“A business is successful to the extent that it provides a product or service that contributes to happiness in all of its forms.”  ~Mihaly Csikszentmihalyi

Why Do Patients Love or Leave A Concierge Medicine Physician? Hint: It rarely is ever about the price tag.

Last Updated: Dec 2020

Originally Written By Michael Tetreault, Editor-in-Chief, Concierge Medicine Today

There’s an elusive and mysterious achievement which all Physicians look for, the New Patient Referral.

It’s a beautiful thing when it happens.

Yet, we don’t always know how it happened.

Whether a team member failed to ask a follow up question or an inquisitive question about why your friend told you about this Doctor and now you’re in the exam room ready for the first exam.

Why did that friend think this office was worthy of the referral? Was it proximity to the house, cost, availability, specialty or just plain likability?

Without further conversation we won’t know.

Every team member should be equipped and at the ready when this new patient arrives for the first time and inquisitive and friendly enough to learn more about the Why behind the visit.

This is one of the most important questions to answer to help grow your practice.

Often we’re afraid to ask customers/new patients these questions because we don’t want to scare them off. However, if we don’t ask … what is at stake is the growth and livelihood of your practice/business and employees salaries.

So we need to ask. We can’t be afraid.

You’ll find people will often be happy to share who and why they referred you.

Unpack these questions. It helps foster positive communication with new patients.

Believe it or not, new patients want to tell you! They’re often very excited to be there.

If you are lucky enough to answer these questions then you’ve struck gold. You’ve unearthed the holy grail for your practice.

Next, you should share these treasures and about the hunt you went on with the patient in your next staff or team meeting with the entire group.

Why?

Because if we know the answers to Why the new Patient walked in we can rinse and repeat the strategy and hopefully in the future, keep these new patient referrals coming in week after week.

So today, we also want to talk about what it takes to keep a current patient and conversely, how keeping current patients attracts new patients.

Often this can be as mysterious and pot-holed as finding a new patient.

“My vision is to cultivate a personal Patient – doctor relationship amidst a bustling urban community where impersonal professional relationships are the norm,” said Dr. Edward Espinosa of Buckhead Concierge Internal Medicine in Atlanta, GA. “Our practice strives to deliver quality medical care with an emphasis on evidence based medicine, open communication, easy accessibility, and a focus on customer service. These benefits can lead to an overall improvement in how healthcare is delivered and may ultimately improve outcomes.”

We’ve all met raving and loyal fans of businesses.

Concierge Doctors and their team of friendly employees are no different.

In fact, the level of patient satisfaction inside a Concierge Medicine practice that must be held up to all team members as above average or better than the competition is critically important for Doctors wishing to retain and attract new patients.

Fortunately, one action (patient satisfaction) feeds the other action (new patient referrals).

It’s understandable that when some people bump into Concierge Medicine, its mass market variants, learn about telehealth or Virtual Private Physician visits (VPV) that we lean in or resist. Those are natural human reactions to change.

But once we learn about a new offering, realize its value and see a preferred future for ourselves by having a relationship with this Doctor [or not], we can make more informed and educated decisions.

Annual Renewal and Patient Retention Figures In Concierge Medicine Offices Remain Very High, (typically, mid-90s percentage)

Observation and early analysis of the retention figures cited by both consultants and independent physicians practicing Concierge Medicine since 2007 or earlier, have proven quite consistent year after year. Both consultancy and independent physicians throughout the past ten years [since 2007] note that ‘as an industry these retention numbers remain incredibly high … annual attrition typically only occurs because of mortality, job changes and/or relocations.’

One interesting component about job or relocation of these patients … [when the physician follows up shortly after their move] finds that Patients who left the care and supervision of a Concierge Medicine Physician still overwhelmingly select another Concierge Medicine practice to join at their new location. Often times, the former Concierge Medicine Physician will be highly involved in the referral and physician selection process by request, throughout this time. This ensures appropriate continuance of care for his/her relocating patient(s).

Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients. The average US panel size is about 2,300. ~Source: www.annfammed.org/content/10/5/396.full

How is that physicially possible?

It’s not. Come on. Let’s get serious.

“A ten minute or fifteen minute visit, are you insane?” said Dr. E.B., a Concierge Medicine Physician in Washington, D.C. we talked to recently. “I’ve spent hours with Patients … and at the end of the day, people understand the value of that.”

Let’s start measuring something worthwhile. Let’s start measuring something that can actually help, not exhaust the Doctor-Patient relationship.

When Do Older Patients Change Primary Care Physicians?

Older patients, particularly those who are older and have more education and income, tend to stay with their PCPs until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive. Changes in the health care system may have increased the number of patients forced to change PCP. (J Am Board Fam Pract 2004;17: 453–60.)

So how do Concierge Medicine Physicians retain loyal patients?

What’s in the secret sauce of customer experience that creates an impression in the mind of current patients that those people then share, talk about or remark to others [their friends, colleagues, neighbors, etc.]. Well, what we’ve observed over the past two decades can be summed up in two words.

Unique and Remarkable.

What we do know today is that Concierge Medicine, retainer medicine and boutique physicians that have a long, relational-history with their Patients often have high, between 92%-96% annual retention rates. Based upon these trends which we are observing year after year, these [Concierge] practices should soon be reporting levels or percentages at or exceeding traditional primary care and family practice length/duration or care expectations.

When was the last time you experienced something worth remarking about when you last visited the Doctor’s office?

We’re all familiar with the stories people and patients share about how horribly wrong a Doctor’s office visit went, but we don’t hear about the good news.

Except in Concierge Medicine.

Concierge Medicine Doctors are setting an example for other Doctors everywhere to follow. They’re leaning into new technologies, A.I., and even evidence based medicine research tools that are designed for the future of healthcare delivery. The Concierge Medicine and private healthcare industry as a whole has become the conscience for many Physicians and health systems operating throughout the country. We find patients, your peers … they all lean-in, straighten up and listen just a little more intently when these Doctors enter the exam room.

“Telling Patients to eat right and exercise is a wish, not a strategy,” said Dr. S.W., a Concierge Medicine Physician in Arizona in a recent interview. “We really have to spell out and educate.”

Practical Steps Doctors and Team/Employees/Staff Can Do Today To Foster New Patient Referrals and Retain Current Patients

1. Don’t Keep Your Customer Service Standards a Secret.

When was the last time you, the Doctor, implemented an idea that wasn’t your idea?

Meaning, if a team member or staff shared an idea that would enhance the patient experience, did you listen and implement the idea?

Patient Satisfaction in Concierge Medicine remains exceptionally high. Conversely, inside a traditional, plan reimbursed medical practice environment patients expect to wait and they expect unnecessary tension with your staff.

Nowhere else in our lives except inside a healthcare facility do we suit-up and prepare for the emotional and psychological battle and ready ourselves for this kind of tension that can only be found when visiting the Doctor’s office or hospital ER or exam room.

“It’s bad out there, find me one of those Concierge Doctors you’ve been talking about,” said K.T., a mother of three we talked to just a few weeks ago.

It’s true. It is rough out there.

Consumers of healthcare today say, they expect a disengaged staff and an unpleasant visit when at their doctor’s office.

However, in Concierge Medicine models, Patients are Invited rather than Expected.

Think about that for a moment. Zero in on the word, Invited.

Attitudes toward Concierge Medicine have undergone significant and positive changes since the signature of the Affordable Care Act in 2010. Patients seeking Concierge Physicians tell us they expected insurance to cover their visit. When it is was not, they expected confrontation.

This counter-intuitive approach exceeds patient expectations. Thereby creating a massively loyal and engaged audience which, in turn, is producing some amazing patient outcome data as released and seen by other organizations operating in this space.

So in summary, don’t keep your patient experience and customer service standards a secret. Study those medical practices and business outside of healthcare that you admire. What are they doing from a customer service perspective that could translate and be implemented into your practice and work environment?

Zappo’s CEO Tony Hsieh, likes to tell people that Zappos’ is a customer service company that happens to sell shoes (and more).

This attitude is emblematic of their intensively customer-first approach to doing business.

Every Doctor, every team member you employ and every patient encounter is a reflection of you and your medical treatment decisions and medical acumen. Doctors, and dare we say every Concierge Doctor, is in the customer service business as well. What if we applied the Zappo’s customer service philosophy to healthcare? It might look something like how your practice operates today.

Wouldn’t it be great if you told your patients something similar … “Yes! Our Medical Practice is a customer service practice that happens to have a Doctor … and he/she is amazing!

What if patients felt that same way about their Doctor?

We don’t have to imagine any more because we see it happening in Concierge Care.

3. Put the right staff members/employees into the right positions in your medical office.

One Concierge Physician wrote to us recently and stated “I had a real battleaxe in the front office. She worked with our team and for me for a very long time. But, our practice has changed. That’s not what we need anymore. We went ‘Concierge’ and like it or not, we needed a softer, gentler and friendlier person in that position now. In fact, the whole position was changed. It took a few months for me to realize this … but I’m glad I did. I just hope my patients will forgive me for taking so long.”

So, to start off with the obvious answer to a common and important question we receive regularly … why do patients leave any medical office, the answer is generally: staff.

Why is that America’s Best Places to Work NEVER include a Doctor’s office?

Staff? The Doctor’s smile?

Patients, both current and new, expect that visiting a Concierge Medicine office is about a Doctor and team members doing something different for the Patient. There’s expectation that must be communicated to Staff to prevent business/customers/patients from leaving the practice.

You can’t afford for your staff to burnout. And subsequently, you can’t sacrifice the organization for one person … even if they do feel like family.

Maybe you need to recenter or adjust your staff positions this month. Or, maybe you need to pay closer attention and learn about what type of first impressions are happening in the lobby and intake area vs. take your employees word for it. One Physician recently said she asks his wife to come in for a lunch hour visit, or just pop-in to say hi. He said that she’s noticed employees are snacking and dropping crumbs and wrappers all over their work station areas which patients can see. Another observation received by a different Physician we talked to was the amount of voicemail messages left and heard/listened to by patients waiting in the lobby area by the Doctor’s staff regarding scheduling changes.

“We moved our receptionist to another area of the practice further away from our front office waiting area because we realized our Patients didn’t need or want to hear our staff have lengthy conversations with existing patients,” said one California Concierge Medicine Doctor. “It removed a lot of the noise and made the office much quieter and more calm up front. Patients started commenting to me directly about the changes we made and now say how serene the office now is.”

There are other valid and very important reasons why patients leave their medical doctor, but in Concierge Medicine specifically, we have observed that staff is the primary reason patients leave. Notice, we didn’t cite price or ‘because my doctor only spent 10-minutes with me.’

“Zappos customers always find a friendly, helpful and empathetic ear,” notes Hsieh. “Customer interactions often include personal topics, such as weddings, pregnancies, graduations, birthdays and anniversaries. It’s not uncommon for customers to be pleasantly surprised days later by a mailed greeting card from their new friend at Zappos!”

What if patients felt that same way about their Doctor?

We don’t have to imagine any more because we see it happening in Concierge Care.

4. Technology and Telehealth Solutions Should Not Isolate Us From Our Doctor and Getting Answers.

There’s nothing more frustrating than silence when we need help.

Today we’re really at the advent of mass use of telehealth technology. Some say we needed the COVID-19 Pandemic to happen in order for Patients to start using telehealth.

If you’ve worked with or talked to Doctors and medical providers you know that really the opporsite is true.

Physicians, healthcare workers, ERs, Urgent Care Centers, primary care and pediatric and family medicine offices, they simply were not ready for widespread use of telehealth adoption in their communities until they really had to use it en masse during the COVID-19 pandemic.

“Patients were skeptical and reluctant because of how accessible and convenient the service was,” says Raymond Zakhari, NP and CEO of Metro Medical Direct, New York. “They expected to be kept waiting on hold. Some seemed puzzled by the fact that when they called I answered the phone and knew who they were. One patient even inquired as to how come they only had one form to fill out.”

These telehealth solutions may seem like they keep the Doctor and Patient away from the exam room and in essence, separate from one another.

However, when we look deeper into these solutions, we find these are just excuses we tell ourselves so we can justify our resistance to change.

Amazon’s approach to connection with its customer and customer service lacks a human touch. No one can argue it’s efficient, requires less labor, and is therefore less costly to operate.

Jacob Stein, a product analyst at Clyde writes “Conversely, the Zappos approach, makes a business’s customer service program a more valuable and marketable asset. Companies that take the Amazon approach to customer service can be successful because they aim to make the process as simple as possible. On the other hand, companies that take the Zappos approach can market or leverage the care they offer their customers as a value-added service, thus giving them an edge over competitors.”

Doctor’s in Concierge Medicine would be wise and thoughtful on how to approach their own customer service program and consider which technology approach to patient care is right for them.

5. What Gets Measured Gets Repeated.

At Concierge Medicine Today, we’re currently polling and asking Physicians and their staff “How Do You ‘Measure’ Patient Satisfaction In Your Practice?”

The answers may or may not surprise you but here’s what Concierge Medicine offices are doing:

• 53% – Patient Satisfaction Survey Card/Questionnaire – Quarterly
• 26% – We Look At Repeats and New Patient Referrals, But They’re Not Accurately Tracked/Measured For Monthly Reporting.
• 11% – We Look at Financial Reports Primarily.
• 10% – Periodically ask patients directly “what can we do better?” … No formal method of tracking though.

Roxanne Warren, a blogger for Zappo’s states “Here at Zappos, our CLT members are specially trained to make sound decisions on their own by taking ownership of each call’s experience, and any adverse issues the customer expresses. Our company enables our representatives to best adjust to the needs of our customers by bestowing them management level decision-making power. For example, all Zappos customer service representatives have the authority to accept special-case returns, offer partial or full refunds in cases of loss of service, pay for damages, and “WOW” customers to provide solutions in any other manner they deem appropriate.

“It’s more important that we make an emotional connection with the customer, rather than just quickly getting them off the phone,” says Derek Carder, customer loyalty operations manager for Zappos.

This is a philosophy that has recently been taken to the extreme at Zappo’s. Last June, a Zappos employee took a customer service call that lasted a record-breaking 10 hours and 43 minutes. Insane? Fanatical? Maybe, but such accusations perhaps miss the point of what Zappos is trying to achieve – loyalty.

So how does that translate into your medical practice? How does this apply to Concierge Medicine?

I’m glad you asked!

In the first and second quarter of 2020, Concierge Medicine Today asked our Concierge Physician readers “What Is Your Longest Patient Visit In Concierge Medical Care?”

• 10% – 1 Hour
• 40% – 2 Hours
• 25% – 4 Hours
• 20% – 3 Hours
• 5% – 8+ Hours

“In selecting only a small population of clients and providing dedicated counseling sessions, sometimes as often as weekly, allows clients to actively participate in their care plan and to move goals forward at a real-time pace. This enables all of us to realize that healthcare can be a positive experience,” says Concierge Medicine Physician Dr. Carrie Bordinko of Paradise Valley, AZ and Founder of Consolaré Primary Care.

6. “Unexpressed Gratitude Communicates Ingratitude.”

Author Andy Stanley I believe has written about this specifically and exhaustively in many of his books over the years.

And, it’s true.

We’ve echoed these sentiments as you may know for years and have also written several books, articles and interviews with Physicians about the unique and creative ways Doctors must learn to connect with Patients to increase patient loyalty, attract new patients using existing patients as referrals sources and how to grow your concierge medicine practice and patient panel.

As many are aware, Concierge Medicine’s strength and albeit, bond with its customer [ie patients] is the relationship that a physician has with his/her patients. It has been this way for more than twenty five years now and it continues to drive daily rituals of these practices across various patient demographies throughout the world of concierge medicine both in the U.S., and abroad.

“Business is tough,” says Dr. Chris Ewin of 121MD in Fort Worth, TX. “If you are doing something just for the money, you are never going to enjoy it. You will be the hardest boss you have ever had. So, find something you love and pursue it. Follow this advice and you will set yourself up for an enjoyable future in medicine.”

We have all received out of this world bills from a hospital ER, specialist or even our pediatrician, right? Maybe you’ve been lucky enough to received a PAST DUE notice from your Doctor.

That’s nice.

What a ray of sunshine on a bright day these notices are.

Well deserved? Maybe.

Does this type of communication with no other form of communication bring the Patient and Physician closer together?

Obviously not.

Maybe the patient forgot.

Maybe it’s hard times.

Maybe the invoice went to Spam.

For whatever reason, a business, a medical practice, etc., must maintain a bottom a line to stay in business and keep helping people.

We get that. We’re in the same boat.

But IF your medical practice sends more of these dreadful notices that says something like ‘Your urgent attention is required. To prevent collection efforts and additional costs such as attorney fees, please remit payment in full…’ — than positive, creative or uplifting communications, where does that at the end of the day leave the relationship between the Patient and the Practice heading?

We know the answer. If the Doctor’s office is sending more collection notices than thank you’s, the relationship between the Patient and Physician is on the road to end, and fast! 

What is even more presumptuous is to presume most patients will sign-up for the next appointment before they leave so they can start this [frustrating] process all over again?

That’s the old way of delivering healthcare.

And when Patients and Physicians alike bump into this model, it’s no wonder they’re burned out, tired, frustrated and fatigued.

So what can you do today to help improve the road and connection with the Patient tomorrow?

Well, at CMT, we asked in 2020 “Doctors, HOW MANY HANDWRITTEN Notes or THANK YOU NOTES Do You Write To Patients Per Month?”

• 32% – “I write between 1-2 per month.”
• 14% – “Between 3-6 per month.”
• 21% – “Between 7-10 per month.”
• 11% – “Between 11-20 per month.”
• 6% – 150+ Thank You Notes/Handwritten Notes Per Month (or 4-5 notes, personally addressed per day).
• 16% – None. Zero.

“The Patients who came with me love it, and they tell me so often, unsolicited, how glad they are that I made the switch.” ~Alexa Faraday, M.D., Baltimore, Maryland | www.DrAlexaFaraday.com

In summary, what gets measured gets repeated. Concierge Medicine Doctors would be wise to set a daily or even weekly goal (e.g. 5 – 10 per week).

And remember, “Unexpressed Gratitude Communicates Ingratitude.”

Doctors have so much to thankful for. But patients don’t often hear it, see it or feel it.

Let’s change that.

Key Takeaways

You are providing an environment for people in your community to have conversation [with you, their doctor], not a presentation. Now that you are armed with specific insight into consumer and patient intelligence, your next step should simply be to create an atmosphere in your medical practice where curious people are comfortable enough to have a conversation with you — and it is your job to put their doubts into words and to hear why they are considering leaving their current doctor or joining yours. This is happening in nearly every community across the country in 2020 … and it is your job to make each person feel heard, noticed and appreciated.

“When a physician is free to create pricing structures that meet their local demographic demands without the intrusion from insurance and avoid providing “hamster healthcare,” which only allows doctors to spend 6 to 9 minutes with their Patients, you foster a happier Patient, healthier family and find a less frustrated and fatigued doctor who is able to care for their Patients more thoroughly and comprehensively.” ~The Doctor’s Guide to Concierge Medicine & Private, Direct Medicine