The Great Practice Makeover: Hitting the Mark

May 1, 2006

As a fertility clinic, this practice needs a steady flow of new patients to remain viable. But its marketing strategies haven't been working.


Reproductive Science Institute (RSI), a three-location practice in the Philadelphia suburbs, wants to take things to the next level. The Wayne, Pa., office Physicians Practice visited plans to build a new facility from the ground up over the next few months, more than doubling its existing square footage.

The clinic currently sees roughly 900 patients a month. That sounds pretty good, but many of these visits are for monitoring and follow-ups related to fertility treatments - and Abraham Munabi, MD, RSI’s founder and medical director, worries about staying one step ahead of the ever-increasing costs of doing business.

Munabi and his executive staff have a good handle on the realities of practicing in their cash-based specialty, but they - like countless other practices - still cite marketing as their top concern. June Amarant, executive director of the practice, says they’ve tried “all aspects” of marketing, but “it’s extremely expensive, and it doesn’t seem like any one avenue is working.”

Because about half of its patients pay cash, RSI is affected by every minute economic change in the marketplace. Overhead is already high because of the lab and other equipment that comes with setting up the practice as a technological leader, and the new building will create additional financial pressures.

Seek outside help

“I’ll be the first to acknowledge that doctors are not good business people,” Munabi laments. An unscrupulous - or simply ineffectual - consultant could easily take advantage of a lack of business savvy, and, as Munabi says, many months could pass before shortcomings are noticed.

RSI knows its business is too complex for it to effectively handle all marketing responsibilities in-house, but the practice wonders what qualities to look for in an outside consultant. Most experts steer smaller practices away from the agency route, which can carry a high price tag.

That said, a quality agency will likely provide snappy, professional-looking advertising pieces, along with a more full-service experience. This is a fine way to go if you’re willing and able to make the initial investment.

The other option is hiring a freelancer or consultant, but you’ll have to do more work internally. This could be a positive for a practice that’s in the process of defining its long-range goals and strategies and has appropriate staff members to take ownership of the process.

Either way, the most important factor is whether the individual or group RSI hires has direct healthcare marketing experience and knows the healthcare market. Asking for references and talking with past customers are essential steps.

The first thing a consultant should do is interview the practice about its business plan and goals. Marketing should always be tied to overall business strategy rather than undertaken as a stand-alone activity. (To the practice’s credit, RSI already includes marketing in its business plan.)

Pass up outside marketers who start a consultation by telling you what your practice ought to do. They should instead listen to your thoughts on the direction you want your practice to take, and then help you write a comprehensive marketing plan in accordance with your goals.

During interviews with prospective marketers, find out how they measure outcomes - formal tracking must be part of the plan. Ask candidates exactly what tools they’ll use to tell you which initiatives worked and which didn’t. Be prepared to hold them accountable for such measurements later.

Know how patients find you

In spite of asking every person who comes in where they heard about the practice, RSI seems to have trouble accurately assessing which media sources are most effective. It should take tracking a step further and calculate ROI for each initiative.


An effective marketing plan is in constant flux. Munabi hopes for a “reliable methodology,” but that goes against the very definition of good marketing, which is always responsive to change and tailored to a practice’s specific patient population (which itself may change over time).

Although continual refinements and adaptations are a must, most initiatives take time to produce results. Just how long will vary widely by practice and activity, but a full year is not unreasonable for a given initiative to start generating a solid return.

Like marketing plans, marketing activities should never be stand-alone. If you want to host a seminar for childbearing-age women, for example, as RSI did in the past, include postcard invitations, radio spots, follow-up mailings after the event, and so on in your plan and the budget.

Consider offering public service announcements to local media outlets to coincide with presentation dates. Munabi is a natural choice for appearing in public arenas - he has presence to spare and a gentle manner that’s probably soothed many nervous patients over the practice’s 15-year history.

Educational seminars like this are expensive to host, but they need not be geared only toward prospective moms. Maximize your impact by inviting women’s parents and spouses as well - people who could influence their decisions.

This brings us to the next critical point in the marketing game: understanding what your patients are all about. For example, men whose wives are considering fertility treatments may be acutely uncomfortable with the prospect, so take advantage of the support group-like setting at a seminar to help them better understand their options.

Understand your audience

Thorough market research, which should be built into any marketing budget, will help RSI align its efforts with its long-term strategies. The practice needs to identify its ideal patient, and target that person with the help of market data. A practice’s ideal patient may be very different from its current average patient in terms of payer source, condition, or demographics.

One smart way to conduct market research, track advertising outcomes, and get your message in front of the patients you hope to attract - all at the same time - is an online tool such as Google AdWords. Practices can place highly targeted ads, which appear at the top right of the results page when users perform an Internet search that includes key words defined by the practice.

The AdWords reporting function lets you directly compare the effectiveness of different ads. RSI has been working toward establishing itself as a technological leader in reproductive endocrinology, so the practice could track how well that message plays with different target audiences (such as women in their 30s or OB/GYNs), versus emphasizing some other quality, such as its unique surrogacy coordinator service. (See “The Tech Doctor” column in the March 2006 issue of Physicians Practice for more on online marketing.)

Simple community focus groups are another great way to gather data on your target population. Guidelines for conducting these meetings are widely available in print and online. Just make sure the practice has established its own focus well in advance of the session - and know what information, elicited through several key questions, you hope to gain from it.

Market research like this is important for getting to know your audience well. Individual communities vary widely in what marketing techniques they find acceptable from medical practices. For example, Amarant heard a lot of buzz about billboards at a recent conference - the consensus seemed to be that they were “tacky, but effective” - but she’s not sure they’re the right medium for RSI. And she may well be right: In some areas of the country, billboards are de rigueur; in others, they are considered in extremely poor taste.

Bear in mind that marketing in the healthcare industry is still in its infancy - advertising by private practices was made legal a few decades ago, and not everyone’s comfortable with the concept.

Don’t forget other providers

RSI has an additional audience to consider - the local medical community in which it operates. Amarant says the practice’s top source of patients is referrals from other physicians. Dianne Amberger, RSI’s business manager, agrees that other physicians play a vital role, but she acknowledges that they are also the most difficult to reach.


Still, the logical place for RSI to start allocating its marketing dollars is in efforts aimed at other providers. Based on its past successes, RSI should probably earmark the greatest percentage of its marketing budget for avenues targeting local OB/GYNs, and possibly primary-care physicians, who might refer patients.

Educational seminars for physicians are another way to get RSI’s message out to the local medical community. These efforts don’t have to be elaborate - their audience will want to know exactly how their services can help their patients.

Creative mailings targeting PCPs and OB/GYNs, social outreach efforts, and public service announcements (this time in arenas your physician targets will likely see) are additional ways to get the message out to a local medical community.

How much is the right amount to spend? According to Medical Group Management Association (MGMA) marketing benchmarks, OB/GYNs spend only 0.62 percent of their total medical revenue on promotion and marketing (median amount). This is obviously too low for a practice with a high proportion of self-paying patients.

A better course for RSI may be to simply look at its overall budget, prioritize it, and make decisions based on what seems reasonable given its marketplace. Outcomes tracking, month-by-month assessments, and necessary adjustments should follow. Examine every avenue. Three hospitals are already sending semen samples to RSI for analysis - additional area hospitals (and continuing efforts to stay top-of-mind with their current clients) could represent more worthwhile marketing targets.

Marketing materials that hit home

Like any business seeking to increase its name recognition, RSI needs a cohesive brand. They’ve already got a great logo - and should use it everywhere possible in a consistent way (color palette, placement) - but effective branding is about more than graphics. The practice needs to present a consistent message to its prospective patients.

It takes a minimum of five repetitions of your practice’s name to even make a patient aware of you, another five hits to get her to remember you, and possibly hundreds more repetitions before she trusts the practice.

Clearly, consistency within messaging is essential. For starters, RSI should look at its patient educational materials with a fresh eye. This is another case in which it may pay to enlist the help of professionals. If you’re making a significant investment in printing costs anyway, seek out an experienced copywriter to tailor your materials. Already emotionally overwhelmed patients who see lots of technical terms like “sperm aspiration” and “gestational carrier service” may run for the hills.

Some research shows that patients paying out-of-pocket for an expensive and complex treatment like IVF may be better informed than many others. Still, RSI’s staff points out that emotions often run high; striking a balance is key.

You want to make sure you’re imparting all the data patients need to have in order to be fully informed, but here again, you also need to spend some serious time thinking about your audience. Experts recommend aiming for a fifth-grade reading level in printed materials. Before printing, road-test your brochures by giving them to as many people outside the healthcare field as possible.

RSI needs to examine every piece that’s going to leave its office (and there are a lot in a specialty like this). Even patient satisfaction surveys and new-associate announcements are important marketing pieces. Taking full advantage of avenues like these to communicate the practice’s message is great, but don’t just tell patients where the new physician received her degrees and completed fellowships; tell them a little about her practice style and personality. Patients will want to know how they might expect to interact with this person, as in, “Dr. Smith believes in giving patients all the information they need to work with her to make decisions about their own care.”

RSI’s current educational materials are professionally produced, but they contain images of both cute babies and microscopic cells - patients could be getting mixed signals and have trouble identifying an overarching message. (Plus, infants may seem hopeful to you but cruel to a woman who’s having trouble conceiving; embryos, on the other hand, could seem cold and clinical. Know your patient base.)

Reprinting all these materials is a major expense, but they’ll have to be updated with the practice’s new address once the new building is finished anyway.

One print marketing piece used by a lot of practices, RSI included, is a patient newsletter. But by sending its newsletter only to established patients, RSI is - excuse the pun - marketing within its gene pool. Existing patients are certainly one valid audience, but in order to grow, RSI knows it needs to extend its reach.


Here, too, repetition and integration into a larger plan count. If you mail only one newsletter and never send another, you’ve missed an opportunity.

Effective market research - and marketing itself, for that matter - doesn’t have to be expensive. Google AdWords charges you only for the ads that work, and simply inviting a colleague out for coffee is a low-pressure way to make connections within your local medical community. Most practices do too little in the way of both formal and informal marketing, so the fact that RSI knows it needs to focus there gives the practice a head start.

Staffing for success

To support its marketing efforts, RSI needs a top-notch staff of individuals who’ve bought into the practice’s message and can deliver it to patients clearly and consistently. Last year, RSI suffered a devastating blow when it lost all three nurses at one of its locations: One had a baby, one got married, and the third left simply because her friends had gone.

Amarant wants to know what to do to avoid situations like this, especially when finding a good fit and providing specialized training is a time-consuming - and financially draining - proposition.

Two possibilities for the practice to consider to prevent or mitigate such losses are job-sharing arrangements and flexible work hours. In such arrangements, two people can share the duties of a full-time equivalent, so scheduling and patient care can be more easily covered than with part-time staff.

Scheduling may initially be more difficult with this arrangement, but you may also be able to increase patient hours by having greater staff availability.

Invite moms - and other good employees who’ve left the practice for whatever reason - to come back. Once the kids are in school, they may welcome the opportunity to return to work, especially in an environment they already know and like.

Careful pre-employment screening - really trying to find out if a person is or could be at home in your community - is a must. RSI should also assign a formal mentor to each new employee. Amberger and Amarant have both been with the practice for about 10 years, so they’d be naturals to kick off a mentoring program.

Amarant points out that RSI pays staff 10 percent to 20 percent above local averages, but the top reason people leave a job is not salary - it’s that the location just isn’t a good fit for them or their family members.

To help minimize the burden of staff training (especially on basics like OSHA requirements), RSI could use an interactive online learning tool or DVD. Build in tests at the end so you know the employee paid attention and will be able to take your practice’s message to patients. The initial investment will quickly be made up in time savings for current staff.

Every staff member, clinical providers included, is part of your marketing team. Any practice’s biggest marketing opportunity is the voice of its patients, and RSI needs its staff to help get that word out.

Laurie Hyland Robertson is a managing editor for MedIQ, the parent company to Physicians Practice. She has been in the medical publishing field for nearly 10 years, working editorially on both clinical and management topics. She can be reached at lrobertson@mediq.com.

This article originally appeared in the May 2006 issue of Physicians Practice.