Marketing Made Easy

Patients and physicians.

When you come right down to it, they are the keys to your practice's success. Patients are your bread and butter. Give them excellent care with just the right customer-service touch, and they can be yours for life. Or they can find another doctor.

Your fellow physicians, who provide you with referrals, exchange of information, and simple collegiality, expect and deserve the same -- access to and responsiveness from you. Or they can send their patients to someone else.

When Physicians Practice asked physicians to talk to us about how they market their practices, we found that what they focused on most was service to their patients and other physicians and outreach to their communities.

So while marketing can mean slick ad campaigns, it also means consistently doing simple things like thanking physicians who refer patients to you, providing excellent care to your patients (along with little touches like remembering their birthdays), and letting the community know who you are and what services you offer.

There was a time when physicians considered marketing a dirty word -- and some still do. For them, it may conjure up images of used-car salesmen hawking their goods, or of tacky roadside billboards. But it doesn't have to be that way.

To be sure, "it was considered sort of inappropriate," in years past for physicians to market their practices, says Robyn Levy, MD, whose asthma, allergy, and immunology practice is based in Atlanta.
Dean Draznin, principal of Dean Draznin Communications, a marketing firm based in Fairfield, Iowa, agrees: "There was a stigma associated with marketing. It was considered taboo for a profession like [medicine]. It was beneath them -- inappropriate and unprofessional."

Why do physicians have this reluctance to promote themselves? It may have something to do with what David Albenberg, MD, a Charleston, S.C., family practitioner calls "the Velveeta factor," which, he jokes, is "a marketing term for being cheesy as a physician."

Most physicians are "very uncomfortable with 'selling' their practice -- it goes against their culture," says Jean Hitchcock, vice president of marketing and communications for Scripps Health, a 2,600-physician health system in San Diego. "But marketing in the true sense of the word can give them an understanding of how they're currently getting patients, what part of the market they're getting or not getting, and what they need to do to increase the number of patients, if that's what they want."

"Marketing is actually a natural and desirable activity for a doctor because, if presented in the right way, marketing is really education," adds Draznin, whose firm has worked with a number of physician clients, including specialists in chronic fatigue syndrome, plastic surgery, and internal medicine. "And education is basic to medicine."

And marketing has become an essential part of staying ahead in the current healthcare environment. "In today's world, anybody who has a business -- and medicine is a business, whether people like it or not -- they have to let the market know they're there," says Draznin.

Know your neighborhood

Before you begin letting the market know about you, you should first know something about the market.

"Outreach to the community is also [about] knowing the community," says Andrea Eliscu, president of Orlando-based Medical Marketing, Inc., and author of two books, Position for
Success: Strategic Marketing for Group
Practices and Ready-Set-Market! A
Comprehensive Guide to Marketing Your Practice in the New Millennium.

"Communities change dramatically. You can have a downtown area that didn't have much that then starts putting in condos, and people are living there, and restaurants are opening. ... That's an entire patient population.

A pediatrician [who's] not really paying attention could turn around and find that her neighborhood, which used to have lots of families, turned into a lot of yuppies who have no children."

Marketing begins with understanding the demographics of your community. It isn't enough to know how many people live in your neighborhood; you also need to know whether there are enough potential patients for your kind of practice, and whether neighborhood trends suggest more potential patients in the future, or fewer. Moreover, you'll want to know the nature of the surrounding medical community. Is the market glutted with competitors? Are there enough potential referral sources nearby?

Give them what they need

Put simply, marketing is the process of bridging the gap between those who have something to offer, like you, and those who have a need for it, like your patients. Community outreach is a good way to start.

"If you are a subspecialist in total joint replacement, and you know there are a lot of assisted living communities and golf communities for seniors, make sure your practice has some initiatives with that community," Eliscu suggests. "Maybe you underwrite the movies they show on a certain night, maybe you sponsor a senior walk. Maybe it costs you $350 to underwrite an activity and refreshments, but [it's worth it because] you are getting the exposure. This is a population of interest, and you are where they are. To me, that's marketing."

Levy says it's harder than ever for physicians to find the time for such activities, what with the increased pressures of managed care, government regulations, and other stresses. She suggests making it easier by choosing activities that fit with your life and interests. 

"Focus on those things that will be profitable to your practice and that you enjoy," Levy says. "Look at where your own interests lie. If your child plays soccer, you may want to go out to a soccer tournament and have a booth set up. If the practice is near a mall, go there, or if you belong to a church, go to the church fair. Do something that will tie you in."

Levy actively offers her expertise, in the form of education, to patients in her practice. For example, she says, "We put a sign up every August in our waiting room and exam rooms saying that if parents want the doctor, nurse, or PA to come to their daycare, church, or school, to contact our secretary." Typically, she will be asked to discuss food allergies or other common ailments she treats.
Her efforts have paid off in an expanded patient base. "Almost every time I give a talk, some other [referral] comes to the practice. From that one patient, you may get their neighbors, their friends, their relatives.

"When I first came into practice," Levy recalls, "I was involved with the Sierra Club and they [asked] what goods or services I could donate for a raffle at the zoo. I didn't have anything really, except my abilities in medicine and my time. So I offered a complimentary allergy evaluation and testing to be auctioned. It generated goodwill with that organization and it got my name out there a bit."

Uchenna Nwaneri, MD, an orthopedic surgeon and managing partner of the Spine and Joint Center in Bowie, Md., says he believes community health fairs and lectures are a good way to create awareness.

"We have a health fair twice a year," says Nwaneri. One is in June at a local community festival, "then in September we have a health fair in front of our office. It's usually hot and people love giveaways," so the practice hands out water bottles with a list of the physicians in the group, their phone number, Web site address, and a picture of Nwaneri with a patient.

He adds that being a member of the local Chamber of Commerce or similar organizations is a plus. "You network with other people, they get to know you ... if they have workers' comp, [you are] somebody they know and trust and can refer their employees to."

Doctor to doctor

Other physicians are an important part of your marketing efforts. Obviously, they need to know who you are and what services you offer. They also need to be treated well when they've sent a patient your way.

"When I went solo in 1997 [a marketing plan] was on my agenda," says Levy. "The practice got so busy, I never had time. Several years later, I asked myself, 'When will I get around to marketing?' But the reality was I had done my own marketing by just taking good care of my patients and [establishing relationships with] their primary-care doctors.

"I send a brief follow-up note on every patient to every doctor, every visit. It can be very time-consuming. Some physicians say it's too costly, it's too much trouble, but the reality is you can build a fax or mailing database" and each note serves as a mini-advertisement for your practice. "If you can't do it every time, do it quarterly or when something comes up [with a patient]," she suggests.

This advice is not just for specialists -- the referring process is a two-way street. "If somebody sends me a patient, we're very grateful," says family physician Albenberg. "In fact, we thank all of our referrings with an e-mail or a card, and that's been helpful."

Face-to-face encounters are beneficial, too. "We have a staff member who goes out once a month and visits physicians' offices. We try to visit about 20 a month, meet with their staff, make sure they're getting their reports, and find out if there are any problems. We also try to visit new practices," says Nwaneri. He estimates that about half of these visits result in a referral.

It's all about the patients

Hitchcock, of Scripps Health, who has developed marketing plans for over 400 physicians in that organization, says physicians should never "take their eye off the ball in terms of [what it's like to be] a patient.

"A lot of doctors forget about customer service," she says. "I worked with a group that had large signs indicating where the doctors park, and the handicapped [parking] sign was buried behind a tree. ... I can't tell you how many physician's offices I've walked into where the front entrance is littered with cigarette butts. The patient experience starts way before they see the doctor. [Physicians] need to walk the path of the patient, literally."

Eliscu says getting staff involved can help physicians see things from the patient's perspective. She has led practices in an exercise in which everyone, including nonclinical staff, was given a sheet of paper and told: You now own this practice. Knowing what you know, what would you do differently?

"They would give you counsel that was brilliant," Eliscu says.
For example, staff at a urology practice told Eliscu they would "have a much better system for cleaning our bathrooms. The doctors never use the patient restroom, but the people who have to collect the money are the ones who hear everything the patients don't like." Staff at another practice suggested subscribing to more general-interest magazines, instead of just the hunting and fishing journals the doctor liked.

"None of these is earth-shattering," Eliscu says. "They are practical and in the moment. You have to give service. If you fail at that, it doesn't matter how much money you throw at marketing. There are too many choices and people have become assertive in their patient rights."

Patients spread the word

And it's not just about patient rights -- it's patients talking. Marketing experts and physicians agree that word-of-mouth is by far the greatest marketing tool they have.

"The biggest thing, the most important thing for bringing patients to us, is word-of-mouth," says Nwaneri. "That's the best referral base we have. Radio, television, and print [advertisements] are great but are not overall what drives our business."

Albenberg agrees: "Just about every effort we have made to reach out to the community has not paid off [like] the word-of-mouth. That is an unbelievably strong force."

In March 2003, Albenberg opened his "retail medicine" clinic (patients pay cash or handle their own insurance claims), and he estimates 35 percent of his current patients followed him from his former practice -- "which shows an incredible amount of loyalty that we weren't expecting -- and 20 percent are word-of-mouth." The remainder come from various sources, including friends of Albenberg, short-term visitors to Charleston, and miscellaneous public relations efforts such as newspaper coverage.

Albenberg realizes it was important to set a higher standard given that the practice is somewhat unusual. "We knew that since we would be asking my previous panel of 5,000 patients to follow me across a bridge -- which is a big deal in Charleston -- and also to file their own claims, we needed to produce a product that was far superior to anyone else's. So the first order of business for marketing was to build something that word-of-mouth was going to spread." 

So far, it seems to be working. "We went from the red to the black in month three, which was about three months earlier than we expected," Albenberg reports.

Levy's practice sends each patient who refers a friend or relative a thank-you note, plus a little something extra: "We send a donation to a children's shelter in town in honor of each referral."

What else can you do?

So the essentials of marketing are pretty simple: giving excellent service and complete information about your practice to other physicians, your patients, and the community around you. The add-ons include things commonly associated with the concept of marketing, like advertising, having a Web site, designing effective print materials with a logo, and more. Here's what physicians and marketing experts think about some of these approaches:

Logos and branding -- "It's very important to develop a corporate image and use that image on everything you do, so people can find you when they need you," says Eliscu. "This is not new. It's developing a logo, a graphic image, and a name that is used on mailing labels, business cards, appointment cards, at health fairs. That's what they remember."

Draznin agrees. "It may just be the physician's name and some description of what they do. But it's important to have that on every piece of paper that goes out," he says.

Hitchcock cautions physicians to avoid trying to be too creative, though. "They need to be careful not to get caught up in the jargon," she says. "You want to have a good name that communicates exactly what you do -- Pediatric Associates, or Sports Medicine. Try to get out of the medical terms." She adds that patients often simply look for the name of the physician.

Eliscu estimates a cost of $750 to $1,500 to work with an artist to create a graphic image.

"Then you have to [apply it to] all your collateral material in the office -- business cards, appointment cards, fax sheet, fact sheet, Web page. By the time you create and print all of those to get you through a year, that's expensive. You can't just plan on $1,500 for marketing because if the fundamentals aren't there, it won't work."

Print advertising -- Advertising doesn't have to be expensive if you carefully choose the right outlet. For example, Eliscu believes advertising in community newspapers can be effective. "Twice a year the paper here does a medical directory. If you buy a quarter-page ad, they do an alphabetical listing of all your doctors and a brief bio in a supplemental directory. A quarter-page ad is $360 [and] the directory goes to 30,000 homes. How can you not be in it? People moving into new communities look for the plumber and the dry cleaner [this way]. They're looking for what's close to home."

But print ads aren't for everyone. "I made a decision this year that we would do less of what I call direct-impact advertising," says Levy. "We track where every patient comes from. So if you're not getting a lot of patients out of the Yellow Pages, you might think about just having a listing" rather than an ad. "... Every year we track it and I get about two patients out of the Yellow Pages."
"Some doctors are out there placing advertisements in key places and they're very up-front, very [visible] about what they offer," says Draznin. "You see very aggressive ad campaigns. ... But it requires a very consistent effort."

"The worst thing we've done is taken out print advertising. It had no return at all," says Albenberg.

Web site -- If your practice has a Web site, the first order of business is to make sure people can find it. "It's important to get on the computer and go to Google and try to find yourself using your name, your specialty, and your city," says Levy. "If you don't find yourself, you need to hire a search engine company" to make your site more accessible to searches.

Nwaneri uses his practice's Web site as a tool for educating patients. "We list some of the common [ailments] we treat -- knee injuries, for example. If [patients] are thinking about having any form of surgery they can go and look step-by-step to see what is involved and what they should expect. After that, if they want to send me an e-mail, all they have to do is click on my picture and I will respond to it," he says.

However, he is less than enthusiastic about the return his Web site has given. "I am a firm believer in the Internet. I thought patients would really be pursuing it, but I haven't been impressed with use of the Web site. It hasn't been a big business driver for us. But it's good because people can learn about our practice and interact with me if they choose to." Nwaneri estimates that he receives four or five e-mails from patients each month.

Newspapers, radio, TV -- For his practice, Albenberg says, "The local press has been fantastic. We were on the front page of our local paper a week before we opened. About 120 of our 1,800 patients have come from that."

Nwaneri uses both radio and television to get the word out about his practice. "On radio," he says, "our emphasis is on education. I get involved as a guest speaker talking about arthritis. We have audience call in with questions and I [give] answers over the phone."

He also participates in an annual call-in TV program in conjunction with the local network station in nearby Washington, D.C.

"Whenever we do TV, that month there is usually a significant spike in the number of referrals," he says.

Levy points out that certain specialties are more likely to be sought out by the media. "Allergies and asthma are [of] interest to all kinds of people, especially on a seasonal basis. Food allergies, sinusitis, and rhinitis -- those are hot topics for laypeople."

She says she is contacted by TV or newspaper reporters looking for information 10 to 20 times a year. For physicians who'd like to put themselves in touch with their local media, Levy suggests, "Simply have your secretary send your CV out to the major news channels and radio stations and say, 'If you're ever in need, here are the ways to reach me.' The nature of news is there is always a deadline. It's not always being the most knowledgeable or the most famous; it's being the most available."

Custom publications -- "One thing that can be extremely helpful is a simple newsletter," says Draznin. "These days it can be sent out as an 'e-zine' [electronic, or e-mailed, magazine] to your preferred mailing list."

To get started, set up a simple layout using desktop publishing software, or even Microsoft Word, and include tips and information from the physician.

"A good example is this past winter, with the threat of the flu -- there are all sorts of tips that could address people's questions. Patients appreciate that. The new face of the home visit could be in the form of this e-zine that updates patients and makes them feel close to your practice. That's a very powerful tool," says Draznin. "The important thing is a practice should actively pursue the capture of e-mail addresses."

Looking ahead

Albenberg believes physicians' interest in and understanding of how marketing can work for them will continue to evolve from fearing "the Velveeta factor" to something more in line with the current competitive healthcare environment.

Right now, he says, many physicians "aren't really focusing on marketing. They're focusing on how they can improve their payer mix so that they don't have to see 30 or 35 patients a day. So marketing isn't a real hot topic among traditional physicians for that reason. It will be -- not could be or should be -- and the reason for that is more and more physicians will be moving to an environment like this [cash-only practice].

"My previous partners are looking at their payer mix now and thinking about making some moves to eliminate some big payers. What happens then is they have to attract better payers ... people who have healthcare reimbursement accounts, people without insurance who are paying cash."

But Albenberg concedes that "the old tried-and-true, traditional things that have worked for physicians in the past continue to work in this model. Those are: be a good doctor, be involved in your community, be written about, be outspoken, and build a product that people will tell one another about." 

Joanne Tetrault, director of editorial services for Physicians Practice, last wrote about financial management staffing in the March issue. She can be reached at jtetrault@physicianspractice.com.

This article originally appeared in the May 2004 issue of Physicians Practice.