Craig Koniver, MD

Now that you have prepared your soil and planted your seeds in your garden of new patients, now is the time to start the maintenance to nurture your garden. This is often the most difficult task. Not because this step is difficult, but because of the lackluster nature involved.

Before we get to the specifics, let’s summarize what we did to get here: First, 

 - this step involved focusing on what different types of patients you wanted in your practice.

The next step is more maintenance than anything else. Now that you have shown yourself and your services to your prospective new patients, now is the time to keep watering the garden to allow these new prospects to turn into new patients.

Notice that I used the word “allow” - that was intentional. Far too often medical practices make the mistake of trying too hard here - pushing and cajoling too much, which ends up being a turn off to prospective patients.

And while the notion of “if I build it, they will come” is not as easy as it sounds, that is the right idea. The distinction, I believe, is not in the building aspect, but in how you nurture it.

So let’s talk specifics: How do you nurture your practice and your new prospective patients at the same time?

Here is a tried and true method for doing just this:

1. Write a blog: Many of you are already doing this, but if not, now is the perfect time to start. When you set up your blog, try to send out posts at predictable times. For example three times a week or even once a week. Create a rhythm so that everyone reading your blog knows exactly what to expect.

2. Once you are writing a blog, you need to then create a sign-up space on the homepage of your website for patients and prospective patients to sign up with their e-mail address. The idea here is to create a list, an audience, for you to blog to. By having a sign-up space on your homepage, you are making this easy for them. Make sure you state in very clear language: Sign up for my blog. Sounds simple, but don’t leave it up to chance that people will know what to do.

 (that’s what I use) to maintain this list. There are plenty of other services such as Constant Contact and others that are similar. You want to use these services so that you can maintain your list of e-mail addresses and be able to send out information directly to these people who have signed up. You can also choose to configure the service so that your new blog post goes directly to each sign-up's e-mail inbox. That makes the blog more personal.

4. In addition to writing blog posts, I think it is a good idea to create auto-responders for each sign-up. You have complete control over the content and the frequency of the auto-responder. Choose to talk about what you are interested in or a new service you are offering. Having an auto-responder allows you to be in closer contact with all of your sign-ups from the get-go. Be careful not to push it too frequently, though, as no one likes being pestered. So use your best judgment, but know that the auto-responder is a great tool for you to tap into for your new prospects.

I have personally found the above steps to be very helpful in growing my practice. Not only does this process help me to keep blogging and keep writing, but it allows prospective patients to learn about who I am and how I practice medicine. This somewhat passive exchange seems to foster a connection so that when they do become a new patient, they already feel comfortable with my approach.

Find out more about Craig Koniver and our other 

Articles

How do you nurture your practice and your new prospective patients at the same time? Here's a four-step method to guide you.

Growing Your Medical Practice: Turning Prospects into Patients

, co-authored by Ezekiel Emanuel, MD, one of President Obama’s health policy advisors, that appeared in the March 21 

Journal of the American Medical Association

? This is scary news if you are a physician.

In this article, Emanuel calls for cutting short the training duration of medical residents as a way to curb and cut costs. We all get the idea - Medicare shells out tons of money to training hospitals each year to help fund medical training. As Emanuel sees it, if we cut off some (or a lot) of that training time, we can reduce the amount of money that Medicare has to pay to teaching hospitals across the country.

He argues that the last year of residency does not do much for a resident’s education - that by the last year, they are well-trained enough and do not need a final year.

While I think we all can agree that there is room for reforming and tweaking medical education from both the medical school curriculums to residency programs, I do not agree that slicing off a year of residency training is a good idea.

In fact, I am alarmed at this proposition and I think you, as a physician, should be too.

[For another take on Ezekiel Emanuel's healthcare opinions, read "

First, as physicians, we are constantly compared to other healthcare providers in terms of our role, what we offer, and how well we perform. It is my perception that our reputation in our society has been diminishing over time: there is a general perception that we are greedy and working alongside the insurance companies to make them more money. Yes, this is a generalization, but the perception remains.

If we start cutting back on our training, we will literally be slicing into our professionalism, something that as always helped us stand out from other healthcare providers. This is not a knock on any other type of provider, but going through the rigors of medical school and residency is vastly different than the training a PA goes through or a chiropractor endures. We sacrifice so much to reach our goal of being a physician.

But in the last 10 years to 20 years, our patients and the healthcare system have tended to undervalue this process. Patients forget that we had to put our families and personal lives on hold for not just one year but a minimum of seven years to become a physician. No other position/job/role in our society has to endure as much as we do.

For most of us, we do this because we enjoy helping others and know that the sacrifice is well worth it. I am afraid once we start cutting back on our training that will be the start of the process in making us seem more mediocre. The less training we do, the less we should be valued (and paid), and the more we are like all the other healthcare providers.

What’s to distinguish us from the PAs and NPs and other practitioners? Right now we know that our training is so much superior. But when that training is cut (and at first it will be one year, but who knows what follows), we become more mediocre.

Next, we should probably get more training, not less. Cutting back on our training may result in saving Medicare money, but I am afraid this will potentially result in doctors who are not as qualified to perform each day which ultimately leads to more errors, more complaints, more lawsuits and worsening outcomes. I think there are many unintended consequences from this action.

Lastly, I am afraid that cutting back on our training is a way for us to be pawns of the system even more than we already are. Let’s face it, we are the middlemen in the healthcare system and the push to make us less trained will diminish our professionalism. We already have to comply with the rules of the healthcare game, and I am afraid that cutting back on our training is a slippery slope that can ultimately lead to places that worsen our reputation and position in medicine.

Medicine has stood for ages as a noble profession. Becoming a doctor is difficult and takes the special blend of endurance, a big heart, and tenacity. Yes, our healthcare system is far from perfect, but let’s not lose sight that here in America we have the best trained physicians anywhere in the world. Cutting back on that training only hurts us.

And because of that, you should be alarmed. So many of us are already unsure of the future of medicine - I think Emanuel’s ideas only make that future seem so much more uncertain.
 

While I think we all can agree that there is room for reforming and tweaking medical education …I do not agree that slicing off a year of residency training is a good idea.

Emanuel's Medical Education Cuts Would Slice at Heart of Physicians

To continue my garden-medical practice analogy, now that you have 

, it is time to start sprinkling and planting the seeds of your new garden. Before you get started, you must first ask yourself the key question: What type of garden (patients) do I want to grow?

For example, in our garden, we have a combination of many different vegetables (corn, onions, peppers, others) fruits (strawberries, blueberries, apples, melons, others) herbs (chamomile, stevia) and even some flowers.

Using this analogy, try to think about the different types of patients you would like to attract to your practice:
• Age: Do you want to focus on children, adolescents, or maybe the baby boomers?
• Condition: Do you want to see more acute problems or help patients with more chronic diseases or maybe both?
• Systems: Would you like more diabetics or heart disease patients or maybe patients who have autoimmune illness?
• Interest: Are you interested in athletics, nutrition, hormones, or maybe many interests?

You can certainly devise your own questions based upon your own interests and goals. The main idea here is that you are in charge of what types of patients you attract and having clear goals makes this process flow more easily and simply.

The next step in this phase is to figure out how best to reach your target audience. Unlike traditional advertising in which you broadcast what you want to whoever happens to be paying attention at the time, a more modern, focused approach allows you to seek out the audience that you specifically want to target.

For example, traditional advertising using TV commercials or radio relies on the principle that you will get your message shouted out to whoever happens to be listening or watching at that point in time. When you choose one of these methods, you are hoping that by chance your message will resonate with a listener and they will be motivated by your message. As most of us can tell from personal experience, this traditional type of advertising can only work when you have a large budget to spend on multiple ads over and over and over again.

It is far better to figure out who your audience is and then meet them there. The most classic example of this type of advertising is Google Ad Words. Choose keywords that you feel your “chosen” audience will type in and then create small text or visual ads to attract them to click to your link.

So if you are hoping to attract diabetic patients you might choose keywords related to diabetes (diabetes, diabetes management, diabetes therapies, etc.) and create your ads. With Google Ad Words you essentially bid for these keywords - the more you agree to pay per click, the higher visibility Google will provide you on the search result page.

Indeed there are many books and specific strategies that go into much greater depth on how to utilize Google Ad Word campaigns. And while I do not have the space to delve into that here, I mention it because it really is the most straightforward and simple way to meet your audience 

Here are some other ways to go meet your audience where they are:

• Free classes/demonstrations/ talks: Seek out your potential audience and ask to be a speaker at one of their events
•Specialty interest conventions/ meetings: Sponsor a booth and hand out your print material as you talk to people about what you do and what you can offer them
•Advertise in local specialty print resources: Every community has a plethora of mailers that are sent out to various clubs and groups - find them and create a well-looking ad highlighting your services
• Become a guest blogger
• Write comments on other people’s blogs linking back to your website: For example, if you are looking to bring more athletes into your practice, seek out the various sporting clubs and sports teams in your area, read their blogs, and make comments
• Host an open house highlighting your list of services and your new approach
• Go out and support the businesses and people who you feel would make great additions as patients: If you like exercise, spend time at different gyms or athletic fields; if you like nutrition, spend time at your favorite healthy restaurants

There are no set rules for how best to grow your practice. The key is knowing what types of patients you want to bring in and then going to them to find them.

Google Ad Words makes this process fairly straightforward for you. But there are so many other directions you can travel as well.

Stay tuned as next week we will talk about how to water your garden and bet ways to nurture your new seedlings.

You are in charge of what types of patients you attract and having clear goals makes this process flow more easily and simply.

Growing Your Medical Practice: Cultivate the Patient Base You Want

The past few weeks I have been helping my wife get her garden set up for spring. Here in Charleston, S.C., we had a mild winter and as I write this, the temperature is in the low 80s - coupled with March rain, our organic garden is set to be the best one yet!

In the next three posts, I am going to use the garden analogy to provide you with some steps for growing your practice. We spend a lot of time talking about how to manage our practices and how to keep revenues up and expenses down. I thought spring is the perfect time to discuss the best way to grow your practice to attract new patients. Because, at the end of the day, attracting new patients is vital to your practice success.

Step 1: Prepare the soil. In order to grow any type of fruit, vegetables, or flowers you cannot just pour some seeds and expect growth. This will lead to an anemic garden, at best, and one likely filled with a lot of weeds at best.

The analogy to your medical practice is that if you just throw your money towards some advertising campaign (radio, TV, online, print, etc.) you will likely end up not getting the best response or getting a response from the wrong types of responders. So ultimately preparing your soil (preparing your practice) for the season is of critical importance.

In order to prepare the soil of your practice to be ready for growth, there are some important questions to ask:

1. How many patients do you seek to gain per week? Per month?
2. How will you make your new patients feel special entering into your practice?
3. Are you sure adding new patients will keep your scheduling well and good?
4. Are you adding the new patients to increase revenue? Or why do you want to add the new patients?
5. How will get your new patients to spread the word about your practice?

These types of questions will allow you to plan ahead and get everything set up so that when your new push to attract new patients succeeds, then you will not only have somewhere in your schedule to put them, but you will also be ready to provide an amazing experience for them.

Not only do you need to ask these questions, I think now is the time to get the rest of your staff on board with your desire to attract new patients. Many times the physicians in a practice don’t feel they need to communicate all of their goals with all of the staff. In this case, I think you will be doing a great disservice to your practice if you do not get everyone on board.

Let’s shoot for May 1st as the day you launch your new patient attraction campaign. This will give you plenty of time to get everything set up (my next few posts will walk you through this) and get all of your staff and schedule ready.

Not only is having a new patient campaign good for your practice (to generate more revenue) but it also allows you to take a step back and view your practice from the outside looking in. And most of the time practices do this, they find many areas that they wish to improve upon.

Come back next week to hear the best way to sprinkle the seeds in your efforts to grow your practice.

Spring is in the air, so let's talk about how your medical practice can blossom after you've prepared it for growth.

Growing Your Medical Practice: Preparing for Change

Most likely you do not have an MBA or any type of degree in business administration. When it comes time to look at the financial health of your practice, I bet part of you cringes thinking about the “numbers” and the data you have to evaluate. Well, I know that’s true for me.

 of the financial markers each month, why not select one number to focus on and use that number as your barometer for your practice. Because in reality, there is not one financial marker that truly defines your practice - rather it is your perception of these numbers that drives you within your practice.

Here are some examples of different markers you could choose to focus on:

1. Number of new patients per month/ week:

 If your goal is growth, why not look at how many new patients you saw each week of the month? You do keep track of who is a new patient, correct? This one marker can tell you how well you are growing from a month-to-month perspective. You will know that your practice is doing well as long as your number of new patients increases

 Maybe you have already figured it out that you need to see 18 patients in a day to break even. Now instead of looking at all the different financial markers you can just look and see how many patients you saw each day and you will know the health of your practice from that number alone.

 If you submit insurance claims, then it is likely difficult to get a grasp on how much revenue you are making on a day-to-day basis. So what if instead of worrying about days for claims to pay, you just focused on how much cash you collected each day? This would include co-pays, co-insurance, and cash from items you sold in your office (supplements, lab tests, prescriptions, etc.)

These are just three different numbers to focus on, but I bet these are a heck of a lot easier than pulling out the monthly financial reports that you are used to.

I am big believer in simplifying the process and feel that evaluation of your financials is one more area where you can keep it simple.

Remember, there are no hard and fast rules for how to run a successful practice, and in fact, the more you individualize your own approach, the more success you will have.

Instead of trying to understand all of the financial markers each month, why not select one number to focus on and use that number as your barometer for your practice.

Gauging Your Medical Practice Success One Data Set at a Time

Why is a trip to the doctor’s office more like going to the DMV than going to Disney World? Both the DMV and Disney World involve waiting in long lines, but Disney has made the entire experience fun and exciting, while the DMV has made it cold and frustrating.

“But medicine is different,” you may say. Seeing the doctor was never meant to be a fun or exciting experience, after all. When you’re sick, you go to the doctor to get well - no more, no less.

This type of thinking, though, is what clearly separates businesses that thrive during rocky economic times (such as Disney, Starbucks, and Apple) and those that do not. The “user” experience, you may say, should not matter in medicine where the idea of getting well is based upon the medicine and not the connection between doctor and patient.

This is what I wrote in my introduction to my book: 

Last week, I visited the DMV. I waited for over three hours there. Three hours! The place was miserable and everyone waiting was stressed and eager to get the heck out of there.

Is this what your waiting room looks like? Probably not yet; but likely in the future.

We need to be honest with ourselves here and note that medicine and healthcare are moving in a direction that promotes more of my experience at the DMV than a room that is quiet and relaxed with smiling people.

Are you smiling these days? Most days? Most of the doctors that I talk to are not. They are fed up with the administrative burden, the declining reimbursements and the overall increase in pressure to see a lot of patients every single day.

I am not a pessimist, but I can appreciate reality. And to me my experience in the DMV last week confirms what I know to be headed our way: longer waits, more frustrated patients, and more administrative hassles

I think it is time you started being honest with yourself about your profession and your daily choices in your practice. I guarantee if you were in any other industry, you would not allow yourself to be as little in charge as you do in medicine.

Here are three brutally honest questions I want you to ponder:

1. On a daily basis, are you practicing medicine the way you truly want to be? If not, why not and what are you going to do about it?

2. If you could change (and you can) one aspect of your career, what would it be? Would you make more money? Would you have more time off? Would you have less staff? Would you still be in medicine?

3. Why do you allow “the system” to dictate to you the terms by which you make money, provide for yourself and your family, and tell you “how to” practice your trade?

I know these are not necessarily easy questions to answer. But it is long overdue that you took a very hard and truthful look at your career and decide for you what is best.

Certainly many of you will ignore this process or brush it off that all is well. But I have a sense that either my recent visit to the DMV or your next one will stay with you for a while. Not because you fear the future, but because you know that on many levels, it is already here.

I think it is time you started being honest with yourself about your profession and your daily choices in your practice.