I was amused recently by a comment made by a surgeon who, somewhat disappointed that his surgical schedule wasn’t as full as he wished a year or two after joining an established practice, said impatiently, “I’m 42 years old. I don’t have time to build a practice.”
Unfortunately, nothing could be further from the truth. Neurosurgeons are engaged in practice building every day of their practice careers. Every patient seen and treated is more than a medical service; it is an opportunity to gain another referral. Every physician and public contact is a chance to expand the sources and numbers of referrals. The correct response to this surgeon’s complaint is, “You don’t have time not to build your practice.”
Establishing, maintaining or expanding a practice in a competitive environment is a full-time effort and requires marketing.
You: The Solution to a Patient’s Problem
Marketing, however, is not simply advertising. Marketing is informing the public about who you are, what you do, and why people want to see you. What differentiates practice marketing from commercial product marketing (such as cars, cameras and computers), is the audience, the methods, and the consumer’s motive. Commercial marketing targets the broad public, using brief images and messages that appeal to personal wants or needs to capture attention, and repetition to implant and reinforce the image in the consumer’s mind, even creating demand where there was none.
Professional marketing is different. Patients see a neurosurgeon not because they want an operation, but because they have a problem. The challenge is matching their needs to your services as the solution to their problem, so when that need arises in the few who have it, your practice becomes the destination for the patient referral.
But neurosurgeons in a busy practice do not have time to personally screen large numbers of potential patients for problems they can treat. They need a referral network and screening process in place to ensure that numerous referrals are received, and that those referrals are appropriately screened for the practice’s services.
Fundamentals Count
The concept of marketing often generates images of advertising agencies and thousands of dollars of consulting and public media costs. This is a misperception. Professional marketing for neurosurgeons is like a pyramid, with the fundamental and most effective means as the base (see figure). In fact, the most powerful and successful practices require little more than the first two levels. The methods of marketing a practice, in descending order of effectiveness, currently are:
- Personal referral source contact
- Personal conversation
- Telephone call
- Patient recommendation
- Local scientific/continuing medical education (CME) presentation
- Informational brochure or newsletter
- Public media advertisement
- Internet Web site
Personal referral source contact is the most potent and effective method of building future referrals. Most referrals come from primary care physicians. Each PCP manages from 1,500 to 4,000 patients, depending on the style and popularity of practice. Each neurosurgeon needs a population base of 60,000 to 100,000, depending on the type of practice. PCPs are the fundamental leverage point in a neurosurgeon’s referrals. A PCP is the neurosurgeon’s reservoir of potential patients, the screening mechanism for appropriateness of referral, and the decision-maker in most cases about the destination of referral. Depending on the practice, referrals may come from other specialists (neurologists, orthopedists, oncologists, or even other neurosurgeons), but the principle is the same. Personal conversation means face-to-face discussion, whether about a particular patient, or about professional practice in general. The important goal is personal acquaintance, so that you, as a neeurosurgeon, come to mind when a neurosurgical referral is needed.
Telephone conversation is the second most effective means of securing future referrals. A personal call to the PCP after seeing a new referral, when a diagnosis or treatment decision is made, or after a surgical procedure is completed ensures that the PCP is aware of the patient’s care and further cements the long-term professional relationship. Each telephone call is another brick placed in the wall that becomes the practice edifice. It is time leveraged wisely.
Finally, written letters and reports that keep referring physicians informed of each encounter are important, are the least time consuming form of communication, and must not be neglected. But for marketing purposes, they are a weaker substitute for direct verbal and visual contact. An opportunity to speak to a PCP is a potent opportunity to market the practice.
Satisfied Patients Spread the Word
Satisfied patients will augment your marketing efforts. Patient-to-patient recommendation is the next most powerful source of referrals, but it takes time to build a reserve of current and former patients in the practice area sufficient to influence patient choice, particularly if it differs from the PCP’s customary referral. However, once a large enough reservoir exists, it is always surprising how often a patient finds others in the community with similar problems and acts on a recommendation from a former patient. Satisfied patients and family members return more business than any public advertising campaign can. This means more marketing benefit comes from respectful care, technical competence, amenities, conveniences, and helpful responses provided to current patients than public media and mail marketing campaigns can ever generate.
Local scientific or CME presentations are solid marketing tools. From a practice perspective, more important than teaching neurosurgical colleagues new techniques is teaching referring PCPs and other specialties what you do and who needs the service. Rarely is there a similar opportunity to talk to an audience that is so concentrated with potential referrals about how you can serve their needs, or what you are doing that differentiates your practice from others. One of the goals of marketing is to seek and exploit a “competitive differential advantage,” something that is in demand and uniquely available in the practice. Scientific and CME presentations are the best professional opportunities to leverage referrals by promoting a competitive differential advantage, whether it be a new or unique procedure, a subspecialty expertise, or simply an area of interest and experience.
Informational brochures about the practice mailed to regional referral sources can be used to promote the practice, especially when a physician is new to the region. They also can be used in combination with personal contacts; for example, when speaking at a scientific presentation, provide brochures to interested parties so they will have a reference regarding what your practice offers and how to contact you. However, the expense can be high, and the return low.
Public media advertisement is the least effective and most expensive means of marketing a practice. It has a high price tag and fails to target the audience where referrals originate. Better to spend that money on improving service in the office on patients who will spread the word for you. Or better yet, spend the time to increase physician contacts to build referrals, and clinic appointment times to receive referrals.
Finally, a growing number of practices have established Internet Web sites as information sources for current and potential patients. In fact, patient use of Internet information is becoming more and more common. It is not a substitute for good service, but it does provide an alternative opportunity for the practice to market information to the public and project the image it would like the public to see. It should include physician profilees, office appointment information, a range of services, postoperative instructions, and links to Web sites that feature medical information.
James R. Bean, MD, is associate editor of the Bulletin and chair of the AANS/CNS Washington Committee. He is in private practice in Lexington, Ky.