Ken Karpay


A few years ago my physician suggested I have some additional blood tests performed; she was concerned by the results of earlier blood work. I was nervous: Was there a problem? Was I seriously ill?

Later, while having the additional blood drawn, the phlebotomist looked at my paperwork and said, “Oh, you have the same doctor as Cal Ripken.” 

Yes, I know the phlebotomist committed a major violation of the retired baseball slugger’s confidentiality. Still, I relaxed. Although I didn’t think of it at the time, that encounter amounted to a brand experience: My physician could never have (intentionally) used her reported association with Ripken to her own advantage, but my discovery of it made me feel more confident in her skills. Surely, I reasoned, baseball’s Iron Man, so known because he never broke down physically, would choose his doctor carefully and wisely. 

Which leads me to two questions: First, do you provide patients with top-quality care? And second, do your patients and fellow physicians believe you provide top-quality care? “Brand schizophrenia” is the difference between what you believe is your brand and the perception of your brand in the marketplace, according to marketing gurus.

Take Apple’s iPod as an example. The internal brand - that is, the corporate message, the experience Apple wants consumers to have with the iPod - is cool, multifunctional, easy-to-use. But have you ever been on a cramped airplane when your iPod’s battery died midflight? I have. When I complained, the nice person in the Apple store smiled at me and said that my iPod’s less-than-stellar battery life was my problem. For me, Apple’s brand integrity went down a notch.

A brand is the essence of a consumer’s experience around a product or service. Brand integrity means that a consumer’s experience with a brand is consistent both internally and externally. When your patients see your practice in the way that you want them to see it, that’s brand integrity. A lack of consistency is brand schizophrenia. Why should you care? Because your brand in the market may actually affect your ability to deliver quality care.

Branding is a lot more than just creating a new logo or Web site. It’s a process that you can use to define the essence of your practice, and then decide how you communicate that to the outside world: in the staff you hire, train, and compensate; in the location and hours of your office; in your flexibility in billing and payers you carry. 

Yet with a growing physician shortage, your schedules may already be packed. In fact you may be turning patients away. Do you need brand integrity?

For one thing, practices with high brand integrity will have an easier time recruiting and retaining good talent. 

For another, you may be able to migrate away from the controlling hands of managed care by integrating cash-only services into your practice. If patients already have a good sense of the experience they will have in your office, they will be more willing to spend their own money. 

Practices with positive “buzz” attract more patients regardless of clinical outcomes; consumers choose practices with strong brands in the community because they lack access to other kinds of information. They derive peace of mind from your brand because they are unable to judge your clinical skills.   

In the end, you can decide what kind of practice you can have and what your brand is all about. Just make sure that this is what’s communicated outside of your office. 

This article originally appeared in the November 2007 issue of

Articles

Branding is a lot more than just creating a new logo or Web site. It’s a process that you can use to define the essence of your practice.

Publisher’s Note: The Brand’s the Thing


The faltering state of U.S. healthcare is sure to remain a very hot topic throughout the race for the White House. All of the major candidates agree that 

Consequently, if any reform is on the horizon, the period just after next year’s election is the best time for it. 

But before any of us pops the cork on a bottle of celebratory champagne, I’d like to share with you an anecdote that the mayor of a medium-sized Florida city regularly shares with his audiences: 

In the span of a month or so, he attended the openings of a new library and a dog park. Only 20 or so people bothered to show up for the library event, while more than 200 turned out for the dog park event. 

“Guess what we’ll be building more of in the future, libraries or dog parks?” the mayor asks. 

To predict what the next president will do about healthcare, it’s perhaps best to ask what the candidates think the public wants rather than what they think it 

Here’s what we’ve heard so far from the would-be presidents. 

Sen. Hillary Clinton (D-N.Y) tells anyone who asks that the American healthcare system is broken. 

But having gotten slapped in the face when she tried to revolutionize healthcare as first lady 14 years ago, Clinton makes clear that she won’t be leading the march for reform. 

“I’ve tangled with this issue before - and I’ve got the scars to show for it,” she told an audience at George Washington University in May. “The key is to develop the political will to make it happen.” 

Translation: I’d rather be president than push unsuccessfully for healthcare reform. 

After eight years of George W. Bush - who has suffered a series of failures on big domestic issues such as immigration, Social Security, healthcare, and tax reform - it’s a sure bet that our next president will choose the path of incremental change and bipartisanship. 

Clinton isn’t the only candidate who is tentative about healthcare. 

Republicans Rudy Giuliani and Sen. John McCain (Ariz.) say it’s time to “do something” about healthcare. But they recognize that forcing Americans to trade in their employer-provided insurance, and its succulent tax deduction, will take a lot of persuasion. Not something to do in the heat of a campaign. 

Mitt Romney is pushing a plan similar to the one he passed when he was the governor of Massachusetts. But like his fellow Republicans, he is vague on some details. 


Among the other Democrats, Sen. Barack Obama (Ill.) says healthcare can be made more affordable if the government encourages the creation of private markets, while guaranteeing healthcare coverage for everyone except those between the ages of 26 and 62. Details to follow Inauguration Day. 

John Edwards, the one-time trial lawyer, U.S. Senator, 2004 Vice Presidential candidate, and poverty think-tanker, stands out from the crowd on this issue, having made public a very specific plan. He would enact a universal health plan funded by large tax increases. 

Look, I don’t know how to fix healthcare, either. But I do know Clinton has one thing right: Changing healthcare in America would be a big deal. And nothing that big will become law without support from many different groups, or at least a promise from those groups not to oppose what is proposed. 

Among those groups will be physicians. What’s likely to be asked of you? Any healthcare plan will almost certainly include a continued push by the federal government for physicians to deploy EMRs and other technology in hopes of reducing errors, streamlining payments to physicians, and cutting unnecessary processing costs. 

For starters, how about a fully funded, permanent physician payment plan? Some federal protections against medical malpractice? 

What else? Please share your ideas with me. We’ll publish them throughout the primary season. After all, we’ve got to let the candidates know what you need and want. 

This article originally appeared in the October 2007 issue of Physicians Practice.

With the future of healthcare at stake, presidential candidates must hear from you.

Publisher’s Note: Our Best Chance for Reform?


In his latest documentary, “Sicko,” Moore examines American healthcare, comparing it to systems around the world. He then delivers his diagnosis for what ails us and prescribes what he believes is the cure. 

While watching “Sicko,” I couldn’t shake the question: Is even half of this true? 

For example, Moore dedicates a scene to a man who has accidentally cut off two of his fingers. The man is faced with a dreadful decision: which finger to reattach because he can’t afford both. 

Well, with the benefit of hindsight, we at least know that many of Moore’s past critiques have proved true. 

Nearly two decades ago, Moore took on General Motors in “Roger and Me,” suggesting that its business strategies would eventually drive them out of business. What seemed preposterous in 1989 is not inconceivable today. 

Five years ago, in “Bowling for Columbine,” Moore took aim at gun owners, advocates, and laws, claiming that unless major changes were made, our schools and other public facilities would likely be visited by more violence. He proved tragically prescient on this count. 

Then in 2005, Moore leveled his camera at the Bush administration and the mainstream U.S. media. He charged that the U.S. offensive in Iraq following Sept. 11 had little to do with fighting terrorists and was more about making money. The war in Iraq, he asserted, would fail and would do little to curb worldwide terrorism. 

Ever since Moore announced plans to take on healthcare, I’ve watched, waited, and wondered. Whom would Moore depict as villains? How would he treat physicians? Let’s start with the villains since there are so many of them, according to Moore. Capitalism itself is one. So too are managed-care payers that feed at the trough of healthcare premiums. 

But physicians don’t draw Moore’s ire. You, my friends, are seen as mere pawns, sympathetic bit actors who are denied the power to treat patients as you see fit. This is a significant break with the stereotype of doctors as Lexus-driving, golf-playing, money-grubbing elitists. Moore characterizes physicians as victims, just like U.S. consumers. 

Moore’s prescription for healthcare is simple: Adopt a national system that makes government employees of private practice physicians and other providers. Many Americans believe this would be disastrous, that similar schemes have failed in country after country around the globe. Moore sets out to disabuse us of this notion. 

He takes us to Canada to reveal patients who do not wait endlessly for care, as many in our country think they do; to Cuba to reveal surprisingly state-of-the-art medical technology and practices; and to England to demonstrate that physicians there can live very comfortably despite tight government controls. 

Moore points to systems that are already nationalized in our country as examples of how successful it could be - the U.S. Postal Service and public education. Not exactly models to be replicated. 

But when it comes to healthcare, Moore’s critique may be on point, but, in my view, his solution is flawed. 

This article originally appeared in the September 2007 issue of Physicians Practice.

Michael Moore, the auteur provocateur, has invented a new genre of film: enter-rage – entertainment intended to outrage its audience.

Publisher’s Note: Would ‘Sicko’ Prescription Make Us Sicker?


I met Sanchez at the Pri-Med West meeting in Anaheim, Calif., while standing at the 

 booth on the trade show floor. He is outgoing, confident, and curious, and we quickly struck up a conversation. 

What I learned from our talk reminds me that despite the doom and gloom that often permeates discussions about the future of medicine in America, primary-care and family practice physicians can lead independent, financially viable businesses if they take the business of their practice as seriously as they do the health of their patients. 

The son of two migrant farm workers, Sanchez was a rather middling student, receiving mostly C’s and D’s in high school. After graduating from high school, he went to work as a laborer in the furniture business. 

It didn’t take long for him to realize that he wasn’t getting anywhere toiling away in a furniture factory. He decided to go back to school, enrolling at a nearby community college. That’s when he made a second realization, that his previous education had left him ill prepared. He had to re-do high school. 

At around the same time, his mother was diagnosed with cancer, from which she died. He decided that he would become a doctor, in part as a commitment to his mother’s memory. 

So there he was, a young man with a dream to become a doctor but without the academic training. 

Sanchez sought out a classmate who routinely produced A’s. He asked if he could shadow him and see how he did it. Watching this successful role model, Sanchez saw what was required. After each class, his role model would go straight to the library, quickly rewrite his notes, then go back and outline the key points covered, and in the process commit his professors’ lectures to memory. Sanchez employed the technique, and his grades improved. Ultimately he made it to medical school and completed his residency at the age of 30. 

After completing his training, Sanchez joined a private practice. He realizes now that while he may have been adequately trained to care for his patients, he lacked the business skills necessary for private practice. 

Joining the practice, he gave up all control over the billing and collections, deferring instead to the office manager. But he soon felt that while he was providing his patients top medical care, the amount of his effort did not translate into higher compensation. “I kept working harder and harder,” but didn’t produce much more income, he says. In hindsight, he realizes, he only had himself to blame. 

In November 2004, Sanchez reached his breaking point and left to form his own practice. But with no training in business, how could he survive? 

With no role model to emulate, Sanchez this time studied the money supply of his practice, tracking how cash came in and how it went out. He took on all the responsibilities frequently handled by an office manager. 

He learned how to balance great patient care with great practice management. 

Recently he hired an office manager. He sees 19 patients a day on Mondays, Tuesdays, and Thursdays. He dedicates Wednesdays and Fridays to accounting and spending time with his family. 

The payoff all of the hard work has been huge. His dad, Sanchez says, gets to introduce him as “my son, the doctor.” 

This article originally appeared in the July/August 2007 issue of

Elias Sanchez, a 40-something general practitioner, became a doctor the hard way.

Publishers Note: Up By His Bootstraps


“Someone ought to start leveling with you,” said Dr. G, the physician on call in the neonatal intensive care unit. She was speaking to my wife. 

Pointing to the two-week-old, two-pound, 12-ounce baby lying motionless in an incubator, she added, “Life’s not going to be a bowl of cherries for this baby. You better start learning to deal with it.” 

We learned of my wife’s pregnancy in her fourth month. Twins were discovered in month five. Then a few weeks later, a second sonogram led to the suggestion that “Baby B” had some type of malady. We were relatively clueless but scared. 

When my wife was in her 29th week of pregnancy and developed pre-eclampsia, her OB/GYN recommended an immediate C-section. Two baby boys were delivered and immediately put on oxygen in the NICU. The first two weeks of life were a struggle. But despite that, we were growing increasingly hopeful. 

Like many patients you probably know, we refused to believe what Dr. G had told us. Baby B, now Robert, was small; every other day seemed to bring another medical challenge. But he also seemed determined to thrive, overcoming almost everything nature threw at him. 

At our insistence, Robert was assigned another physician. That’s when we met Dr. H. A pediatric neurologist, Dr. H spent a good hour examining Robert, holding him, massaging his small arms and legs, and evaluating his muscle tone through the power of touch before agreeing to see us at the hospital. 

“I am cautiously optimistic,” he said. On what do you base your prognosis, we asked? 

“I looked at the patient,” he answered. 

Dr. H was big on looking at and examining the patient, not just the medical labs and reports - the stuff Dr. G had focused on exclusively. 

Hospitalizations and surgeries followed. Dr. H remained positive throughout, as did Robert’s development. 

“Look, he may walk later than his twin brother; maybe he won’t be great at baseball or running. But he’s going to be fine.” Dr. H was right. He did start walking and talking later than his twin brother. 

But despite Robert’s progress, Dr. G’s words had made an indelible impression on us. They were seared on our brains. Anytime Robert took a step backward, her words recurred like a bad dream and haunted us. 

Dr. H encouraged us: “Look, there’s nothing I can do to erase what you were told. Don’t let those words hold Robert back.” 


Eighteen years later, it is clear that Dr. G was right. Life wasn’t a bowl of cherries for Robert. Chronic medical conditions slowed his development. 

But Dr. H was also right. Over time, with the help of a superb group of committed physicians, counselors, teachers, family, friends, and peers, he prevailed. Most important, in spite of - or maybe because of - the challenges he faced early in life, he was drawn to the world of music. In grade school, he learned to play the piano. In secondary school, the cello. And more recently, he has learned to compose music. This fall he’ll be a freshman at a world-renowned musical conservatory. 

Dr. G’s words are still with us. But Dr. H’s unfailing optimism and support helped us overcome them. 

In a world where we all occasionally feel helpless, incapable of doing anything as if restrained by a straightjacket, it’s important to remember just how powerful we can be. Beyond the tremendous medical care that you can provide, your words can make all the difference in the lives of the patients you see each day. 

This article originally appeared in the June 2007 issue of

Sometimes what you say is stronger than any treatment or medications you may prescribe.

Publisher’s Note: The Power of Your Words


When it comes to healthcare, what happens in Vegas isn’t likely to stay in Vegas for much longer. 

Health insurance behemoth UnitedHealth Group, Inc. is poised to take over Sierra Health Services Inc. in what’s being billed by the companies as a $2.6 billion “merger.” You know, sort of like how Jonah and the whale 

If regulators approve the deal - and precedent strongly suggests they will - Sierra, which is headquartered in Las Vegas, will soon start shipping its handsome profits to Minnetonka, Minn., home of United. 

What does this have to do with you? Quite a bit, actually: the potential further erosion of your negotiating power when it comes to payment. 

Unfortunately, regulators, who are all that stand in the way of the United-Sierra union, aren’t likely to give physicians’ well-being much thought during their deliberations. 

That’s because federal antitrust laws are intended to protect consumers - not businesses such as yours - from anticompetitive corporate practices. 

Whenever I speak to physicians, it usually takes no more than a minute or two for the topic of payers to come up. As often as not, they refer to payers as “bullies” and other more colorful names. 

While it stopped short of name-calling, the AMA expressed profound displeasure with the United-Sierra proposal in a letter to Attorney General Alberto Gonzales. 

“Federal authorities must not allow United’s blatant grab for dominant market power,” argues J. James Rohack, MD, a member of the AMA’s board of directors. “The proposed merger would have negative long-term consequences for patients, physicians, hospitals, and employers.” 

For its part, United expects the merger to produce a company with “the scale, resources, and commitment to offer the most comprehensive range of affordable services to our clients in the Southwest, as well as for clients with business interests across the country.” So says Stephen J. Hemsley, United’s president and chief executive. The AMA contends that United, if permitted to acquire Sierra, will have 78 percent of the Nevada HMO market and 95 percent of the Las Vegas metropolitan market. 

United says those facts are misleading because the AMA is focusing on the “fully insured HMO market” and ignoring other products in Nevada. 

Regardless of which side is right, the U.S. Department of Justice will decide the outcome. If past is prologue, the odds of a rejection are long. 

During the last 12 years, the government has signed off on more than 400 proposed mergers, never rejecting even one. It did place conditions on two of the deals, including one of United’s previous purchases. 

It’s time for federal regulators to start weighing the likely impact on physicians, because what affects you affects your patients, as you know all too well. 


Consolidation makes it increasingly difficult to negotiate fair contracts with payers like United, and anyone else who stays in the market. And that, of course, also hurts consumers. 

As physicians find it difficult to obtain contracts they can live with, they may decide to stop participating in health plans altogether, reducing the supply of physicians and driving up the cost to patients and further inconveniencing them. 

Consolidation also increases the prices that consumers pay for premiums, which can increase the ranks of the uninsured. This too hurts physicians, who are forced to care for patients with no ability to pay. 

If we really want to improve healthcare, we should allow the people who provide the care - you - to negotiate openly and fairly. The United merger, while great for United’s shareholders, would be another step in the opposite direction. To say otherwise is to avoid reality. 

This article originally appeared in the May 2007 issue of

Another health plan grows; physicians’ leverage shrinks