Neurosurgeons can no longer wait for patients to beat a path to their doors.
Many neurosurgeons refrain from marketing, considering that strategy incompatible with the practice of medicine. Yet marketing is not the same as advertising. A true marketing initiative involves education. And the tools for marketing are not shrill TV spots or highway billboards but patient satisfaction surveys, outreach to the media and community groups, AANS program materials, Web sites and, perhaps most importantly, improving customer satisfaction and building relationships with referring physicians.
Consider James Bean, MD, a private practice neurosurgeon in Kentucky, for example. He greets an office full of patients day after day. It’s no accident his patient volume is steady. He and his staff assiduously court primary care doctors.
“We do local medical staff presentations from time to time. We communicate by letter to every referring physician about each patient contact,” he says. “Whenever we find extra office time, we call referral sources, usually about patient contacts.”
Dr. Bean doesn’t buy ads in the Yellow Pages, advertise in newspapers or air a local radio spot. But he does indeed market his practice. “The most effective marketing strategy is direct conversation with primary care physicians who may make a referral and prompt written communications and responses to their referrals,” he attests.
Marketing works for Dr. Bean, and it can work for all neurosurgeons. In a time of shrinking reimbursement, the need to market one’s practice has become more acute. Neurosurgeons who wait for patients to beat a path to their door may eventually find the wolf at their door.
The New Consumer
Negative connotations blemish marketing. The “M” word conjures up images of a plaid-coated, hand-waving carnival barker hawking discounted cars or televisions. The assumption is that it’s perfectly OK to pitch cars and washing machines but inappropriate to promote a health service.
Well, it is indecorous to aggressively advertise a health practice. But that’s not what marketing is. Marketing is a more sophisticated and more subtle strategy than blatant advertising. Even the most conservative neurosurgeon, one emotionally tied to the healthcare climate of prior generations, would feel comfortable with a genuine marketing plan.
“You should think of marketing as educating the public and referring physicians,” says Rebecca Anwar, a senior consultant of the Philadelphia-based Sage Group, a healthcare consulting firm. “People get advertising and marketing mixed up. Most advertising would be very inappropriate for a neurosurgeon.”
Anwar, who has a PhD from the London School of Economics, is the president of the National Association of Healthcare Consultants. She can attest from her work with the association that healthcare specialists are rapidly turning to marketing to maintain or increase patient volume. Orthopedic surgeons, radiologists, obstetricians, gynecologists and ophthalmologists in particular are embracing marketing.
Marketing is particularly important in the era of managed care. One of the primary goals of marketing is to increase patient satisfaction, and making patients happy is critical under managed care. If only five percent of a physician’s patients express their dissatisfaction to a managed care entity, the physician could lose 100 percent of the patients from that plan if the contract is not renewed.
Power of the Internet
Besides shrinking reimbursement and managed care, what’s driving the new emphasis on marketing?
In a word, the Internet.
The information highway has changed consumers. This is the age of consumerism. The healthcare field is being transformed. Healthcare definitely is still not mall-like, a bastion of unfettered choice. But it definitely is more of an open marketplace.
Leland Kaiser, a notable futurist, says, “We have moved from physician-managed care to third-party managed care and are on our way to patient-managed care. Consumer empowerment via the Internet will forever change the way we deliver healthcare in this country.”
Care to hazard a guess what will happen to those who don’t jump on the bandwidth?
Kaiser predicts that the “physician, clinic, hospital or third-party agency that does not understand this revolutionary transformation is doomed.”
Consumers want physicians who are electronically accessible. More than one third of consumers are more likely to select a physician who offers electronic communication options such as appointment scheduling and test results than one who doesn’t, according to a survey in 2000 by LaurusHealth.com. A growing number of Internet sites grade doctors on such factors as education, accreditation and experience. Forty-eight percent of consumers would like the ability to send e-mails to their doctor, according to a survey in 2000 by Cyber Dialogue.
The power of the Internet can be deceiving, however. The point is not that consumers are wedded to technology but are enamored of choice. And that’s why marketing is vital. The Internet has helped Baby Boomers, always quick to make their own demands, understand that choice is an option even when it comes to healthcare.
Former U.S. Surgeon General C. Everett Koop, MD, explains: “Baby Boomers have run our society since the 1960s. They are information junkies. They kick the tires, look under the hood, read labels in supermarkets. Before this, the doctor was the authority, and the patient was passive. The Internet has changed all that.”
No Shortcuts Allowed
A 36-year-old ophthalmologist in Silicon Valley does as many as a dozen vision-correction surgeries an hour. He provides patients limo pickup and dropoff. He buys 30-second TV spots, a 30-minute infomercial, radio and Internet ads. He even rented a billboard on a major highway.
Fortunately, there are a multitude of quieter, more dignified ways to reach out to consumers.
But the first step is to form a plan. Come up with an objective and methods to reach that goal.
Avoid flippantly saying, “I’d like to double my number of patients.” That may not be realistic. Or it may be underestimating the potential patient base.
A neurosurgeon needs to analyze his or her patient base. Where are the patients coming from? Has there been a shift? Have some referring physicians stopped sending patients?
Marketing is not quick and easy. It takes planning and then careful execution.
“Marketing without a marketing plan would be like going on a trip without a map,” says Anwar.” It’s shooting from the hip.
“I’m a real stickler for market research. You don’t just walk into a doctor’s office and say you need surgery. And you don’t embark on marketing without research.”
Another preliminary step is getting staff informed and involved. Their relationships with patients and referring physicians can make or break the marketing plan. “Make networking important to them. That’s basic common sense and courtesy, which is what marketing is all about,” says Kristi Sykes, director of marketing for Koxville, Tenn.-based Doctors Management, a health consulting firm.
Finally, before moving ahead with marketing, a neurosurgeon needs to make sure he or she can handle with aplomb any increase in patient traffic. Is another phone line needed? Another staff person? Providing poor service to a larger number of patients will eventually backfire.
Cautions Dr. Bean, “You should always have space available on the appointment list within a seven- to 10-day period after a referral is made. Nothing is more self-defeating than rapport building with physicians countered by no available office time. The good referrals will be sent elsewhere and the lousy ones, which have the leisure to wait, will fill the office six weeks later.”
Marketing Strategies
Stan Pelofsky, MD, one of the owners of the Oklahoma City Spine Hospital, doesn’t spend a dollar on marketing. Yet his operation is imbued with marketing savvy.
“Every person who works in our hospital has been handpicked,” he says. “They understand the patients are facing a difficult situation and need support. We don’t hire sourpusses. If they don’t have a personality, they better find one.
“We have a hospital environment that is positive, upbeat and nurturing. That’s the best marketing tool of all, far better than a newspaper ad.”
The spine hospital also nurtures its relationship with referring physicians. Neurosurgeons send a letter within 24 hours of seeing a patient to the referring physician explaining the course of treatment. The bond of trust between the neurosurgeon and referring physician is solidified.
“Marketing is all about relationships with patients and referral sources,” says Sykes. Seconds Anwar, “The golden source for a specialist are previously satisfied patients and referral sources.”
Think Wizard of Oz to appreciate the No. 1 principle of marketing. The Scarecrow, the Tin Man and the Lion already possessed inside of them what they believed they lacked. Dorothy only had to click her heels to go home. Specialists already possess the network they need to increase their patient volume. What they need to do is nurture that network.
Internal marketing strategies should focus on building patient and referring physician satisfaction. Are patients greeted promptly and courteously? Are they cared for with kindness and gentleness rather than cold professionalism? Are the telephone calls of referring physicians returned quickly?
“You have to make your referral sources happy as a clam,” says Anwar. “You may be the only game in town but maybe they don’t like you. It could take a simple action like a phone call to set things right.”
Neurosurgeons may want to consider surveying their patients to find ways to improve service. Surveys a Key Tool in Assessing patient Satisfaction They also may want to distribute a practice brochure. It creates a positive image of the practice, provides information about services and office policies and saves time by addressing repetitive questions such as how to bill insurance or where hospital privileges are held. A practice brochure is a sort of super-delux calling card, a surefire method to instill respect for the practice.
A typical brochure is 4 by 9 inches, or small enough to fit comfortably inside a standard No. 10 business envelope, with six to eight panels. The cover should include a motto such as “our goal is your health,” an encapsulation of the reason the practice exists. Neurosurgeon should use a reassuring photo of themselves talking to a happy, healthy patient. Especially for a first-time patient, a photo helps immensely with familiarity, easing the discomfort of meeting with a new doctor.
Design the brochure with your audience in mind. A neurosurgeon in the rough-hewn backcountry of South Dakota or Idaho may want to consider a photo of himself hunting or fishing. The writing style should be warm and relaxed. A neurosurgeon in New York City needs a more sophisticated approach.
External Strategies
If Horace Greeley, the newspaperman who knew where fortunes were to be made, were alive today he might say, “Go Web, young man.” Neurosurgeons need to market themselves through traditional means such as making speeches before civic groups and getting their name and expertise in the local newspaper. But they also need to hop on the information highway and take full advantage of an increasingly wired society.(See Computer Ease)
An estimated 72 million Americans have used the Web seeking healthcare information. And that number will be hopelessly outdated next month. Some neurosurgeons, as well as competitors, are already using the Internet to reach patients and referring physicians. Keeping up with the Joneses is essential. If nothing else, a Web site sends the message that a practice is innovative and progressive.
AANS members can get free customized practice Web sites and secure e-mail service with patients through AANS’ partnership with Medem. (Call 888-566-AANS for information.)
The site should give an overview of a neurosurgeon’s practice and a list of the physicians, nurses and other professional staff. It should highlight the surgeon’s credentials, state the practice philosophy and offer patient education. A section for referring physicians can offer suggestions on when to refer a patient, post scientific papers and list hospitals where privileges are held.
The site is a way to make it easier for patients to schedule appointments. It should provide directions to the office and include information on billing policies and insurance matters. An interactive site can offer on-line appointment scheduling and the completion of registration forms in advance of an office visit.
Best of all, market your marketing tool. Announce the site in press releases to newspapers and flyers to patients and referring physicians. The Web is hip. Having a site in itself is a positive attribute.
One more external audience needs to be considered. Forming relationships with competitors can be productive. Orthopedic surgeons, chiropractors and radiologists frequently refer patients to neurosurgeons.
The Cost of Marketing
Some marketing strategies cost absolutely nothing, such as improving relationship with patients by being more friendly and accessible. More involved strategies such as surveys can cost tens of thousands of dollars. Hiring a consultant and initiating a multiyear, full-blown marketing blitz can be quite expensive. Neurosurgeons intent on maximizing their marketing potential should allocate 3 to 8 percent of their gross income on marketing, says Anwar.
Another option is to appoint someone from the office staff with a marketing background to coordinate on a part-time basis the marketing initiative. Though the time investment for a neurosurgeon would still be substantial on the front end, this would free up time down the road.
Questions about the cost of marketing are really secondary to the cost of not marketing. Patients demand more today. Neurosurgeons ignore reaching out to them at their peril.
“People are becoming more sophisticated, more skeptical,” says Anwar. “They need to be reassured. Marketing is an educational process and a reassuring process.”
Need Marketing Assistance? AANS Gets Smart
Not sure you have the time or expertise to market your practice? Don’t worry. The AANS offers a comprehensive array of programs and services to launch a successful marketing initiative.
The flagship program is Getting SMART About Neurosurgery, a collection of materials created by AANS and CNS that promote your practice to referral sources, patients, the media and civic groups. The Getting SMART package includes 200 patient information brochures, 100 physician referral booklets, ready-to-use slide presentations (for both patients and medical professionals), sample promotional letters and press releases. Neurosurgeons can choose from two topics: lumbar spinal stenosis and stroke.
The materials serve two purposes. They increase awareness of the scope and quality of neurosurgery and promote a neurosurgeon’s practice. The patient brochures, for example, have a space for a label or stamp to insert your own name or practice logo.
Getting SMART makes marketing easy. Sample letters help you target senior citizen groups, hospital chiefs of staff and heads of primary practice resident programs with offers to be a speaker. The stroke materials also are available on CD-ROM or Zip disk as well as slides. The cost for either the stroke or lumbar spinal stenosis Getting SMART package is $300.
A second popular marketing tool is the eight-page Neurosurgery Today insert that ran in USA Today. Reprints are ideal as an education and outreach tool for patients, referring physicians, managed care administrators and the media. The cost for 100 copies is $50.
A Patient’s Guide to Neurosurgery is a brand-new patient education brochure. It summarizes in lay language the many conditions treated by neurosurgeons. It can be mailed to referring physicians or handed out at health fairs, career days and lectures. A pack of 50 is $50 for AANS members.
Marketing advice is featured in several softcover books sold by the AANS, including Starting A Medical Practice and Managing the Medical Practice. AANS members can upgrade their listing for $125 in the “Find a Neurosurgeon” section of NEUROSURGERY://ON-CALL® .
Finally, the AANS can help you get a deluxe home site on the information superhighway, where you are sure to be visited. Medem, an Internet partner of AANS, provides AANS members with free customized Web sites and can set up an e-mail service with patients, too. SpineUniverse.com, another Internet partner of AANS, offers the option of listing your practice in specialist referral data banks. Neurosurgeons who already have a Web page can link up to Medem and SpineUniverse or build a page on their own and link up.
The Internet partners function as referral sources for AANS members. Some visitors to these sites inevitably link up with the home pages of neurosurgeons. And you’re in business.
Surveys a Key Tool in Assessing Patient Satisfaction
You are a competent, caring neurosurgeon. Your staff is polite and efficient. Your office is conveniently located near the community hospital. Yet your patient volume continues to drop.
The culprit could be a simple but overlooked problem such as a lack of patient privacy. Patients may not be able to give sensitive personal or medical information at the front desk without other patients overhearing.
A practice survey can help you identify hidden barriers to practice success. It’s important to gauge patient satisfaction to ensure patients’ needs are being met.
Minor annoyances for patients, already under stress and uncomfortable before they arrive, can keep them from returning and cause them to badmouth your practice to friends and their referring physician. Is the TV too loud? Is the waiting room too hot or cold? Is there ample, convenient parking? Maybe customer service is the problem. Can patients quickly get their questions answered over the telephone? Are staff friendly?
A survey with 20 to 30 questions, one that fits on both sides of a sheet of paper, will provide sufficient feedback. Surveys need to be done at six-month or 12-month intervals to compare results.
Surveys can be handed out to patients while they are in the office. Or you can hire a firm to coordinate either a mailed survey or a telephone survey.
Handing out surveys at the office is the least expensive option. But it’s not scientifically valid because survey respondents self-select. Also, patients worried about confidentiality may not be candid. Still, if you want to spend little money and time on a survey, this may be the way to go.
A mail survey gives patients more time to reflect on their experiences. Getting a large enough response to be scientifically valid can be a problem, though some survey experts maintain that 50 patient responses per doctor will give you roughly the same data as 500 replies. Depending on the size of your practice, the cost of mail surveys can be as low as $1,500.
A telephone survey is expensive, as much as $20,000. And some patients may resent being called at home (though a call being made on the behalf of a personal physician is hardly received with the same distaste as calls from telemarketers). But telephone surveys provide quick feedback and elicit a relatively high response rate.
Two publications sold by the AANS, Starting a Medical Practice and Managing a Medical Practice, contain background on surveys and sample surveys. Call (888) 566-10 for information.
The National Association of Healthcare Consultants can provide a list of firms that do surveys. Call (202) 452-8282.
Media, Public Outreach Bring In Patients Neurosurgeons who are willing to work with the media and reach out to community groups will boost their patient volume.
Consider Stan Pelofsky, MD, for instance. He not only makes his rounds bedside but also in the community as a whole. The Oklahoma City neurosurgeon gives talks to Chambers of Commerce and meets with medical students at medical schools. To further increase his visibility, he distributes the USA Today insert done by AANS about neurosurgery.
“e;You can order copies from the AANS or print articles off the Web site and send them to the local TV news show with a note to say you’re interested in talking about strokes. On a slow news day, you’re in business,” says Dr. Pelofksy, one of the owners of the Oklahoma City Spine Hospital.
Dr. Pelofsky’s outreach is paying off. His hospital, owned and operated by physicians, is close to 100 percent occupied and will expand by six beds to 18.
Making yourself accessible to the media and community groups will steer patients to your door.
“You have to position yourself as the expert in your community,” says Kristi Sykes, director of marketing for Knoxville, Tenn.-based Doctors Management, a health consulting firm. “Send out what we call ‘technical-based alerts.’ These can be case studies, updates on new technology, drug treatments.”
Neurosurgeons need to show initiative. Build a relationship with the local media and reporters will come to you when a neurosurgery-related story breaks. Concentrate on the local newspapers and radio and TV stations, most of which carry a “health beat” feature. Find out who the reporter is who covers health and position yourself as an information resource.
“Once you establish a positive relationship with the media, they will return to you when they need a spokesperson for a story,” says Susan Nowicki, director of communications for the AANS.
Consider a Proactive Approach
- Write a column, op-ed or letter to the editor for your local newspaper.
- Suggest health segments for local radio and TV shows.
- Send a copy of the Neurosurgery Today insert from USA Today and offer yourself as a resource on stroke, back pain or other neurological condition.
- Sign up as a member of the AANS Spokesperson Network.
In dealing with the media, communicate key points.
Punctuate your points with phrases such as “the bottom line is …” or “the most important thing to remember is …” to ensure your message is getting across.
Precisely because the public associates neurosurgeons only with brain surgery, neurosurgeons need to be visible in the community, not just once or twice but often.
“Don’t expect an immediate response,” says Rebecca Anwar of the Sage Group in Philadelphia, a health consulting firm. “Marketing is a continuous process.”