching for a doctor online."

When marketing backfires While effective advertising and marketing can attract new patients, it can also backfire if you're not careful. Consider the case of Richard W. Feldman, a family physician in Nashville, who claims he was the first doctor in the state to advertise his services, back in 1979. Thanks in part to his success at marketing, he now owns several diet clinics in Nashville and nearby cities.

In February 2000, Feldman mailed postcards to about 8,000 former and current patients, offering a 50 percent discount on one session if they brought in a "diet buddy" on their next office visit.

After investigating Feldman, the state charged him with "unprofessional conduct" for violating a Board of Medical Examiners regulation prohibiting the offering of "any fee or other consideration" to a third party in return for referrals. After a hearing, the Board of Medical Examiners imposed a civil penalty of $1,000 in October 2001.

Feldman appealed the Board's action, arguing in part that his postcards were protected as "commercial speech" under the First Amendment. In November 2003, however, the state appellate court affirmed the Board's decision, ruling that the free-speech protection applied only to lawful activity. Since Feldman's postcards weren't legal, they were therefore not protected.

Marketing and advertising could raise other potential legal problems for doctors. If patients believe that a physician's ads are misleading, they might file a consumer fraud claim.

Plaintiffs' attorney Bruce Nagel of Livingston, NJ, points out that physicians who advertise their services to the general public can be held accountable not only under state medical board regulations for unprofessional conduct, as in the Feldman case, but also under a state's Consumer Fraud Act. "From a regulatory standpoint, a doctor is no different than anyone else selling his services or a product—like a car salesman," says Nagel.

For patients who sue their doctors, consumer fraud suits offer several advantages over malpractice claims: The burden of proof is less onerous, because in most states they don't have to prove damages or negligence. The statute of limitations is generally longer—five years or more vs two or three for malpractice suits. And while punitive damages are rare in malpractice cases, some consumer protection laws allow them, plus attorney fees, as well as compensatory damages for any injury.

For doctors, consumer fraud suits pose an additional risk. If the alleged misconduct involves the commercial rather than clinical aspect of the practice, your malpractice carrier could refuse to cover any resulting settlement or verdict (although it may agree to provide a defense). A business insurance policy might cover it, but if not, you could end up paying it out of your own pocket.

"To avoid such claims," says William Krais, a malpractice attorney in Morristown, NJ, "physicians who advertise and market their practices should take great care to represent their experience, abilities, and success rates as accurately as possible, and should resist the urge to raise unreasonable expectations."