Palliative care – what I have learned

DB, I’ve been reading your blog for some years now, and my question for you is this: if Primary Care goes the way you hope gaining transparency of pricing, and lower overhead, thus making it more attractive, do you believe it will need to market itself as rigorously?

I ask because I watch my sister-in-law’s dental practice, which is very similar to how many primary practice physicians used to run their offices. She is the only dentist. Cash up front. Insurance claims are done by the patient. Emergencies are handled by calling her at home.

This is a model worth studying for several reasons. One, her school took the time to give the dental students seminars on how to run a business. Two, she has been able to turn this into paying off her student loans within 6 years of graduation, and her business loan in 4 years. She is also well-respected, and her waiting list is as full as she cares to have it. The only boss she has to answer to is her husband, who also happens to be her business manager. She seems to have no problem marketing herself simply by purchasing an ad in the yellow pages, and word of mouth.

I must ask, why the change of heart? I tend to look at marketing as something that drains money, and is not necessarily in the best interest of the smaller practice physician. What complications am I missing?

-j

Like others I have been following the medical blogs for a number of years. As a businessman I have been surprised at how little doctors know about their industry. Yes, they know a great deal about their practices and use simplistic tools such as simply increasing the number of patients, or hiring cheaper and cheaper help, to cut cost with the resulting increased work load and patient dissatisfaction leading to an ever increasing frustrating work environment.

The recent question of changing the science portion of the medical students curriculum would be the perfect time to add some business and ethics classes. Doctors need to understand the economic environment they are going to be placed in and the pressures, free lunches/dinners, that will be used to influence their behaviors. (I have found it shocking the kickbacks doctors receive, with no concern about the ethical issues, or the insistence that this is standard in the business community.)

Doctors do need to market their product and then sell to the customer. Taking the dentist example we see full page ads in our local paper for a smiling female dentist with a smiling all female staff ready to help you through your dental ordeal. My dentist runs an on time, all digital practice, where he has a person who’s only task is to talk to patients in the waiting area. While you may not enjoy the procedure, you will at least enjoy the time spent in the office.

I have never understood why doctors think that repeating the same behaviors, or test, will somehow produce different results. In my world we call this beating a dead horse.

Steve Lucas

A. Skeptic

My dentist is not the smiling woman. He does accept insurance, but does value added services covered only in part by insurance. My wife is having an old tooth capped after a filling failed at an out of pocket cost to us of $500 and a total cost of $1,000. His computer system allows him to not only do the work, but process the paperwork so as to maximize profit.

I agree that the current system for compensating doctors is “broken.” As you pointed out it will be up to doctors to fix their system. Cash only, concierge, or a model yet to be defined, pick a system, then go out and do it.

With 900,000 doctors in the US and 300,000 involved in primary care you are a commodity. The insurance companies, hospitals, and everyone else involved in health care will try to minimize your importance and thus minimize their cost and your income. Doctors need to make the point that very little of the average $12,000 paid per year for health insurance makes it into their offices.

The current system of office visits, test, medicate, and repeat as often as the insurance company will allow is not winning any patients hearts. The economic cost are horrendous. The question of: Why visit the doctor only to go to a specialist? arises immediately.

I can think of any number of business models that would improve the financial situation of doctors. The question is will they work? Not a doc, I do not know if any of them will work, or are legal, but I do know the current system is not working for anyone and until someone is willing to risk failure it will not change.

Steve Lucas

From the outside I would agree with Jared. There are a couple of business ideas that have served me well over time. One is: It does not matter what you make, only what you get to keep. Loosing a little on every unit and trying to make it up in volume does not work. (Personal experience)

Another idea is: If you are not running on time you are loosing money. It is great to be the center of attention, this really feeds the ego. The reality is, the object is to move the people along. Moving is the marketing, doing it in a way so as to make people happy is the selling.

A cash only system cuts overhead and reduces back room work. Another business concept is the best fee is the one you have in hand.

The added value is time. I as a patient, will be scheduled and have a reasonable expectation of being seen and leaving on time. This is worth money to me and most of my peers.

Another point of a cash only practice is you can cut out the drug reps and have a generic first practice. Personal point. Many doctors in an effort to generate some type of free service allow drug reps access to them and their staff in exchange for free lunches and dinners. The added value is with no drug reps, free samples allowed, I am assured you are prescribing the best medication for me at the lowest cost.

Cash or concierge, doctors need to return to the position of being a person’s health expert, and they need to sell that point.

Steve Lucas