What's on YOUR walls?
Those Mediterranean motives painted in fake impressionistic style usually sold to mass tourists on side walks, now available at your trusted Wal-Mart? That style of "art" that seems obligatory in medical offices if you believe your local decorator? You know, those pictures of Portofino, Lago di Garda, Lago di Como...
Try the following low cost – high style alternatives:Nicholas Nixon “The Brown Sisters”. Shows 4 Massachusetts sisters as photographed yearly by one of their husbands over a time frame of 27 or 28 years now, one photo each year. A wonderful series – very suitable for an Ob/Gyn office. Buy 2 books for $39, tear out the pages and frame them. Or pay 100 K for a signed original 25-image-series available in a NYC gallery.
Take a look at the following artist websites (and remember that taste is subjective):Photographies by Emerson Matabele http://www.emersonimages.com/
One great photographer, whom I happen to know in person, and whose art I have bought without regretting it one second is Martin Berinstein. Take a look at his photographies at http://www.berinstein.com/.
Dry pigment paintings by Diane French who has studios in La Crosse, WI and St. Augustine Beach, FL http://www.statestreetgallery.com/ and http://www.canvascompany.com/
Ansel Adams never hurts either.
Should you have an Ikea nearby, they have very affordable framed and unframed art…
For nature images of the Everglades and Florida wetlands look up Clyde Butcher, a photographer who for me comes close to Ansel Adams. He photographs South Florida and its beaches, the Everglades, and the Big Cypress Swamp. On his website http://www.clydebutcher.com/ take a look at the “posters” section - for $40 you get excellent images…
I have the privilege to live in Boston (a privilege for which I pay dearly with lower income and higher malpractice rates) and we have a fabulous thing called "open studios". These are events, usually weekends, where many or most or all artists in particular areas of the city open their studios to the public. They even offer wine, mineral water, crackers, sometimes music and always conversation. Truly a wonderful thing, I love it. I consider it one of the best sides of Boston. If you are anywhere near the city look in the Boston Globe or on the Boston Globe website or google the term "Open Studios Boston" and visit...
Put some real art, and even if it is only a copy or print, in your office. Be different!
And, of course, you could send me your ideas about this, but you won't anyway, I know that.
Monday, July 23, 2007
Marketing Your Practice - on the Web
Top 10 reasons to see an ObGyn in 2005
based on nationwide survey of about 198 ObGyns, done by Verispan
Supervision of normal 2nd or later pregnancy 16.6 %
Gynecological exam 13.6 %
Contraceptive counseling 5.7 %
Symptomatic menopausal state 4.6 %
Surgery follow up 3.4 %
Vaginitis 3.1 %
Contraceptive surveillance 2.7 %
Routine postpartum follow up 1.9%
UTI 1.7 %
Osteoporosis 1.7%
A few thoughts on this:
1. These numbers can be a good guide for your marketing, and for the way you present your practice on the web. You may consider declaring yourself a specialist in the most common reasons for people to see an ObGyn. You post this on your website in exactly the order of frequency, and a maximum number of potential patients may be attracted to your office.
2. Where is the dysfunctional uterine bleeding in this list? DUB has the potential to be the biggest money maker in any gyn practice. DUB means ultrasound, saline-infusion sonography, in-office hysteroscopy, EMB - which may be billed as D&C if you do it right, in-office ablation (HerOption, Novasure), myomectomy, hysterectomy. Given these issues it makes sense to become and advertise yourself as THE expert in dysfunctional uterine bleeding. We all may be experts, but your website says YOU are THE expert.
3. Where is the incontinence treatment in this list? A TVT pays as much in MA as 9 months of prenatal care including delivery - talk about fairness!? I ask all my patients during annual exams about incontinence in a gentle way "do you sometimes loose urine? Do you leak urine when you cough or laugh? That leads to some further testing and some procedures, but the majority of patients still come through PCPs as referrals. Incontinence treatment is another service you should advertise on your website. A urologist in my community recently told me that he used to do about 50 slings a year and now, "thanks to the ObGYns" he does only 2 or 3.
based on nationwide survey of about 198 ObGyns, done by Verispan
Supervision of normal 2nd or later pregnancy 16.6 %
Gynecological exam 13.6 %
Contraceptive counseling 5.7 %
Symptomatic menopausal state 4.6 %
Surgery follow up 3.4 %
Vaginitis 3.1 %
Contraceptive surveillance 2.7 %
Routine postpartum follow up 1.9%
UTI 1.7 %
Osteoporosis 1.7%
A few thoughts on this:
1. These numbers can be a good guide for your marketing, and for the way you present your practice on the web. You may consider declaring yourself a specialist in the most common reasons for people to see an ObGyn. You post this on your website in exactly the order of frequency, and a maximum number of potential patients may be attracted to your office.
2. Where is the dysfunctional uterine bleeding in this list? DUB has the potential to be the biggest money maker in any gyn practice. DUB means ultrasound, saline-infusion sonography, in-office hysteroscopy, EMB - which may be billed as D&C if you do it right, in-office ablation (HerOption, Novasure), myomectomy, hysterectomy. Given these issues it makes sense to become and advertise yourself as THE expert in dysfunctional uterine bleeding. We all may be experts, but your website says YOU are THE expert.
3. Where is the incontinence treatment in this list? A TVT pays as much in MA as 9 months of prenatal care including delivery - talk about fairness!? I ask all my patients during annual exams about incontinence in a gentle way "do you sometimes loose urine? Do you leak urine when you cough or laugh? That leads to some further testing and some procedures, but the majority of patients still come through PCPs as referrals. Incontinence treatment is another service you should advertise on your website. A urologist in my community recently told me that he used to do about 50 slings a year and now, "thanks to the ObGYns" he does only 2 or 3.
Saturday, July 21, 2007
Find and Hire New Physicians - without paying for a recruiter
The Internet brings new tools to everybody's desktop and has fundamentally changed how employers can search for a new physician associate. There are excellent new ways to recruit and I will explain some of them here in detail.
Consider sidestepping recruiters. Your human resources department or Physician Liaison or Network Development Department can do most of the recruiting unless they are hopelessly inept or understaffed.
Recruiters usually cannot tell you anything about physician candidates that you or your staff would not find out in a few minutes too. They hardly know the candidates - except for that 10-minute phone call and the reading of their CV.
Contrary to their marketing, they do not "select" or "screen" candidates, they sell them to you. A candidate that has been "screened out" does not pay the bills. Selecting does not make money - selling does. And recruiters are in the business of selling.
The $18-22,000 you have to pay the recruiter for a few CVs and a candidate have to come from somewhere! Many employers simply reduce the first annual salary of the newly hired physician by those 20,000. Unfortunately you immediately become less attractive to good candidates, since you pay less than the competition or maybe less than the average market salary. You would get better candidates if you offered a higher salary. Have you considered increasing incentives as a marketing tool?
Last, not least, the fact that you are using a recruiter raises a red flag for the good and savvy candidates. They wonder why you even need to advertise through a recruiter. Are you in a hurry to find an associate? Do you have sub-optimal working conditions? Do you have a high turnover of new associates? How come you are not popular enough to have candidates on a waiting list? Why on earth do you have to PAY to find a new associate?
And of course, recruiters are trained sales people with an arsenal of answers and some rethoric to remove your objections. The "Gopher recruitment software" from Blackdog has a few tips and tricks for recruiters how to overcome client objections - yes, the client is you and the objections is what you think and feel: Click here to read them, so that you are prepared for the attack!
It makes financial sense to actively market your position yourself. This is easier and more affordable than you may think. Here is a way to find a new associate for about $2000-4000, including all the time your colleagues, associates and secretaries will spend on it. You may delegate every single one of these activities.
Write an ad briefly describing your practice or hospital, including your philosophy and goals or your mission, characteristics of the practice, number of physicians, hospital affiliation, and number of deliveries each year, number of surgeries each week. Explain what responsibilities and how much work the position entails, for example how many work days a week, what the call ratio is, mention additional administrative duties, and –very important - what you are willing to offer in terms of payment. You should mention a salary range, for example "160-190 K depending on experience". And no, this will not lock you in into a certain salary! Describe benefits and future opportunities, such as partnership, and the time to partnership. And finally, describe the community in a few words - something that the local tourist bureau can help you with. This ad should be about half a page – and you can always modify it later. The 2 most important points for me have always, always been: location and salary. Make sure you mention these two points if you want your ad to have maximum impact.
Now, how do you get your letter to potential employees?
1. Advertise in print media (and here I assume you are searching for an ObGyn) such as "Ob.Gyn.News", "OBGmanagement", "Contemporary ObGyn", or in the Green Journal.
2. Post your position on the largest and most relevant job sites for ObGyns: NTNjobs.com, healthecareers.com, Practicelink.com. Do not forget to post the job on your own website.
3. Approach potential candidates directly through mail, fax, and email.
Here are a few more details to illustrate the above points:
1. Print media. You can also advertise for about the same amount of money in the three most popular "throw away journals" - OBGmanagement, Ob.Gyn. News and Contemporary ObGyn. They all have websites and 800 numbers. Their prices are reasonable and vary by size of the ad. Since these three magazines are for free for the reader, they are literally everywhere and get a lot of attention.
2. Advertise your job on the Internet! There are two great websites to reach a large number of ObGyns and physicians in general. Post your ad on NTNjobs.com for about $ 315 for 3 months and $215 for the following three months. NTNjobs is a great website, it has a clear design and is easy to navigate. It has been around for over 15 years and gets a lot of attention from job seekers. They are known to have numerous direct-from-employer ads and less recruiter ads. NTNjobs also gives you access to a list of physicians who are presently searching for a job in your geographical area and you could contact them directly.
Very important! A new excellent tool for finding physicians has emerged in 2008. SERMO.COM, a physician-only online community, now has a Job Board. AND IT IS FREE. And it will continue to be free. You register at sermo.com (for free) and post your job offer in the form provided on the same page as the registration. Since semro has 65,000 registered users so far, the exposure is quite good. They will not remove your ad, the posting time is not limited. You post the description of the job and leave a name, telephonenumber and email adress where an interested physician may contact you. Voila! You have the chance of reaching a large number of physicians for free....
I also recommend posting your ad on the new "ACOG Career Connection" section of the ACOG website, which is "healthecareers.com". A single posting costs $350 for 60 days.
A number of successful bloggers are trying to cash in on their popularity and have started advertising jobs. At the moment (July 2007) I do not recommend advertising there, since they are not established yet and the number of eyes that you reach are too small.
3. I would like to explain the direct mail approach in more detail, since it is less known and very underused.
For a direct mail or fax campaign you need the names, addresses, fax-numbers etc of the physicians you want to reach.
You can easily, quickly and comfortably buy addresses of physicians from a list-provider such as InfoUSA.com. You can do this online within minutes. Once you are on their website, look in the center, go down and click on: "Doctors, Dentists and other medical lists". In the window that opens click on "Physicians and Surgeons Database" then check the specialties you are interested in, e.g. "Obstetrics and Gynecology" and then, further down, check "office based" or "hospital based" or whatever you need. On the following page uncheck the specialties you are not interested in contacting, e.g. MFM, critical care obstetrics etc. Do not check the "fax number" box, since this will exclude doctors that have not listed a fax number. You want all the names and addresses and phone numbers! On the next page you can select the geographic area, which can be the whole country or just one zip code, or a radius of 500 miles around an address or just 10 miles. Then you get to review the list. Should the list be too large, then choose a smaller geographic selection, or change the selection by introducing age limits or gender etc. Of course, you can also increase the number of physicians this way.The price is 50-75 cents per address. There is no minimum to buy. InfoUSA will instantly email you a list in CSV format, which you can import into Microsoft Outlook, Act!, Excel or any other Contact Manager software program.
The American Medical Association has been collecting the contact information of all physicians in the US for many years and has made quite a few dollars by selling your good name, mainly to pharmaceutical companies. They have founded their own list provider company "MMSlists.com". They have very good and reliable data, but unfortunately they are very expensive. And they impose all sorts of restrictions, such as number of times you can use the data. Because of this, I do not recommend them.
A more economical solution is the following: Buy or borrow the American Medical Association book and the companion CD that contain the contact information of every single doctor in the US. The book plus CD cost about $1200, and it does NOT allow downloading and exporting of the data into a database! Yes, the AMA is expensive. But, there are some inexpensive and very useful alternatives!
Oh, well, but then there are Address Grabber and List Grabber, 2 most interesting software programs. They are very nifty tool to collect addresses, names, phone numbers etc for your lists! "Address Grabber" sells on the net as a download for $70. It allows you to "grab" and capture any address you see on your screen from any website, from any source - with a single click. If you can see it on your screen, you can transfer it to your database! You highlight the address with the mouse; the Address Grabber recognizes it and transfers all information into a contact manager such as Outlook or ACT! The info will almost magically appear in the correct place, address in address field, name in name field, fax in fax field etc. It is well worth the money if you search for a job in a metro area and are collecting contact information from yellow pages, from WebMD and other lists. Obviously it is good for many other things, such as building address databases for referrals, fund raising, other mailings etc. The more advanced version is called "ListGrabber". It imports not only a single address, but a whole page or list of addresses - hence the name. It costs over $250 and most likely it will not pay off if you do not use it a lot. It may be worthwhile for large multispecialty groups and hospitals.
You also could contact all the graduating residents in your specialty in the US. The best time is September – November of each year when they start looking for a job.
To reach the graduating residents you could send your one page ad to the residency program directors of all the programs you wish to see candidates from. Ask them to post your leaflet on their job boards and to announce it during morning rounds or weekly meetings.
You can obtain the addresses of all residency programs from the Graduate Medical Education Directory, the so called Green book. It is sold by the AMA to members for about $70 as a book or CD. Have your secretary fill in a database with all those names and addresses, or buy a database from the marketing arm of the AMA and import those data directly into Excel, which may save two or three hours of typing.
Then there is PracticeMatch.com, a data and recruiting company. On their website you can buy - online, fast, and with your credit card - the names and hospital addresses of all the graduating residents in the country - by specialty. For ObGyn you would get the names and addresses of about 1100 ObGyn residents about to graduate in June of that year. The price is a mere $250. Get the addresses, and mail them your ad or leaflet individually. I would choose mail over fax, since graduating residents would receive a fax in an office of the program director or the chief of Ob or Gyn. A letter on the other hand would go directly to their personal mail box. Voila, you have access to a whole year of graduates!
I should mention a very-low-cost list provider called "Doctorlistpro.com". They claim to sell the whole directory of physicians in the US for $500. The list of all physicians in a single specialty, meaning e.g. all ObGyns in the US, costs only $ 300. Click on http://www.doctorlistpro.com/ and see what they have. They also have a list of physicians email addresses! Emails campaigns are very inexpensive and will probably be the way of the future.
And now enjoy the CVs coming in. You can go through the pile yourself or you can set a few criteria such as level of medical school, level of residency training, years of experience, age etc. and have someone else go through the list of CVs. Your colleagues, your wife, your secretary, your office manager etc. all could help you.
Send a standard letter to the selected candidates and invite them for an interview.
Your Matthias Muenzer,MD
Consider sidestepping recruiters. Your human resources department or Physician Liaison or Network Development Department can do most of the recruiting unless they are hopelessly inept or understaffed.
Recruiters usually cannot tell you anything about physician candidates that you or your staff would not find out in a few minutes too. They hardly know the candidates - except for that 10-minute phone call and the reading of their CV.
Contrary to their marketing, they do not "select" or "screen" candidates, they sell them to you. A candidate that has been "screened out" does not pay the bills. Selecting does not make money - selling does. And recruiters are in the business of selling.
The $18-22,000 you have to pay the recruiter for a few CVs and a candidate have to come from somewhere! Many employers simply reduce the first annual salary of the newly hired physician by those 20,000. Unfortunately you immediately become less attractive to good candidates, since you pay less than the competition or maybe less than the average market salary. You would get better candidates if you offered a higher salary. Have you considered increasing incentives as a marketing tool?
Last, not least, the fact that you are using a recruiter raises a red flag for the good and savvy candidates. They wonder why you even need to advertise through a recruiter. Are you in a hurry to find an associate? Do you have sub-optimal working conditions? Do you have a high turnover of new associates? How come you are not popular enough to have candidates on a waiting list? Why on earth do you have to PAY to find a new associate?
And of course, recruiters are trained sales people with an arsenal of answers and some rethoric to remove your objections. The "Gopher recruitment software" from Blackdog has a few tips and tricks for recruiters how to overcome client objections - yes, the client is you and the objections is what you think and feel: Click here to read them, so that you are prepared for the attack!
It makes financial sense to actively market your position yourself. This is easier and more affordable than you may think. Here is a way to find a new associate for about $2000-4000, including all the time your colleagues, associates and secretaries will spend on it. You may delegate every single one of these activities.
Write an ad briefly describing your practice or hospital, including your philosophy and goals or your mission, characteristics of the practice, number of physicians, hospital affiliation, and number of deliveries each year, number of surgeries each week. Explain what responsibilities and how much work the position entails, for example how many work days a week, what the call ratio is, mention additional administrative duties, and –very important - what you are willing to offer in terms of payment. You should mention a salary range, for example "160-190 K depending on experience". And no, this will not lock you in into a certain salary! Describe benefits and future opportunities, such as partnership, and the time to partnership. And finally, describe the community in a few words - something that the local tourist bureau can help you with. This ad should be about half a page – and you can always modify it later. The 2 most important points for me have always, always been: location and salary. Make sure you mention these two points if you want your ad to have maximum impact.
Now, how do you get your letter to potential employees?
1. Advertise in print media (and here I assume you are searching for an ObGyn) such as "Ob.Gyn.News", "OBGmanagement", "Contemporary ObGyn", or in the Green Journal.
2. Post your position on the largest and most relevant job sites for ObGyns: NTNjobs.com, healthecareers.com, Practicelink.com. Do not forget to post the job on your own website.
3. Approach potential candidates directly through mail, fax, and email.
Here are a few more details to illustrate the above points:
1. Print media. You can also advertise for about the same amount of money in the three most popular "throw away journals" - OBGmanagement, Ob.Gyn. News and Contemporary ObGyn. They all have websites and 800 numbers. Their prices are reasonable and vary by size of the ad. Since these three magazines are for free for the reader, they are literally everywhere and get a lot of attention.
2. Advertise your job on the Internet! There are two great websites to reach a large number of ObGyns and physicians in general. Post your ad on NTNjobs.com for about $ 315 for 3 months and $215 for the following three months. NTNjobs is a great website, it has a clear design and is easy to navigate. It has been around for over 15 years and gets a lot of attention from job seekers. They are known to have numerous direct-from-employer ads and less recruiter ads. NTNjobs also gives you access to a list of physicians who are presently searching for a job in your geographical area and you could contact them directly.
Very important! A new excellent tool for finding physicians has emerged in 2008. SERMO.COM, a physician-only online community, now has a Job Board. AND IT IS FREE. And it will continue to be free. You register at sermo.com (for free) and post your job offer in the form provided on the same page as the registration. Since semro has 65,000 registered users so far, the exposure is quite good. They will not remove your ad, the posting time is not limited. You post the description of the job and leave a name, telephonenumber and email adress where an interested physician may contact you. Voila! You have the chance of reaching a large number of physicians for free....
I also recommend posting your ad on the new "ACOG Career Connection" section of the ACOG website, which is "healthecareers.com". A single posting costs $350 for 60 days.
A number of successful bloggers are trying to cash in on their popularity and have started advertising jobs. At the moment (July 2007) I do not recommend advertising there, since they are not established yet and the number of eyes that you reach are too small.
3. I would like to explain the direct mail approach in more detail, since it is less known and very underused.
For a direct mail or fax campaign you need the names, addresses, fax-numbers etc of the physicians you want to reach.
You can easily, quickly and comfortably buy addresses of physicians from a list-provider such as InfoUSA.com. You can do this online within minutes. Once you are on their website, look in the center, go down and click on: "Doctors, Dentists and other medical lists". In the window that opens click on "Physicians and Surgeons Database" then check the specialties you are interested in, e.g. "Obstetrics and Gynecology" and then, further down, check "office based" or "hospital based" or whatever you need. On the following page uncheck the specialties you are not interested in contacting, e.g. MFM, critical care obstetrics etc. Do not check the "fax number" box, since this will exclude doctors that have not listed a fax number. You want all the names and addresses and phone numbers! On the next page you can select the geographic area, which can be the whole country or just one zip code, or a radius of 500 miles around an address or just 10 miles. Then you get to review the list. Should the list be too large, then choose a smaller geographic selection, or change the selection by introducing age limits or gender etc. Of course, you can also increase the number of physicians this way.The price is 50-75 cents per address. There is no minimum to buy. InfoUSA will instantly email you a list in CSV format, which you can import into Microsoft Outlook, Act!, Excel or any other Contact Manager software program.
The American Medical Association has been collecting the contact information of all physicians in the US for many years and has made quite a few dollars by selling your good name, mainly to pharmaceutical companies. They have founded their own list provider company "MMSlists.com". They have very good and reliable data, but unfortunately they are very expensive. And they impose all sorts of restrictions, such as number of times you can use the data. Because of this, I do not recommend them.
A more economical solution is the following: Buy or borrow the American Medical Association book and the companion CD that contain the contact information of every single doctor in the US. The book plus CD cost about $1200, and it does NOT allow downloading and exporting of the data into a database! Yes, the AMA is expensive. But, there are some inexpensive and very useful alternatives!
Oh, well, but then there are Address Grabber and List Grabber, 2 most interesting software programs. They are very nifty tool to collect addresses, names, phone numbers etc for your lists! "Address Grabber" sells on the net as a download for $70. It allows you to "grab" and capture any address you see on your screen from any website, from any source - with a single click. If you can see it on your screen, you can transfer it to your database! You highlight the address with the mouse; the Address Grabber recognizes it and transfers all information into a contact manager such as Outlook or ACT! The info will almost magically appear in the correct place, address in address field, name in name field, fax in fax field etc. It is well worth the money if you search for a job in a metro area and are collecting contact information from yellow pages, from WebMD and other lists. Obviously it is good for many other things, such as building address databases for referrals, fund raising, other mailings etc. The more advanced version is called "ListGrabber". It imports not only a single address, but a whole page or list of addresses - hence the name. It costs over $250 and most likely it will not pay off if you do not use it a lot. It may be worthwhile for large multispecialty groups and hospitals.
You also could contact all the graduating residents in your specialty in the US. The best time is September – November of each year when they start looking for a job.
To reach the graduating residents you could send your one page ad to the residency program directors of all the programs you wish to see candidates from. Ask them to post your leaflet on their job boards and to announce it during morning rounds or weekly meetings.
You can obtain the addresses of all residency programs from the Graduate Medical Education Directory, the so called Green book. It is sold by the AMA to members for about $70 as a book or CD. Have your secretary fill in a database with all those names and addresses, or buy a database from the marketing arm of the AMA and import those data directly into Excel, which may save two or three hours of typing.
Then there is PracticeMatch.com, a data and recruiting company. On their website you can buy - online, fast, and with your credit card - the names and hospital addresses of all the graduating residents in the country - by specialty. For ObGyn you would get the names and addresses of about 1100 ObGyn residents about to graduate in June of that year. The price is a mere $250. Get the addresses, and mail them your ad or leaflet individually. I would choose mail over fax, since graduating residents would receive a fax in an office of the program director or the chief of Ob or Gyn. A letter on the other hand would go directly to their personal mail box. Voila, you have access to a whole year of graduates!
I should mention a very-low-cost list provider called "Doctorlistpro.com". They claim to sell the whole directory of physicians in the US for $500. The list of all physicians in a single specialty, meaning e.g. all ObGyns in the US, costs only $ 300. Click on http://www.doctorlistpro.com/ and see what they have. They also have a list of physicians email addresses! Emails campaigns are very inexpensive and will probably be the way of the future.
And now enjoy the CVs coming in. You can go through the pile yourself or you can set a few criteria such as level of medical school, level of residency training, years of experience, age etc. and have someone else go through the list of CVs. Your colleagues, your wife, your secretary, your office manager etc. all could help you.
Send a standard letter to the selected candidates and invite them for an interview.
Your Matthias Muenzer,MD
Thursday, July 12, 2007
Put your Practice on the Web - Practice tips 6
Have a web presence by setting up a practice website. It is your business card on the web. It allows your patients to get a view of your practice and a chance to evaluate your practice beforehand. This gives them a chance to build trust and gain confidence in you before they see you for the first time. It also saves phonecalls if you publish often needed information such as your prenatal information leaflet or package. Patients have access to it around the clock. Your leflet can answer the question if it is OK to e.g. take a certain medication during pregnancy. You can post office hours, telephone numbers, procedures you do, areas of specialisation, directions etc on your website.
Websites from MEDEM are reasonably priced, but look a little stodgy and dry. Medem is a corporation that unites many medical societies on the web. Their biggest plus are the great links that you can place on your website. For example, you can post links to numerous ACOG leaflets for free! Given the price of $18 for 50 leaflets that alone is worth the subscription for the website. ACOG’s “Physician finder” leads patients who are looking for a physician to your website. You have limited, but reasonable choices for customization.
The people from "Healthcare Success Strategies" will write and design your website in a very bice and possibly very succesful fashion - for about $7000. The websites from Healthcare Success Strategies that I have seen look excellent and are very well written. They also do write in the correct keywords that give you higher ratings right from the start. It seems expensive, but might be worth it.
My impression on ratings in the following: Content is key. If you have good content, you are better off. Skip the flash introductions, the spiders cannot read it and it slows down the loading of the site. Keywords are very important. When planning a website you should go to Yahoo and another website that shows you which words / keywords are searched the most. This could be prenatal care, baby, pregnancy, the name of your town etc. Use those words often and repetitively in everything you write.
I would be careful with "search engine optimization services" and possibly stick with those affiliated with and recommended by the web hosting service.
There are a number of services that offer ready-to-go websites for very affordable monthly fees. The least expensive and quite good one is: 1&1 web hosting. It gives you the biggest bang for the buck. It has numerous templates of good quality, although the better looking ones cost extra, and it gives you great control over your website.
Other similar services are : Yahoo, which has recently improved their templates, GoDaddy, and then the infinite number of smaller service providers.
1and1 webhosting, Google and GoDaddy have links to webdesigners that can customize your site.
Google has a service, which is in beta right now (12 06) called page creator, which allows you to publish your pages. This may turn into a full fledged website software (conveniently free, like most Google services).
You also can publish your information, your patient instructions, thoughts and links on "Blogger", which is probably the least expensive web presence you can get. You can set up the "favorites" as your index or as links to the most read info leaflets, and you can use the "profile" to direct your patients how to use your Blog as your patient information system. Insert many links and your patients will find what they are looking for.
Be careful with web designers and hosting services that "specialize on doctors", since they tend to charge more than others. After all doctors are rich, right?. Correspondingly they usually target colleagues with higher incomes such as dentists, orthodontists and plastic surgeons.
Should you be a bit more computer savvy, you could set up your website yourself or with some help. You could also hire someone form a nearby college to set it up for you or you could post your website project as a job on Guru.com. Guru.com is site that posts jobs for programmers and software people in general. You post the job, assign a payment and the programmers email you and offer their services. No obligation. Very helpful. take a look at it.
You could also ask your hospital IT department to give you recommendations about local software people that might help you set up and or maintain your website.
Should you want to do a good part of your website building yourself, you will find good website templates go to Allwebco.com. I especially like the "Graphix" series of templates - very cool! Also take a look at templatemonster.com. Templatemonster is a company that constantly develops and designs new website templates, from simple to fancy. You should know that they have a large number of resellers, so you may find their website templates on numerous websites under different names.
Learn about Google. Google is not only the gateway to the Internet, the way to find whatever you are looking for, the new phonebook and the closest thing to the "answer man". Google has a number of nifty and free tools: Gmail, "Docs and Spreadsheets", Blogger, Pagecreator (a web publishing tool) and Google Analytics. Docs and Spreadsheets is interesting and I use it daily. It is the equivalent of having Word and Excel online. It is especially useful if you routinely work on many computers (home, travel, office, hospital) and work on a project. With Google Docs and Spreadsheets you can continue writing on your text wherever you are. You can also allow others to collaborate on your projects, which is great when you have to write policies or consensus papers.
Also get to know Google hacks, learn ways to speed up your search and learn how to better find what you are looking for.
Don't forget to list your office on "Local Business" of Google and, if you want, on its equivalent on Yahoo. Go to their websites and follow the links.
Websites from MEDEM are reasonably priced, but look a little stodgy and dry. Medem is a corporation that unites many medical societies on the web. Their biggest plus are the great links that you can place on your website. For example, you can post links to numerous ACOG leaflets for free! Given the price of $18 for 50 leaflets that alone is worth the subscription for the website. ACOG’s “Physician finder” leads patients who are looking for a physician to your website. You have limited, but reasonable choices for customization.
The people from "Healthcare Success Strategies" will write and design your website in a very bice and possibly very succesful fashion - for about $7000. The websites from Healthcare Success Strategies that I have seen look excellent and are very well written. They also do write in the correct keywords that give you higher ratings right from the start. It seems expensive, but might be worth it.
My impression on ratings in the following: Content is key. If you have good content, you are better off. Skip the flash introductions, the spiders cannot read it and it slows down the loading of the site. Keywords are very important. When planning a website you should go to Yahoo and another website that shows you which words / keywords are searched the most. This could be prenatal care, baby, pregnancy, the name of your town etc. Use those words often and repetitively in everything you write.
I would be careful with "search engine optimization services" and possibly stick with those affiliated with and recommended by the web hosting service.
There are a number of services that offer ready-to-go websites for very affordable monthly fees. The least expensive and quite good one is: 1&1 web hosting. It gives you the biggest bang for the buck. It has numerous templates of good quality, although the better looking ones cost extra, and it gives you great control over your website.
Other similar services are : Yahoo, which has recently improved their templates, GoDaddy, and then the infinite number of smaller service providers.
1and1 webhosting, Google and GoDaddy have links to webdesigners that can customize your site.
Google has a service, which is in beta right now (12 06) called page creator, which allows you to publish your pages. This may turn into a full fledged website software (conveniently free, like most Google services).
You also can publish your information, your patient instructions, thoughts and links on "Blogger", which is probably the least expensive web presence you can get. You can set up the "favorites" as your index or as links to the most read info leaflets, and you can use the "profile" to direct your patients how to use your Blog as your patient information system. Insert many links and your patients will find what they are looking for.
Be careful with web designers and hosting services that "specialize on doctors", since they tend to charge more than others. After all doctors are rich, right?. Correspondingly they usually target colleagues with higher incomes such as dentists, orthodontists and plastic surgeons.
Should you be a bit more computer savvy, you could set up your website yourself or with some help. You could also hire someone form a nearby college to set it up for you or you could post your website project as a job on Guru.com. Guru.com is site that posts jobs for programmers and software people in general. You post the job, assign a payment and the programmers email you and offer their services. No obligation. Very helpful. take a look at it.
You could also ask your hospital IT department to give you recommendations about local software people that might help you set up and or maintain your website.
Should you want to do a good part of your website building yourself, you will find good website templates go to Allwebco.com. I especially like the "Graphix" series of templates - very cool! Also take a look at templatemonster.com. Templatemonster is a company that constantly develops and designs new website templates, from simple to fancy. You should know that they have a large number of resellers, so you may find their website templates on numerous websites under different names.
Learn about Google. Google is not only the gateway to the Internet, the way to find whatever you are looking for, the new phonebook and the closest thing to the "answer man". Google has a number of nifty and free tools: Gmail, "Docs and Spreadsheets", Blogger, Pagecreator (a web publishing tool) and Google Analytics. Docs and Spreadsheets is interesting and I use it daily. It is the equivalent of having Word and Excel online. It is especially useful if you routinely work on many computers (home, travel, office, hospital) and work on a project. With Google Docs and Spreadsheets you can continue writing on your text wherever you are. You can also allow others to collaborate on your projects, which is great when you have to write policies or consensus papers.
Also get to know Google hacks, learn ways to speed up your search and learn how to better find what you are looking for.
Don't forget to list your office on "Local Business" of Google and, if you want, on its equivalent on Yahoo. Go to their websites and follow the links.
Tuesday, July 10, 2007
Market Your Practice - Practice Tips 5
You probably already have maxed out the cost saving measures in your practice. The better way to more income is to increase the number of patients that you see and to get more of the patients that you LIKE, and do more of the procedures that you like and that pay well.
For that, you should market yourself. It would be by far too much to go into details, but I would like to point you in the right direction for good information that is worth reading and does not waste your time.
You must buy and or read this book:
Marketing Your Clinical Practice: Ethically, Effectively, Economically (Hardcover) by Neil Baum, Gretchen Henkel
Neil Baum's book contains the sum of all other advice that I had ever heard before I bought it and I was surprised how much more it contains. No wonder nobody recommended it to me. Every resident should receive it as a graduation gift from her or his program director. It is an absolute must for planning a private practice or if you already are in private practice. Consultants are not going to tell you more than what you will read in this book. Read this book for $89 instead of attending $ 2000 weekend courses - where you mostly will be solicited for more consulting services. This is hands down the single most valuable book for marketing your own practice.
"Guerrilla Marketing" by Jay Conrad Levinson. A classic on marketing creatively. The title suggests that it is possible for the little guy to succeed against the competing big guys. Interesting and stimulating to read, you get a lot of ideas and inspiration while reading it. Take notes! It is paperback, cheap, about $15. Levinson he has written numerous books on the subject in all its facts: guerrilla marketing handbook, marketing for free, marketing on the Internet etc etc. All book stores have his books. You can browse through his titles and look inot some of his books on Amazon and you will find an idea which of his books are appropriate for you.
The Book "Marketing to Women, How to Understand, Reach, and Increase Your Share of the Largest Market Segment" written by Marti Barletta, a female marketer. This was especially enlightening for me as a male ObGyn. It lays out in great detail what makes women tick, what motivates women, what gets their attention. Essential for an ObGyn.
"Healthcare Success Strategies" is a marketing company that specializes on marketing private physician practices. Lonnie Hirsch and Stewart Gandolf, the two founding partners, left "Practice Builders", the biggest national company for practice management and marketing and started their own company. They seem to have a lot of experience and success.
I recommend buying their 8 CD set on "Marketing your practice" from Advanstar, the publisher of Medical Economics. It gives you numerous insights, more if you listen to it more often. It also serves to subtly convince you that "marketing is more than a list of ideas" and that you should have "professionals handle it for you" - you know where this is going. They offer a reasonably priced (about $1000) two day seminar (with preparation and follow up home work) to come up with a comprehensive marketing plan tailored to your practice. I do not recommend it if you have the CD set, since it repeats verbatim what you heard on the CDs. Go to the seminar only if you think of actually hiring them to market your practice.
Take a look at their website, if you like it, buy their CD set for $200 and then decide if you want to go further. I think they are good and worth the money. They will soon publish the material of the CDs and their seminar in a book for about $100. It will come out the end of 2007 or early in 2008.
Otherwise follow the old rules:
The best marketing is word of mouth. Take good care of your patients and ask them to send their friends. Tell them that you are accepting new patients. Send them a nice thank you card when they refer someone. Inform your patients about what you do, they often do not know and will be surprised to find out.
Get to know the referring physicians. Fax them a short letter every time you see one of their patients. Ask them what you can best help them. Say good things about them to their patients - it will get back to the referring doctor.
Call patients that need more attention, call patients that you have operated, show that you care.
For that, you should market yourself. It would be by far too much to go into details, but I would like to point you in the right direction for good information that is worth reading and does not waste your time.
You must buy and or read this book:
Marketing Your Clinical Practice: Ethically, Effectively, Economically (Hardcover) by Neil Baum, Gretchen Henkel
Neil Baum's book contains the sum of all other advice that I had ever heard before I bought it and I was surprised how much more it contains. No wonder nobody recommended it to me. Every resident should receive it as a graduation gift from her or his program director. It is an absolute must for planning a private practice or if you already are in private practice. Consultants are not going to tell you more than what you will read in this book. Read this book for $89 instead of attending $ 2000 weekend courses - where you mostly will be solicited for more consulting services. This is hands down the single most valuable book for marketing your own practice.
"Guerrilla Marketing" by Jay Conrad Levinson. A classic on marketing creatively. The title suggests that it is possible for the little guy to succeed against the competing big guys. Interesting and stimulating to read, you get a lot of ideas and inspiration while reading it. Take notes! It is paperback, cheap, about $15. Levinson he has written numerous books on the subject in all its facts: guerrilla marketing handbook, marketing for free, marketing on the Internet etc etc. All book stores have his books. You can browse through his titles and look inot some of his books on Amazon and you will find an idea which of his books are appropriate for you.
The Book "Marketing to Women, How to Understand, Reach, and Increase Your Share of the Largest Market Segment" written by Marti Barletta, a female marketer. This was especially enlightening for me as a male ObGyn. It lays out in great detail what makes women tick, what motivates women, what gets their attention. Essential for an ObGyn.
"Healthcare Success Strategies" is a marketing company that specializes on marketing private physician practices. Lonnie Hirsch and Stewart Gandolf, the two founding partners, left "Practice Builders", the biggest national company for practice management and marketing and started their own company. They seem to have a lot of experience and success.
I recommend buying their 8 CD set on "Marketing your practice" from Advanstar, the publisher of Medical Economics. It gives you numerous insights, more if you listen to it more often. It also serves to subtly convince you that "marketing is more than a list of ideas" and that you should have "professionals handle it for you" - you know where this is going. They offer a reasonably priced (about $1000) two day seminar (with preparation and follow up home work) to come up with a comprehensive marketing plan tailored to your practice. I do not recommend it if you have the CD set, since it repeats verbatim what you heard on the CDs. Go to the seminar only if you think of actually hiring them to market your practice.
Take a look at their website, if you like it, buy their CD set for $200 and then decide if you want to go further. I think they are good and worth the money. They will soon publish the material of the CDs and their seminar in a book for about $100. It will come out the end of 2007 or early in 2008.
Otherwise follow the old rules:
The best marketing is word of mouth. Take good care of your patients and ask them to send their friends. Tell them that you are accepting new patients. Send them a nice thank you card when they refer someone. Inform your patients about what you do, they often do not know and will be surprised to find out.
Get to know the referring physicians. Fax them a short letter every time you see one of their patients. Ask them what you can best help them. Say good things about them to their patients - it will get back to the referring doctor.
Call patients that need more attention, call patients that you have operated, show that you care.
Monday, July 9, 2007
Stay Uptodate With the Best CME - Practice Tips 4
I like the Harvard courses in Boston called "Annual Update in ObGyn" that are held in spring and fall. I attend one of these courses every one to two years. The courses in Spring and Fall are not the same in terms of faculty and content. Check for alternatives at Yale, Duke, Cornell, UCSF, etc - these alternatives may exist, although I am not aware of them. A further advantage is that you have the chance to get in touch on a personal basis with the outstanding and very approachable faculty of Brigham and Women's. You also receive excellent print materials. You may purchase excellent Video CDs of surgical techniques for a reduced price.
Audio-Digest CDs, "the spoken medical journal" is the best CME program I have found.After you subscribe they send you a CD (or MP3) every two weeks with selected lectures of very good, renowned, expert speakers, many of them nationally known, on topics that really matter. Lectures are easy to understand. I listen to the CDs in my car on the way to work and back, over and over again - until I am bored. This is a very effortless way of learning. The material kind of diffuses in.They send you a printed summary of each CD, you can get short abstracts of their website, you can download a list of these lectures from their website. This is something I include in my recertification / relicensing papers. Of course you have the ability to collect CME points.Has proven to be incredibly effective, I would not want to miss it. The best bang for the buck in terms of CME.
The other best CME is the ABOG list of publications and the corresponding questionnaires they send out four times a year. Our hospital librarian finds the publications and copies them for all the ObGyns that participate. You can't beat this - a. you keep your board certification up to date, b. someone does the legwork of selecting interesting and relevant publications for you and c. you get CME credits
Consider a subscription to “UpToDate”, my favorite medical database and, yes, textbook. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search.Uptodate also has another very nice feature: the section on "what is new in..." and the section on ObGyn then reports about "10 important developments in the last year". Very nice, easy tool to keep up and make sure you have not missed anything during the last year!!
I also like two of the Throw-away journals:
1. "OBGmanagment" since Robert Barbieri is the editor. Barbieri, the chief of the ObGyn department at Brigham and Women's, happens to be incredibly smart, talented and also is a brilliant teacher. He and his editorial staff have an uncanny ability to find out which topics are relevant at the moment. The journal is presented very well, with hints how to read it fast, with hints as to what is important. And on top of everything he is nice if you meet him in person.
2.Contemporary ObGyn, which is Yale-powered. Similar praises as for 1.
Not so good and not recommended:
1. ObGyn Survey: somehow the selection of topics is off, I subscribed, ended up not reading it and cancelled.
2. Practical Reviews, ObGyn and Women's Health by Oakstone Publishing: they select articles, review them and comment them. The selection was just OK, the abstracts were good, the comments were just slightly changed abstracts without many new insights. Overall - not worth the time and money. Cannot hold the water to AudioDigest.
Audio-Digest CDs, "the spoken medical journal" is the best CME program I have found.After you subscribe they send you a CD (or MP3) every two weeks with selected lectures of very good, renowned, expert speakers, many of them nationally known, on topics that really matter. Lectures are easy to understand. I listen to the CDs in my car on the way to work and back, over and over again - until I am bored. This is a very effortless way of learning. The material kind of diffuses in.They send you a printed summary of each CD, you can get short abstracts of their website, you can download a list of these lectures from their website. This is something I include in my recertification / relicensing papers. Of course you have the ability to collect CME points.Has proven to be incredibly effective, I would not want to miss it. The best bang for the buck in terms of CME.
The other best CME is the ABOG list of publications and the corresponding questionnaires they send out four times a year. Our hospital librarian finds the publications and copies them for all the ObGyns that participate. You can't beat this - a. you keep your board certification up to date, b. someone does the legwork of selecting interesting and relevant publications for you and c. you get CME credits
Consider a subscription to “UpToDate”, my favorite medical database and, yes, textbook. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search.Uptodate also has another very nice feature: the section on "what is new in..." and the section on ObGyn then reports about "10 important developments in the last year". Very nice, easy tool to keep up and make sure you have not missed anything during the last year!!
I also like two of the Throw-away journals:
1. "OBGmanagment" since Robert Barbieri is the editor. Barbieri, the chief of the ObGyn department at Brigham and Women's, happens to be incredibly smart, talented and also is a brilliant teacher. He and his editorial staff have an uncanny ability to find out which topics are relevant at the moment. The journal is presented very well, with hints how to read it fast, with hints as to what is important. And on top of everything he is nice if you meet him in person.
2.Contemporary ObGyn, which is Yale-powered. Similar praises as for 1.
Not so good and not recommended:
1. ObGyn Survey: somehow the selection of topics is off, I subscribed, ended up not reading it and cancelled.
2. Practical Reviews, ObGyn and Women's Health by Oakstone Publishing: they select articles, review them and comment them. The selection was just OK, the abstracts were good, the comments were just slightly changed abstracts without many new insights. Overall - not worth the time and money. Cannot hold the water to AudioDigest.
Sunday, July 8, 2007
Patient Education - Practice Tips 3
One of the basics in medical practice is to educate your patients well. It is good for them and it saves you a lot of time and phone calls. The Internet is your friend! I have had almost exclusively good effects of patients doing their own research on the net. Patients know more - good for both of us. I routinely hand out a list of websites that I recommend. I had posted this list before and I am including it again here.
Here are my tips for patient education:
Leaflets:1. ACOG leaflets – expensive, but they are “the standard”, and they look nice, fit into most purses, can be conveniently kept in wall hangers even in small examination rooms…they are just the best.
2. Significantly less expensive than the ACOG leaflets: Subscription to “MD-Consult”, which is only $220 a year over the net. This service not only gives you a large amount of textbooks, journals and pharmaceutical and pharmacological information, but, and this is the great thing that alone makes it worth the annual subscription, it gives you access to about 3000 (!) patient instructions, very well written, a good number also in Spanish. Often they have a short and long version of the same topic. I print out the instructions leaflets, copy them and keep them organized in my drawer, so that I can hand them to patients as needed - without having to log on and print them out each time. Printouts can be personalized with your name and office data. If you would purchase the “CRS Patient Advisor” on floppy disks or CD, which is what is included in MD Consult, it would cost you about $1000-1200. MD Consult includes not only the “Patient Advisor” but also info leaflets published by 2 more companies all for a lower price than you would have had to pay for the “Patient Advisor”.
3. Easiest, cheapest solution, but it feels somewhat dated: a book with CD by Miller, McEvers, Griffith: “Instructions for obstetrical and gynecological patients”, now in its third edition, at about $50-60. You are specifically allowed to copy all pages and hand them to your patients, the book comes with a CD that you can load onto your computer and that lets you easily print out all 200 plus patient instruction leaflets. The book also includes diets and illustrations. A steal. Has proven to be extremely cost effective, but may be outdated by now, since it does not contain the newest developments in e.g. HRT, contraception etc. Still good for the standard surgeries and things that have not changed such as ectopics.
4. My preferred solution - Write your own leaflets and information material! You will have tailored and customized information from you and your practice. And, your patients will first hear it from you and then read the same information on a paper at home (hopefully). This achieves maximum retention and effect. This also eliminates mixed messages or confusion when you say one thing and a website recommends another thing. I recommend not writing leaflets by a list or on demand, let's say, in response to the thought, "well, what leaflets might I need?" and then sit down and write them...NO, do not do that. I recommend a different approach: as soon as you realize that you are explaining something several times, as soon as you find yourself talking about something repetitively, let's say three times or more, you simply write down exactly what you just said. You use spoken language, simple terms. Voila, your leaflet is done. Then continue to correct and expand it with time, as the additional questions and ideas arise.
5. "The Female Patient" magazine frequently has good information leaflets in the back that you can copy and distribute to your patients.
Writing down what you think and say to your patients is also the best way to write a practice newsletter. Write down the things you explain to your patients, or the things you would love to explain, but do not have the time and mail them out or email them out every so often. Nobody says that a practice newsletter has to come out every three months. Write them and mail them as the issues arise. For example in late 2006 it was HPV, and the answers to the questions " Do I need an HPV test? Do you recommend the HPV vaccine?"
Post this information on your website. A good place to keep the original files or master files is in "Google Docs and Spreadsheets". This way you can pull them up anytime, work on them and store them.
Specifically for pregnancy:I recommend “The Girlfriend’s Guide to Pregnancy” by Vicki Iovine to all my patients, and at one time have even given it out for free to all new prenatal patients. It is written by a mother of four, smart, witty, self-deprecating and straightforward – it really delivers what the title promises. The book is so entertaining that it reads like a novel and patients learn while laughing. Paperback, 288 pages, published by Pocket Books, ISBN 0671524313, around $12.
If you call the “special sales division” of the publisher and order about 25 books or more, you get 40% off. Many people know this book, but not all. It deserves more attention than the standard bestseller “What to expect..” which more often then not leaves patients concerned about complications and is more tedious to read. I do not recommend "What to expect..." and, by the way, one of the friends and relatives will give it to the expecting mother anyway.
I also recommend the book by Curtis and Schuler: "Your Pregnancy Week by Week", a great book that is easy to read since you only have to digest the material for one week. Has excellent drawings that help you understand how the baby looks, how large it is. Also contains useful tips for dads, such as "bring flowers without reason" or "help with housework". DaCapo Press / Lifelong Books, paperback, 15.95
My book recommendation for the time after pregnancy:"The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer", Paperback, by Harvey Karp
"Ever since I had my baby" by Roger Goldberg, a book that goes into the details of the consequences for your body of giving birth - from Roger Goldberg, MD, who is a very smart, well writing and accomplished urogynecologist from the Continence Center in Evanston, IL, and with whom I had the honor of training at BIDMC in Boston.
An excellent educational tool is to refer patients to good websites. They search on the net anyway, so tell them which sites are reliable and keep them away from the Quack and the snake oil sites. Here are the websites I refer my patients to:
http://medlineplus.gov/ MedLinePlus is the consumer health portal of the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Very extensive, very good.
http://patients.uptodate.com/index.asp Uptodate patient information is an outstanding and very informative website published by doctors of Harvard Medical School.
http://www.acog.org/, the website of the American College of Obstetricians and Gynecologists. They have excellent “patient information leaflets” on all topics in Women’s Health.
http://www.4woman.gov/, the government’s website for women’s health, surprisingly good, considering that it is presented by the government.
http://www.familydoctor.org/ , the website of the Association of Family Doctors, covers all areas of medicine and explains issues very well and in plain English, in an easy to understand style
http://www.noah-health.org/. NOAH is the “New York Online Access to Health” database, which is big and bold, like so many “New York” things. Very extensive, uptodate and well done. Most important – it comes in Spanish too!
http://www.hormone.org/
http://www.menopause.org/, the website of the North American Menopause society
http://www.mayoclinic.com/, the website of the famous and excellent Mayo Clinic
http://www.fda.gov/
http://www.cdc.gov/. The website of the Center for Disease Control has great information about infections such as human papilloma virus (HPV), Herpes, HIV, travel medicine and much more
www.Managingcontraception.com. This is the website that offers the best and most accurate information on contraception. You can even download a booklet "Managing Contraception" for free. They also have a very good book on perimenopause: "The Midlife Bible" by Dr. Goodman, $17
http://nccam.nih.gov/health/ NCCAM is the National Center for Complimentary and Alternative Medicine of the National Institutes for Health, a great starting point for alternative medicine questions and information
Last, not least:www.quackwatch.org/ the site that keeps the web honest. Reports on all kinds of unscientific quackery on the Internet. Should a diagnostic method or treatment sound unfamiliar or too good to be true, look it up on this website.
Here are my tips for patient education:
Leaflets:1. ACOG leaflets – expensive, but they are “the standard”, and they look nice, fit into most purses, can be conveniently kept in wall hangers even in small examination rooms…they are just the best.
2. Significantly less expensive than the ACOG leaflets: Subscription to “MD-Consult”, which is only $220 a year over the net. This service not only gives you a large amount of textbooks, journals and pharmaceutical and pharmacological information, but, and this is the great thing that alone makes it worth the annual subscription, it gives you access to about 3000 (!) patient instructions, very well written, a good number also in Spanish. Often they have a short and long version of the same topic. I print out the instructions leaflets, copy them and keep them organized in my drawer, so that I can hand them to patients as needed - without having to log on and print them out each time. Printouts can be personalized with your name and office data. If you would purchase the “CRS Patient Advisor” on floppy disks or CD, which is what is included in MD Consult, it would cost you about $1000-1200. MD Consult includes not only the “Patient Advisor” but also info leaflets published by 2 more companies all for a lower price than you would have had to pay for the “Patient Advisor”.
3. Easiest, cheapest solution, but it feels somewhat dated: a book with CD by Miller, McEvers, Griffith: “Instructions for obstetrical and gynecological patients”, now in its third edition, at about $50-60. You are specifically allowed to copy all pages and hand them to your patients, the book comes with a CD that you can load onto your computer and that lets you easily print out all 200 plus patient instruction leaflets. The book also includes diets and illustrations. A steal. Has proven to be extremely cost effective, but may be outdated by now, since it does not contain the newest developments in e.g. HRT, contraception etc. Still good for the standard surgeries and things that have not changed such as ectopics.
4. My preferred solution - Write your own leaflets and information material! You will have tailored and customized information from you and your practice. And, your patients will first hear it from you and then read the same information on a paper at home (hopefully). This achieves maximum retention and effect. This also eliminates mixed messages or confusion when you say one thing and a website recommends another thing. I recommend not writing leaflets by a list or on demand, let's say, in response to the thought, "well, what leaflets might I need?" and then sit down and write them...NO, do not do that. I recommend a different approach: as soon as you realize that you are explaining something several times, as soon as you find yourself talking about something repetitively, let's say three times or more, you simply write down exactly what you just said. You use spoken language, simple terms. Voila, your leaflet is done. Then continue to correct and expand it with time, as the additional questions and ideas arise.
5. "The Female Patient" magazine frequently has good information leaflets in the back that you can copy and distribute to your patients.
Practice Newsletter
Writing down what you think and say to your patients is also the best way to write a practice newsletter. Write down the things you explain to your patients, or the things you would love to explain, but do not have the time and mail them out or email them out every so often. Nobody says that a practice newsletter has to come out every three months. Write them and mail them as the issues arise. For example in late 2006 it was HPV, and the answers to the questions " Do I need an HPV test? Do you recommend the HPV vaccine?"
Post this information on your website. A good place to keep the original files or master files is in "Google Docs and Spreadsheets". This way you can pull them up anytime, work on them and store them.
Book recommendations
Specifically for pregnancy:I recommend “The Girlfriend’s Guide to Pregnancy” by Vicki Iovine to all my patients, and at one time have even given it out for free to all new prenatal patients. It is written by a mother of four, smart, witty, self-deprecating and straightforward – it really delivers what the title promises. The book is so entertaining that it reads like a novel and patients learn while laughing. Paperback, 288 pages, published by Pocket Books, ISBN 0671524313, around $12.
If you call the “special sales division” of the publisher and order about 25 books or more, you get 40% off. Many people know this book, but not all. It deserves more attention than the standard bestseller “What to expect..” which more often then not leaves patients concerned about complications and is more tedious to read. I do not recommend "What to expect..." and, by the way, one of the friends and relatives will give it to the expecting mother anyway.
I also recommend the book by Curtis and Schuler: "Your Pregnancy Week by Week", a great book that is easy to read since you only have to digest the material for one week. Has excellent drawings that help you understand how the baby looks, how large it is. Also contains useful tips for dads, such as "bring flowers without reason" or "help with housework". DaCapo Press / Lifelong Books, paperback, 15.95
My book recommendation for the time after pregnancy:"The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer", Paperback, by Harvey Karp
"Ever since I had my baby" by Roger Goldberg, a book that goes into the details of the consequences for your body of giving birth - from Roger Goldberg, MD, who is a very smart, well writing and accomplished urogynecologist from the Continence Center in Evanston, IL, and with whom I had the honor of training at BIDMC in Boston.
Websites I recommend to my patients:
An excellent educational tool is to refer patients to good websites. They search on the net anyway, so tell them which sites are reliable and keep them away from the Quack and the snake oil sites. Here are the websites I refer my patients to:
http://medlineplus.gov/ MedLinePlus is the consumer health portal of the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Very extensive, very good.
http://patients.uptodate.com/index.asp Uptodate patient information is an outstanding and very informative website published by doctors of Harvard Medical School.
http://www.acog.org/, the website of the American College of Obstetricians and Gynecologists. They have excellent “patient information leaflets” on all topics in Women’s Health.
http://www.4woman.gov/, the government’s website for women’s health, surprisingly good, considering that it is presented by the government.
http://www.familydoctor.org/ , the website of the Association of Family Doctors, covers all areas of medicine and explains issues very well and in plain English, in an easy to understand style
http://www.noah-health.org/. NOAH is the “New York Online Access to Health” database, which is big and bold, like so many “New York” things. Very extensive, uptodate and well done. Most important – it comes in Spanish too!
http://www.hormone.org/
http://www.menopause.org/, the website of the North American Menopause society
http://www.mayoclinic.com/, the website of the famous and excellent Mayo Clinic
http://www.fda.gov/
http://www.cdc.gov/. The website of the Center for Disease Control has great information about infections such as human papilloma virus (HPV), Herpes, HIV, travel medicine and much more
www.Managingcontraception.com. This is the website that offers the best and most accurate information on contraception. You can even download a booklet "Managing Contraception" for free. They also have a very good book on perimenopause: "The Midlife Bible" by Dr. Goodman, $17
http://nccam.nih.gov/health/ NCCAM is the National Center for Complimentary and Alternative Medicine of the National Institutes for Health, a great starting point for alternative medicine questions and information
Last, not least:www.quackwatch.org/ the site that keeps the web honest. Reports on all kinds of unscientific quackery on the Internet. Should a diagnostic method or treatment sound unfamiliar or too good to be true, look it up on this website.
Practice Evidence Based Medicine - Practice Tips 2
PRACTICE EVIDENCE BASED MEDICINE
Use the Cochrane.org database. The Cochrane initiative was started about 20 years ago with the goal to provide Obstetricians in the UK with the best possible evidence in their field. It has developed into a global movement that fosters evidence based ObGyn by choosing a specific question, searching for available literature, eliminating insufficient studies, analyzing the remaining ones in detail, and summarizing the results. These summaries are available as “abstracts” and they are free on the Cochrane website. If you subscribe to the service you receive the complete analysis, which is not really necessary for everyday work. The Cochrane database is the best available evidence in our field - anywhere.
Use “Pubmed”, the free search engine that gives you access to 12+ million publications of the National Library of Medicine. Use the “limits” feature to customize your searches. To get the web address simply enters “Pubmed” in the Google search engine search field.
Consider a subscription to “UpToDate”, my favorite medical database. Test it with their a free 10-day trial on the net. At $500 for subscription for an individual it is more expensive than “MD Consult”, but definitely worth the money. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search, just great content!. They also have a patient information section, which I recommend to all my patients to avoid them falling prey to weird Internet rumors. Patients appreciate guidance and advice from you in that regard. It is faster to look up things on uptodate than on MD Consult, which at the moment takes quite some time to load. Check your hospital library to see if they have it and if not, ask them to get it.
Uptodate also has a very very nice feature: they have a section on "what is new in....and the section on ObGyn then reports about 10 important developments in the last year. Very nice, easy tool to keep up and make sure you have not missed anything during the last year!
Another alternative, somewhat less expensive, but it has drawbacks – not my favorite. I let my subscription expire last year. It is “MD Consult”, a database of medical information – essentially everything you need. It’s a cooperation of the 4 or 5 largest medical publishers in the country. Costs around $220 a year and is fully searchable. MD Consult gives you 40 standard textbooks including the Gabbe as well as full text articles of the “Clinics of North America” and the Mosby “Year Books” and numerous medical and scientific journals – a great steal from whichever angle you look at it. They also offer decent patient information leaflets, although they are not too well presented, do not have drawings or photos and are a little dry. If you are a customer of PIAM (Physicians Insurance Agency of Massachusetts) it’s free, if you are a member of the Canadian Medical Association it’s free, and if you have links to a major medical center it is possible that they offer it for free to their attendings – ask.
Drawbacks are: takes a looooong time to load, especially if you want to just look at or print out a patient instruction leaflet quickly. Also, their search function is a little clumsy and difficult, unforgiving in terms of spelling errors and just not as easy as we expect after using Google for a while.
Get the book “Clinical Evidence”, which was developed by the BMJ Publishing Group, publishers of the 160 year old “British Medical Journal” – it’s free if you request it from, who would have thought so, United Health. You can register to have the follow-ups sent to you for free too. It is presents pretty bare bones results evidence based medicine, and as such worth having. The book includes a CD with the complete text that you can load onto your computer and use it with full search capabilities.
To obtain book and CD, go to
http://www.clinicalevidence.org/ orWrite to the United Health FoundationWilliam W. McGuire, MDChairman, United Health FoundationMN008-T500 PO Box 1459Minneapolis, MN 55440-1459Or email him under uhfce@uhc.com
Also check out http://cebm.jr2.ox.ac.uk/ ---- the British Centre for Evidence based medicine.
Try the national guideline clearinghouse, guideline.gov.
And of course, google the term “evidence based medicine” and see what you get.
Use the Cochrane.org database. The Cochrane initiative was started about 20 years ago with the goal to provide Obstetricians in the UK with the best possible evidence in their field. It has developed into a global movement that fosters evidence based ObGyn by choosing a specific question, searching for available literature, eliminating insufficient studies, analyzing the remaining ones in detail, and summarizing the results. These summaries are available as “abstracts” and they are free on the Cochrane website. If you subscribe to the service you receive the complete analysis, which is not really necessary for everyday work. The Cochrane database is the best available evidence in our field - anywhere.
Use “Pubmed”, the free search engine that gives you access to 12+ million publications of the National Library of Medicine. Use the “limits” feature to customize your searches. To get the web address simply enters “Pubmed” in the Google search engine search field.
Consider a subscription to “UpToDate”, my favorite medical database. Test it with their a free 10-day trial on the net. At $500 for subscription for an individual it is more expensive than “MD Consult”, but definitely worth the money. It is written mostly by Harvard faculty, very easy to read, very uptodate (as the name implies), very thoroughly researched. Easy to search, just great content!. They also have a patient information section, which I recommend to all my patients to avoid them falling prey to weird Internet rumors. Patients appreciate guidance and advice from you in that regard. It is faster to look up things on uptodate than on MD Consult, which at the moment takes quite some time to load. Check your hospital library to see if they have it and if not, ask them to get it.
Uptodate also has a very very nice feature: they have a section on "what is new in....and the section on ObGyn then reports about 10 important developments in the last year. Very nice, easy tool to keep up and make sure you have not missed anything during the last year!
Another alternative, somewhat less expensive, but it has drawbacks – not my favorite. I let my subscription expire last year. It is “MD Consult”, a database of medical information – essentially everything you need. It’s a cooperation of the 4 or 5 largest medical publishers in the country. Costs around $220 a year and is fully searchable. MD Consult gives you 40 standard textbooks including the Gabbe as well as full text articles of the “Clinics of North America” and the Mosby “Year Books” and numerous medical and scientific journals – a great steal from whichever angle you look at it. They also offer decent patient information leaflets, although they are not too well presented, do not have drawings or photos and are a little dry. If you are a customer of PIAM (Physicians Insurance Agency of Massachusetts) it’s free, if you are a member of the Canadian Medical Association it’s free, and if you have links to a major medical center it is possible that they offer it for free to their attendings – ask.
Drawbacks are: takes a looooong time to load, especially if you want to just look at or print out a patient instruction leaflet quickly. Also, their search function is a little clumsy and difficult, unforgiving in terms of spelling errors and just not as easy as we expect after using Google for a while.
Get the book “Clinical Evidence”, which was developed by the BMJ Publishing Group, publishers of the 160 year old “British Medical Journal” – it’s free if you request it from, who would have thought so, United Health. You can register to have the follow-ups sent to you for free too. It is presents pretty bare bones results evidence based medicine, and as such worth having. The book includes a CD with the complete text that you can load onto your computer and use it with full search capabilities.
To obtain book and CD, go to
http://www.clinicalevidence.org/ orWrite to the United Health FoundationWilliam W. McGuire, MDChairman, United Health FoundationMN008-T500 PO Box 1459Minneapolis, MN 55440-1459Or email him under uhfce@uhc.com
Also check out http://cebm.jr2.ox.ac.uk/ ---- the British Centre for Evidence based medicine.
Try the national guideline clearinghouse, guideline.gov.
And of course, google the term “evidence based medicine” and see what you get.
The Basics of a Successful Practice - Practice Tips 1
The 8 basic principles:
1. Practice evidence based medicine - it’s not just better, it is easier and cheaper
2. Develop and/or maintain good bedside manners: listen, teach, learn how to say the most important things in a short time and hand out leaflets as reinforcement and reminder
3. Educate your patients well
4. Do as much in your own office as possible, you save time and you earn the
facility fee for procedures
5. Market your practice efficiently, economically and ethically and on the Internet
6. Have a great office staff and make sure their morale is good
7. Document and bill well
8. In 2006/7 still be cautious about EMR
The basic principles for financial success in an ObGyn practice:
The big idea, the general plan, the overall strategy for a financially successful practice is:
Do as much in the office as possible, do as many diagnostic and therapeutic procedures in the office. This way you get paid for the procedure plus you receive the facility fee.
You also save yourself the wasted time that it takes to change over in the OR.
Spend as much time your office as possible, since it is YOUR office and you are in command and you can streamline all procedures to maximum efficiency. I heard it again and again from successful colleagues: if you can work most of the time in the office and avoid going to the hospital, you earn more.
Should you have to go to the OR, then try not to have block time, but try to get the first slot in the OR in the morning for one procedure. This way you avoid the loss of time involved with changing patients in the operating room.
Do your surgeries on your on-call weekends, where you can't do much else anyway or have to be at the hospital anyway. Many hospitals allow scheduled surgeries on Saturdays.
It may be worth it to combine procedures, such as hysteroscopy and saline infusion sonography.
Learn coding well to maximize your reimbursement, attend courses, listen to your colleagues, and remember - the HMOs are using sophisticated, expensive, highly specialized software to aggressively downgrade your reimbursements no matter what you do.
Visit an ACOG coding and billing course (one of those courses that are always sold out)
Market your practice.
Read the book by Neil Baum and Gretchen Henkel "Market Your Practice", $ 89. This book has all the marketing advice you will ever need, just follow his advice.
Read the books by Jay Levinson on Guerilla Marketing, and you will be inspired.
Read the book by Michael Port "Book Yourself Solid" - which inspires you to think like a marketer.
You might even consider hiring a professional marketer for developing a marketing plan and for carrying it out.
1. Practice evidence based medicine - it’s not just better, it is easier and cheaper
2. Develop and/or maintain good bedside manners: listen, teach, learn how to say the most important things in a short time and hand out leaflets as reinforcement and reminder
3. Educate your patients well
4. Do as much in your own office as possible, you save time and you earn the
facility fee for procedures
5. Market your practice efficiently, economically and ethically and on the Internet
6. Have a great office staff and make sure their morale is good
7. Document and bill well
8. In 2006/7 still be cautious about EMR
The basic principles for financial success in an ObGyn practice:
The big idea, the general plan, the overall strategy for a financially successful practice is:
Do as much in the office as possible, do as many diagnostic and therapeutic procedures in the office. This way you get paid for the procedure plus you receive the facility fee.
You also save yourself the wasted time that it takes to change over in the OR.
Spend as much time your office as possible, since it is YOUR office and you are in command and you can streamline all procedures to maximum efficiency. I heard it again and again from successful colleagues: if you can work most of the time in the office and avoid going to the hospital, you earn more.
Should you have to go to the OR, then try not to have block time, but try to get the first slot in the OR in the morning for one procedure. This way you avoid the loss of time involved with changing patients in the operating room.
Do your surgeries on your on-call weekends, where you can't do much else anyway or have to be at the hospital anyway. Many hospitals allow scheduled surgeries on Saturdays.
It may be worth it to combine procedures, such as hysteroscopy and saline infusion sonography.
Learn coding well to maximize your reimbursement, attend courses, listen to your colleagues, and remember - the HMOs are using sophisticated, expensive, highly specialized software to aggressively downgrade your reimbursements no matter what you do.
Visit an ACOG coding and billing course (one of those courses that are always sold out)
Market your practice.
Read the book by Neil Baum and Gretchen Henkel "Market Your Practice", $ 89. This book has all the marketing advice you will ever need, just follow his advice.
Read the books by Jay Levinson on Guerilla Marketing, and you will be inspired.
Read the book by Michael Port "Book Yourself Solid" - which inspires you to think like a marketer.
You might even consider hiring a professional marketer for developing a marketing plan and for carrying it out.
Tuesday, July 3, 2007
There is no physician shortage
You may have heard the rumors an "impending physician shortage". Dr. Richard Cooper from Wisconsin calculated that we will need 80-100.000 physicians more in 15 years, and is spreading alarming news about a "looming physician shortage". He recommends that we should enroll more students in medical schools, found new medical schools and expand existing residency programs and create new programs.
I disagree with the notion of physician shortage that resulted from Dr. Richard Cooper's study. I suspect the numbers and basic assumptions are wrong.
There is no shortage now. While we had 1.6 physicians per thousand Americans in 1970 (500.000 physicians total), in 2000 we had 2.4 physicians per thousand (over 800,000 physicians) and presently we have an average of 2.6 physicians per thousand Americans. Despite population growth, the ratio of physicians to patients has grown, has improved. Our present system of education is actually increasing the number of physicians per 1000 Americans.
In addition, in my opinion we have an oversupply of physicians since the 1980s. Here is why: The cost of any service is determined by supply and demand. This is so simple that most people forget it, although the sudden rise of gas prices after hurricane Katrina should have reminded everybody. Physician earning power has dropped to about 1/3 of what it was in the mid eighties.
One example from my area: 20 years ago an ObGyn in Boston earned about 400 K and a very nice home in the best area of Boston cost about 400K. Nowadays the very same house costs 1.6-2 million and the same ObGyn (working a lot harder and seeing about twice the number of patients) earns 200K. Physician income has dropped dramatically. And that means that we have an oversupply of physicians. And we have an oversupply since the 80's. No study required. You have been reading about continuous unstoppable decreases in reimbursements for physicians. Is that a sign of a balance between supply and demand? No, It is a sign of oversupply.
This means that Dr. Cooper is wrong in assuming that the present situation is "balanced" or "neutral". The present situation is not the "normal level", it is a level of oversupply.
There is no good way of planning physician supply. Who knows what will happen tomorrow and how it will impact physician supply and demand? Maybe we will find the gene for motivation to exercise or the gene for weight and obesity and the manipulation of that gene will make all the heart diseases shrink to 5% of what they are now?
When considering prediction for the future, do you remember what 60's thought the cars of the future were going to look like? There were pictures of large ship like cars with fins, rotating seats, driving fully automatically... which is just what we have now - right?
Dr. Cooper, the author of the unfortunate study, did not foresee ...
1. The "minute clinics" that are sprouting like mushrooms in CVS stores, Walmarts etc all over the country. The numbers of patients seen in these clinics are rising rapidly and the number of visits are already reaching millions. These clinics, operating under the slogan "you are sick, we are quick", are rapidly gaining in acceptance, and not only the number of visits to these clinics are growing, but also the average payment per visit. The customer satisfaction is on par with the satisfaction in physician offices. These clinics will be a tremendous competition to physicians, or, in the eyes of Dr. Cooper, a "relief" of the "shortage ". The development and growth of these clinics alone may prove Dr. Cooper wrong.
2. Dr. Cooper did not foresee or consider telemedicine. Indian physicians are already reading numerous x-rays, CTs and ultrasounds at night, due to the fact that our nighttime is daytime in India. This trend will expand, since Indian labor is cheaper, and soon we will have a decreasing need for radiologists.
3. There are large numbers of very well trained and very competent physicians in Central Europe (Germany, United Kingdom, France, Spain and Italy) that could transition to the US. These physicians would only need residency training. They would not need medical school. The cost savings for the US would be dramatic and these physicians would be available much faster than physicians newly schooled and then trained in the US.
5. If, yes, if there is really more demand for health care providers it would be much more economical to train more nurse practitioners and physician assistants, who are very well suited to take care of routine cases. Physicians would diagnose and treat the more unusual and difficult cases.
Overall, I seriously doubt we can reliably foresee the demand for physicians in 15-25 years and prefer to go with Yogi Berra's statement "predictions are very difficult, especially about the future". I do not see a shortage now and I see easy relief for any kind of "shortage" that may (or may not) present itself in the future.
Dr. Cooper's statements are extremely damaging for physicians and should be re-evaluated. This should be done before the present oversupply of physicians is worsened and perpetuated by creating more and unnecessary medical schools and residency programs.
Who benefits from this alarming rumor? Who makes money from it? Guess who - the HMOs.
HMOs make money by withholding payments, delaying payments and by lowering reimbursements. This is only possible because they can rely on a large number of physicians who have no alternatives to the current HMO contracts and payment methods (or better witholding-payment methods). The HMOs exist only because of physicians need to contract with them - because of an oversupply of physicians. It would be a disaster for HMOs if physicians could demand better payments. The future of HMOs depends on the ability to have a large supply of physicians, an oversupply of physicians, willing to work for less and less. Actually, the future of HMOs is at stake here. What do YOU want to do about it?
I disagree with the notion of physician shortage that resulted from Dr. Richard Cooper's study. I suspect the numbers and basic assumptions are wrong.
There is no shortage now. While we had 1.6 physicians per thousand Americans in 1970 (500.000 physicians total), in 2000 we had 2.4 physicians per thousand (over 800,000 physicians) and presently we have an average of 2.6 physicians per thousand Americans. Despite population growth, the ratio of physicians to patients has grown, has improved. Our present system of education is actually increasing the number of physicians per 1000 Americans.
In addition, in my opinion we have an oversupply of physicians since the 1980s. Here is why: The cost of any service is determined by supply and demand. This is so simple that most people forget it, although the sudden rise of gas prices after hurricane Katrina should have reminded everybody. Physician earning power has dropped to about 1/3 of what it was in the mid eighties.
One example from my area: 20 years ago an ObGyn in Boston earned about 400 K and a very nice home in the best area of Boston cost about 400K. Nowadays the very same house costs 1.6-2 million and the same ObGyn (working a lot harder and seeing about twice the number of patients) earns 200K. Physician income has dropped dramatically. And that means that we have an oversupply of physicians. And we have an oversupply since the 80's. No study required. You have been reading about continuous unstoppable decreases in reimbursements for physicians. Is that a sign of a balance between supply and demand? No, It is a sign of oversupply.
This means that Dr. Cooper is wrong in assuming that the present situation is "balanced" or "neutral". The present situation is not the "normal level", it is a level of oversupply.
There is no good way of planning physician supply. Who knows what will happen tomorrow and how it will impact physician supply and demand? Maybe we will find the gene for motivation to exercise or the gene for weight and obesity and the manipulation of that gene will make all the heart diseases shrink to 5% of what they are now?
When considering prediction for the future, do you remember what 60's thought the cars of the future were going to look like? There were pictures of large ship like cars with fins, rotating seats, driving fully automatically... which is just what we have now - right?
Dr. Cooper, the author of the unfortunate study, did not foresee ...
1. The "minute clinics" that are sprouting like mushrooms in CVS stores, Walmarts etc all over the country. The numbers of patients seen in these clinics are rising rapidly and the number of visits are already reaching millions. These clinics, operating under the slogan "you are sick, we are quick", are rapidly gaining in acceptance, and not only the number of visits to these clinics are growing, but also the average payment per visit. The customer satisfaction is on par with the satisfaction in physician offices. These clinics will be a tremendous competition to physicians, or, in the eyes of Dr. Cooper, a "relief" of the "shortage ". The development and growth of these clinics alone may prove Dr. Cooper wrong.
2. Dr. Cooper did not foresee or consider telemedicine. Indian physicians are already reading numerous x-rays, CTs and ultrasounds at night, due to the fact that our nighttime is daytime in India. This trend will expand, since Indian labor is cheaper, and soon we will have a decreasing need for radiologists.
3. There are large numbers of very well trained and very competent physicians in Central Europe (Germany, United Kingdom, France, Spain and Italy) that could transition to the US. These physicians would only need residency training. They would not need medical school. The cost savings for the US would be dramatic and these physicians would be available much faster than physicians newly schooled and then trained in the US.
5. If, yes, if there is really more demand for health care providers it would be much more economical to train more nurse practitioners and physician assistants, who are very well suited to take care of routine cases. Physicians would diagnose and treat the more unusual and difficult cases.
Overall, I seriously doubt we can reliably foresee the demand for physicians in 15-25 years and prefer to go with Yogi Berra's statement "predictions are very difficult, especially about the future". I do not see a shortage now and I see easy relief for any kind of "shortage" that may (or may not) present itself in the future.
Dr. Cooper's statements are extremely damaging for physicians and should be re-evaluated. This should be done before the present oversupply of physicians is worsened and perpetuated by creating more and unnecessary medical schools and residency programs.
Who benefits from this alarming rumor? Who makes money from it? Guess who - the HMOs.
HMOs make money by withholding payments, delaying payments and by lowering reimbursements. This is only possible because they can rely on a large number of physicians who have no alternatives to the current HMO contracts and payment methods (or better witholding-payment methods). The HMOs exist only because of physicians need to contract with them - because of an oversupply of physicians. It would be a disaster for HMOs if physicians could demand better payments. The future of HMOs depends on the ability to have a large supply of physicians, an oversupply of physicians, willing to work for less and less. Actually, the future of HMOs is at stake here. What do YOU want to do about it?
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