No matter how much pressure you’re getting from a peer, a consultant, your staff or even your patients to deliver subscription-based healthcare services right now, please take stock and inventory of your responsibilities first. It’s okay to take a breath, ask for more time and ask more questions. This is a big decision for you, your family and your Patients. You must feel confident and move with certainty … and know that you’ve wrestled with every question and sat down with your spouse, business partners, accountants, knowledgeable attorney and staff … and mapped out a strategic business and marketing plan complete with your own goals, costs and an achievable timeline to accomplish your goals … that you’re comfortable with for the next one to three years. And, consultants, are really great at helping Physicians wrestle with these dramatic decisions, so learn and lean on them … use them!
By Concierge Medicine Today Staff with Contributions From CMT, Editor-in-Chief
UPDATED FOR APRIL 2022 | ATLANTA, GA – We have been writing, observing and focusing on this industry for well over a decade now.
A lot of faces have seasoned but everyone’s spirits are still pretty high and optimism about the industry and career marks from Physicians also remain high when compared to the physician career satisfaction scores received in other areas.
We have kept our relationships with so many of the Concierge Doctors during the years and whom opened in the mid 1990’s. We’ve all watched as many have succeeded beyond their wildest dreams.
At the same time, we have seen many doctors flounder and struggle. Particularly concerning are those that are younger in age, business and medical experience and price themselves well below what they are truly worth to their Patients and their local community.
Over the years, they’ve told us operating and starting a membership medicine practice was not easy but it is so incredibly rewarding, they’re glad they did it.
Conversely, it’s not an easy road to follow. If done properly, it can be the most rewarding career adventure a Physician will ever enter into.
We thought we’d put together a list of helpful do’s and Do Not’s new concierge and/or direct care doctors can use to help you succeed when starting up your practice.
1. Reach out for help.
If you think you can do this alone, think again. You need trusted voices around you that can help you see your own blind spots. You also need specific legal, accounting, financial and even business insights from experts that can put guard rails around you and your future practice business plan that prevent you from driving your practice into the ditch.
You also need staff around you that can support you (and believes in what your new practice model stands for).
Finally, a supportive spouse that thinks you should do this. This is probably more important than anything. If they’re not on board yet, Physicians and industry experts alike say, ‘Wait until they come around, then move into this.’
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Over the past several years at Concierge Medicine Today, we’ve reported on a number of doctor’s who’ve struggled to find their place in the concierge medicine and direct-pay marketplace in the first two years. Yes, they’ve announced their new private-pay or retainer-based medicine practice service offerings might have been priced right and when opened their doors they had some success. But about a year later, thirty percent of surveyed doctors we interviewed were still unsure of their decision and we found that one in ten doctor’s in 2011 for example, said they were worse off than before.
What any good friend, trusted advisor should tell you is that no matter how hard you work, there are only 24 hours in a day and you’ve got to sleep during eight or nine of them. That’s why it’s important to reach out to people who can help you.
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Here’s another quick tip, FOR DOCTORS
If you already have great employees, make sure they understand what you are trying to do with your new practice.
Education and mental buy-in amongst your staff is key. If they don’t believe in what you’re about to do, you may need to make some tough decisions.
2. Write your questions down first. Then, interview your consultant(s) carefully like they’re interviewing for a Job at your practice.
Don’t put more time and research into which refrigerator or car you’re going to buy than the future of your medical practice. Do the work. Put in the time. If there’s one thing we know about you (eg Physicians), it’s that you can learn new things.
Industry consultants in this space have a lot of experience and can teach you a lot of new things and maybe even remind you about some old principles as well. Industry consultants in the private, subscription-based industry are a wealth of knowledge. Not only have they already helped countless Physicians navigate hurdles, see opportunities but have helped countless Physicians, like you, move into this space and thrive.
They’ve truly seen it all.
So, we recommend you interview any and every consultant(s) you can but please, do your self a favor before you set up a meeting. Write down your own questions that are specifically important to you and don’t leave that call or meeting without clarity and some amount of certainty that you’ve gotten your answers addressed.
You may even want to consider interviewing at least three or maybe even four or five companies that have experience in the transition. Know what’s available to you in the marketplace.
We’ve put together a list of industry consultants and more, here.
We’d also suggest asking them all of the questions you think patients and staff might ask of you as well. See how they answer these questions.
For example, how long does this process of transition take for most Doctors in my specialty? Have you done any Physicians in my area? What about my EMR System … will it change? What if this doesn’t work out? What then? What happens to Patients who don’t continue with me? What’s your fee? How long is the contract with you? What’s expected of me and my team? What about legal and Medicare and Payor contracts? What’s your timeline and implementation strategy to help me do this? Do you have a patient-practice or patient-physician service contract I can review? Do you have a referral of another Physician I can talk to that has worked with you?
We’re sure these questions will get your gears turning and you’ll eventually with a little effort develop your own list of questions.
Announcing that your medical practice is now accepting subscriptions, memberships, retainer-fees or going strictly going to a cash-only payment system can be a scary and exciting adventure. And, we’re not believers in the entire DIY-approach either. A DIY approach can work, don’t get us wrong. But a DIY approach to transitioning your practice without legal, business, financial, accounting and other professional help is not going to serve you, your Patients or your practice well in the months and years ahead.
Do yourself a favor, do a little homework first. Most physicians that we’ve interviewed over the years will tell us it’s a challenge at first, but one adventure they are SO HAPPY they chose for themselves.
3. Find A Great Accountant and Fight The Battle on Paper First.
Skipping this step before you start your concierge-style or direct-pay practice could cause you a lot of frustration.
According to industry ‘practice conversion’ consultants, making a to-do list, crunching the numbers and reviewing your current human capital and operational resources prior to announcing any pricing or business structure change is key. It’s always easier to fight a battle on paper (or a computer spreadsheet) than to promote first and ask questions later.
No matter how much pressure you’re getting from your consultant, staff or even patients to deliver new services right now, you need to take stock, take a breath, feel confident and certain that you’ve sat down with your business partners, spouse, accountants, attorney or staff and mapped out a strategic business and marketing plan complete with your own goals, costs and an achievable timeline that you’re comfortable with.
A concierge-style or direct-pay operation will have to estimate how many additional employees (or in many cases, how many less employees) will be needed to service the expected influx of new faces taking orders on a daily basis over the course of the next year. According to Concierge Medicine Today interviews over the years, the average concierge-style medical office employs 1.5 to 3.5 employees (2010-2022).
4. Communicate with your patients often and early, but set your expectations accordingly.
One of the best pieces of advice I heard one Physician at our industry conference tell a group of her peers was “You’re not the center of nor as important to your patients as you think you are.”
Humbling sentiment. But what she also expanded upon right after saying that was essentially “Stop putting so much pressure on yourself. You haven’t had the time nor the opportunity to be that for your Patients, until now. So don’t expect this flood of interest right away. It will happen gradually. It needs to happen over time otherwise you’ll become overwhelmed and burned out, again.”
What a great speaker.
What you should expect is a little local media criticism, a few skeptical patients who misunderstand what you are saying and what you’re trying to accomplish with your new business model, a private-pay or concierge-style practice that lacks the planning, capital, staff and the operational infrastructure to handle such issues can promptly get crushed when news of so-called ‘limited access’ becomes a popular hit.
Clear communication is the lifeblood of any business relationship, but it’s even more important when your concierge medicine practice suddenly takes off. Once you’ve worked with your trusted team of advisors or even a conversion consultant to formulate the proper strategy, rhythm, letters, printed promotional materials, verbiage, legal stuff and met with your staff and coached and educated them now on what to say and what not to say, and you’ve approved your strategic plan/calendar – the biggest mistake any doctor can make now is failing to communicate with his or her patients that there is a deadline in which to join and after that, it’s might too late. This might seem counter intuitive, but we all need deadlines. It helps make us finally move towards a decision. Otherwise, we’ll continue to do what feel comfortable. It’s just human nature.
So remember, the majority of concierge medicine and retainer-based practices limit their patient-base to approximately 300-600 patients each year. You may think that on day one, your practice will suddenly become overwhelmed with interested patients, phone calls and discovered locally or even nationally by the media as some great story. That would be every doctor’s dream come true, right? Yet, too often, that overnight success can quickly become a doctor’s worst nightmare. Typically, day one expectations like that can be a let down. You see, the popular movie line “If you build it they will come.” is a great movie quote. I love that movie too. But it is a terrible business strategy.
An overnight success is a myth. If you have these lofty expectations you’ll always feel like you’re behind. So, surround yourself with the right people, possibly the right consultant(s), accountant, attorney and advisers to help you.
5. Don’t Go Into Debt By Leasing More Office Space.
While it’s only natural to want to celebrate your new practice with a new medical office, remember that concierge-style and direct-pay physician doctor’s office’s usually end up reducing the amount of leased office space they actually need. While it might seem like downsizing your office space is a bad thing, according to our physician sources, leased office space is the most expensive annual expenditure for concierge doctors and direct primary care physicians followed by staff payroll.
6. Prepare your staff.
Before you go on a hiring binge and prepare for the influx of phone calls, concerned patient inquiries and unavoidable angry and tears of joy conversations, it’s important to figure out how much working human capital you’re going to need to meet your local markets demand. Your conversion consultant and/or business advisors and business plan should be able to answer and address all of these questions for you and help train your staff to address these questions and more.
7. Don’t apologize to your patients for the business changes you’re making. This new process will help them. Inform them that this is a positive change and will help you maintain more secure patient-physician communication on a timely basis and offers them a much more affordable payment system with routine and convenient access to their doctor.
As we’ve said before, clear communication is the lifeblood of any good business relationship, but it’s even more important when your concierge medicine practice suddenly takes off.
Once you’ve worked with your team or consultant to formulate the proper communication, the biggest mistake a doctor can make is failing to explain the value, features and benefits of this new business model with his or her patients. For example, a patients immediate response might be one of great acceptance and they will sign-up with your right away. On the other hand, there will be patients that might feel like you’re abandoning them after years of service.
Be prepared for questions. Be prepared to respond with kindness and grace. Wrestle with the tough questions before you patients have to make what they might feel are dramatic decisions. Talk to your team. Talk to a trusted attorney about these issues. Talking with Patients can be one of the most scary aspects of conversion but it’s one that is absolutely necessary. Many ‘conversion consultants’ can also help coach you and your staff through various conversational scenarios that might occur. Sometimes, consultants will even place an outside person to help you and your staff explain the new model features and benefits in your practice for a few weeks.
8. If you build it, they WILL NOT Come. So, invest for the future now.
Remember, this isn’t financial advice. But Physicians in this space may say that while it may be tempting to reap the profits from your new business model right away and buy new equipment or put new signage out front, it’s important to re-invest some of those profits to help your business grow and get more patients. New patients, word of mouth, that’s how you grow and make an impact in this healthcare culture today. Not necessarily by going into more debt.
According to interviews over the past five to ten years with concierge doctors and private-pay physicians and their staff, the number one most successful way they attracted new patients to their practice was by … ‘hiring a marketing agency’ to help with the educational component of your practice.
Don’t get a marketing agency confused with what a ‘conversion consultant’ and ‘marketing consultant’ or what an ad agency is.
These are two very different types of consultants.
A Marketing Consultant (or Marketing Firm) should have marketplace expertise in both writing and designing materials and effective, lead-generating communication for your practice.
A ‘Conversion Consultant’ is there before you make the switch to help you organize internally, prepare emotionally and plan accordingly as you announce your new business model and pricing structure to your existing patients.
The marketing consultant might be your trusted patient-referral resource and growth advisor several months after the conversion consultant(s) have left your practice and your annual patient attrition is beginning to increase.
See the difference? Clear as mud, right? 🙂
9. Regroup, retrain and learn from past mistakes, missteps and mishaps.
After the excitement of the initial patient rush has died down, take some time to sit down with your staff to figure out what went right, what went wrong and what you think you could do better in the future. This will help you put a strategy in place for the future.
CMT has put together several resources and outlined below a few steps that should set you on a path to finding new patients for your new private-pay medical practice and hopefully to higher annual sales as well.
- Additional Resources
- 3 Ways to Update Your Concierge/Private Practice Business Plan for Higher Sales …
- Letter from the Editor: “Happy Doctors Are Not Malfunctioning Physicians”
- Editor: What Does Hospitality Have To Do With Healthcare?
- 10 Startup Tips For 2022 From Docs Say Will Set You Up To Win!
- Editor: “Concierge Medicine isn’t easy. If it was, more Doctors would do it.”
10. Bonus Tip! Don’t commit to hiring full-time employees with payroll taxes and benefits until you’re sure your medical office model and strategy is here to stay.
Got thoughts you would like to share? Email us at email@example.com or attend our industry conference, the Concierge Medicine Forum each fall in Atlanta, GA USA.