Adaptation.

All businesses that want to survive do it. Medicine is no different — and medicine is adapting by allowing patient email access to their physician.

If new technologies or practices immediately cause you to think of increased workloads and decreased compensation, you need to start thinking outside the box.

For example, let’s take a look at a recent article published at AMNews entitled e-mail means fewer patient calls and visits.

A Kaiser Permanente study showing that physicians who e-mailed with patients saw a drop in visits raises the specter that online communication might reduce revenue.

The article headline might sway you into thinking that you’ll take a paycut. We all know that’s the last thing you want. However, the article actually shows that allowing email access to physicians offers greater practice flexibility, time efficiencies and marketing power. This is a very good thing.

Positive Work Hour Control and Easy Documentation

Remember, the key is to find ways to adapt to changing business practices, but to make them work for you in a positive way. Naysayers will see an inbox full of patient complaints, decreased patient visits and an overall drop in revenue. I see positive benefits across the board.

• You’ll have better time control.
  Instead of answering the phone and turning a 3 minute explanation into a 25 minute conversation, with email you’ll be able to deliver the relevant information to the patient and save loads of time. Physicians would be better off to phase out phone consults altogether. Times are a changin’.

  “It’s like taking a phone call at your leisure. I almost never talk to patients on the phone. I find when I do, it’s like an office visit, it’s like 20 minutes,” she said. “I will do the e-mail with them because I can control how much time I spend on it, and I can control when.”

• Documentation will be on easy mode.
  A phone call is difficult to log. Physicians still have to manually write notes and keep track of the conversation. With email, physicians can either a) print out the entire conversation and place it in the patient’s chart or b) save the email and place it on the patient’s electronic chart. More time saved.

Seizing Opportunity

So far, physicians have been reluctant to begin offering email to patients across the board due to the lack of reimbursement. There are some payment models currently being tested.

Medem, whose owners include the AMA and other medical societies, allows patients to e-mail doctors’ offices free of charge. But to e-mail a doctor directly, a patient has to enter a credit card number and is charged for an e-consultation. There are about 10,000 doctors using the system. Dr. Fotsch said the charge for e-consults is typically the same as a co-pay, which makes the insurer’s involvement in the process unnecessary.

This is a beautiful system. Free access to email the office, but a charge for direct-to-physician contact all covered by insurance.

The Targeted Consumer

Patient’s who prefer to email physicians are targeted consumers. They have health concerns and are looking for a solution. Whether you charge for direct email access or not, you can collect email addresses and offer a free newsletter about health maintenance, deliver lab results to patients electronically, send appointment reminders, and best of all — stay in constant contact.

Contact Means More Revenue

If you change practice locations, how many of your patients will follow? More if you contact them on the regular basis. To make this worth your while, you’ll need to draft up a series of email messages that are sent to your entire patient list. Using some email list management software, these messages are personalized just like you wrote them one-by-one, but they are actually done in bulk. To the patient, you are staying in constant contact. To you, it means a few extra hours of work one time that can pay off for years to come.

Here are some additional ideas of content you can send to your patients on a regular basis:

• Health news, highlights, and videos
• Healthy cooking, recipes, and shopping advice
• Skin and beauty tips
• Sleep remedies and tips
• Dieting and tips for weight loss
• General health and wellness information

Hopefully you’ll be able to apply some of this to your own practice one day. Remember the importance of thinking outside of the box — it can pay off for years.

Popularity: 11% [?]

Some people work to pay the bills. Some people work to achieve power. Some people, like us, are so passionate about creating things, the prospect of being able to create with no rules, no oversight, and no strings attached is just about the most appealing job in the world.

Very powerful words.

Popularity: 4% [?]

Incentives are everywhere. You see them from car dealerships, credit card companies and travel agencies. Why should medicine be any different? Let’s take a look at how you, the potential future private practice owner, can pad your bottom line by offering incentives to established and new patients alike.

Incentives Aren’t Just For New Cars
You’ve seen the $2,000 rebates or the 0% financing to entice buyers to purchase vehicles. Incentives work. The consumer thinks they are getting more than they would elsewhere, and in many cases they are. Just as incentives work for purchasing new vehicles, they’ll work for getting more patients into your private practice.

How do we do that? Let’s take a look at a few examples that I came up with in order to increase your patient volume and ROI.

Getting Creative With Incentives
Drug companies love to leave free samples lying around, particularly if it’s a family medicine practice or other primary care practice. One thing you could do is offer an incentive to new patients to give them one month of their medication for free. For many patients, this means saving anywhere from $10 to $60 or more in copay fees for drugs. Some patients will jump on this while others won’t bother. Those that do will probably convert into a regular patient and you’ve just increased your patient load.

Let’s take a look at another incentive that targets those patients who regularly miss appointments. Missed appointments for you mean a loss in revenue. You could offer a private shuttle service (or offer to pay for a taxi) if it means getting that patient into your office and giving you a net positive addition to your revenues. Obviously it wouldn’t make much business sense to pay out of pocket to get that patient into your office if it meant breaking even or going into the red on that particular transaction. For incentives such as these, you’ll need to roughly figure out what it’s going to do to your bottom line before you offer it.

Cutting Down Wait Times
A popular complaint with patients is the amount of time that they have to wait to see the physician. If your practice was known for incredibly short wait times, this is an indirect incentive for the patient to come to your practice versus other physicians in the area. This mostly applies to new patients, but you should still be able to acquire patients from another practice if you offer comparable service with much shorter wait times.

How you should cut down your wait times will certainly vary by practice. Just evaluate your triage procedure from office entry until the patient gets back into the exam room and find out what you can do to decrease that time period. Cutting down wait times also means that you’ll have to be efficient with seeing patients yourself. Making the patient wait shorter times in the waiting room, but transferring that wait time to the examination room won’t cut the mustard.

More Indirect Incentives
Indirect incentives are those that you don’t physically offer to the patient but are rather built into your practice to begin with. These incentives have a significant impact on patients, because you’re not really “advertising” anything. Instead, patients interpret the incentive as better service coming from your practice. These incentives perhaps have the largest impact on patient retention and your overall bottom line. Let’s take a look at a few more.

Office Appearance
Having a nice-looking office will do wonders for your practice. How many times have you been to see the doctor and find uncomfortable plastic chairs, cheap-looking art on the wall, and industrial-grade tile floors in the waiting room? It gives a bad impression to patients.

Go ahead and take the plunge to purchase a furnishings for a really stand-up waiting room. If you don’t know what I’m talking about, head over to a prominent cosmetic plastic surgery practice in a large city and take a look. These guys realize that appearances matter, and it does truly make a difference. Instead of plastic chairs, get leather (or pleather if you can’t afford it) couches and chairs. Buy some nice pictures that don’t look like prints from Wal-Mart. Put down some nice carpet or hardwood flooring. It costs more up front, but it will give your practice much more credibility. Appearances matter.

Examination Room Appearance
Along the same lines as the appearance of your office, take some time to make your examination rooms as comfy as possible. Put in some nice flatscreen TVs (they are really cheap these days), and put leather (or pleather) furniture for guests of the patient to sit on. Keep all medical equipment that’s not essential out of site in drawers or cabinets. I know you medical folks out there are used to seeing needles and syringes sitting all over the place, but your patients aren’t. It gives off a bad vibe, so don’t do it.

Stock each examination room with a mini fridge and keep diet soft drinks or juices for the patient and guests. Make sure magazines are neat and tidy, and up-to-date. Keep some snacks lying around as well. The patient knows whether or not he’s supposed to eat.

Free Advertising
Make the patient and the patient’s guest as comfortable as possible. Chances are they have never been to a doctor’s office that is so comforting and “professional” looking. Do what the other guys aren’t doing, and watch in amazement as word-of-mouth recommendations spread like wildfire about this new, incredible practice in town.

Even if you’re not the best physician in town, you’ll still win over patients with the direct and indirect incentives that you offer. Remember the key is to be different. Since many practices are doing the same thing right now, it shouldn’t be too hard to stand out.

Popularity: 5% [?]

Some of you may consider this post to be somewhat off-topic, but I don’t. The reason I don’t think this post is off-topic is because money is universal. No matter what we do for a living, we all need it to survive. With that being said, let’s take a look at what “pentamillionaires” do that the general public with average income do not, and then let’s apply some of those ideas to medicine and what you can do to approach reaching that seven-figure mark.

Earlier I wrote about working smart in medicine for maximum income generation. The latest article in Smart Money magazine talks about what the millionaires these days are doing, and some of my ideas fall along the lines of those that were successful in generating seven figure net worths. Before we get into the nuts and bolts of the article, let’s take a look at some interesting statistics quoted from the article:

• One million is yesterday’s news. In fact, to reach the top 1% of income earners in the nation, you’ll need to amass a net worth of $5 million.
• The number of people worth $5 million or more has quadrupled since 1997 to more than 930,000.
• 70% of these fortunes are less than 13 years old and the people that have earned them are by and large entrepreneurs. Many of these people accumulated wealth as a byproduct of their passion. This is very important.
• Respondents reported that only 10% of their wealth came through passive investments and only 10% of pentamillionaires inherited their wealth.

OK, there are some interesting tidbits in the above statistics, but what’s most important is that the wealth was actually a byproduct of people doing what they love to begin with. Read that again — the wealth is a byproduct of people doing what they love to begin with.

Another thing to consider is that these people did not make their wealth working a 9-5 (or 6am-6pm for some of our medicine friends). Instead, they all did their own thing through business. Yes, we all know that medicine isn’t the most efficient way to make money but if you’re going to be working in medicine why not make as much money as possible?

But how do you do that? Unless you’re a practice owner you are technically the employee of somebody else. You have a salary, perhaps with bonuses for doing volume. If you choose to stay somebody else’s employee, you’ll have a steady paycheck but I’ll be the first to tell you that you’ll probably never make the top 1% of income earners in the United States.

Let’s take a look at what some of the people did that Smart Money interviewed for the story:

Once you’ve got food in your belly and a big-screen TV, the mere prospect of more Benjamins isn’t enough to get you leaping out of bed at 5 a.m. Rather, rich folks often make their fortunes after they make up their minds to solve a problem or do something better than it’s been done before. When Frank Darras graduated from law school, all he wanted in terms of material wealth was a middle-class life for his wife and kids. But while working as a doctor’s assistant to put himself through school, he developed a burning desire to help the folks he saw struggling with unpaid insurance claims. “It was the David and Goliath aspect that attracted me more than anything,” says the Ontario, Calif., attorney. Once he had his degree, Darras was like a cruise missile aimed at the insurance industry. By 1990 Darras had his first million-dollar year, and today he oversees one of the nation’s largest disability and long-term-care practices. “I never thought I’d make $5 million in two lifetimes,” he says. “I just loved the work.”

So here’s another possibility for all of you medicine people out there — keep your ear to the ground at all times. Find something during your normal day-to-day work routine that you can do better. A perfect example is a surgeon. If you’re doing a procedure with a particular instrument and you know a way it could be done in a safer, more efficient, and/or more cost effective way — start working on developing that. The same idea can be applied across all fields of medicine.

The honest-to-God truth is that you’re not going to want to work the insane hours that you are working now along with the stress when you’re 60 years old. Doing something like this could be your meal ticket out of the rigors of medicine and into something way more lucrative at an early age.

Remember, medicine is business and it’s not a sin to treat it as such.

Popularity: 10% [?]

This post is part two in a two-part series. Please read part one for an introduction on working smart in medicine for maximum income generation.

Yesterday I told you that I was going to give you an example of how to exchange low-paying time for a passive income that will pay you for a lifetime.

In order to do this, let’s think inside of the box - a “doc in a box.” Yep, urgent care.

Urgent Care Is In Its Infancy

Urgent care is gaining in popularity, and when Wal-Mart starts experimenting with something in their stores, you better start taking notice. I predict that urgent care is going to explode over the next 10 years.

Now, I know what probably 75% of you are thinking right now. Urgent care physicians are paid very low salaries, so how in the world can this represent exchanging that on-sale time for premium-priced time?

Did I ever say you had to employed by somebody else at one of these urgent care centers? That’s mistake number one. You are already in the mindset that your time is on sale. The first thing is to get rid of that mindset and shoot for a new one - one where your time is valuable.

Business Medicine

Instead, let’s open a single urgent care center. Just one to start out with. Being low on funds and new at this whole entrepreneurship thing, you’ll probably want to practice some at your new facility. This is different than being employed by somebody else, though. You are now working for yourself. No matter how hard you work, you are working for you. You have more control over your free time and your paycheck. You are taking the right steps towards passive income.

As your business grows, and more physicians are employed by you to practice at your urgent care center, you are starting to see a bigger return on your investment. Perhaps you start taking more time off and your paycheck stays the same, or you choose to work more while writing yourself a bigger check each week. Flexibility is starting to come into play.

With all of this nicely positive ROI and flexibility, you choose to stop practicing altogether. At this point, you are the practice manager. Years of practicing and running the business simultaneously has taught you valuable skills. These are skills that your classmates who also matched into family medicine don’t have. These physicians are continuing to make the average family doc salary while working even more.

Business Expansion

You’ve seen the success of your single urgent care center, and you’re quite confident that you can duplicate it. Let’s open another one and do the same things. Except this time, you don’t have to practice. Let’s staff it from the get-go with physicians (or nurse practitioners) who would rather work for somebody else than work smarter. These people are a valuable commodity to you. Thank God you took the time to learn just as much about business as you did medicine. Take advantage of this.

Before you know it, you have a network of urgent care centers spread through a state, a region, or nationally. You do nothing but recruit physicians or nurse practitioners to work for you, or you can pay somebody to do that for you.

At this point, you have reached passive income status. In most cases you’re making much more than average physician salaries and working as much as you want to, when you want to.

You have taken a specialty where the average physician exchanges their time for money at rock-bottom prices, but you are now making a huge premium for your time.

That’s exactly what these guys did.

At the Wal-Mart locations, once signed in to see a doctor, patients can shop and be signaled by pager or cell phone when the doctor is ready. A queue screen in the center lobby of the clinic will give minute-by-minute wait times.

Putting The Pieces Together

1. Find a specialty that you love, or at the very least can be happy practicing
2. Work smart to leverage your time versus income
3. Start thinking about and actively creating passive income streams
4. Duplicate, duplicate, duplicate
5. Reap the rewards over time

I used urgent care as an example, but you could use any business strategy at all from investing in high-yield funds to starting other businesses completely unrelated to medicine. Ryan wrote up a nice post at SDN outlining some other strategies. I’m not saying this is easy. It’s not, it takes tons of work. The vast majority of business fail within the first year.

If you take nothing else away from this post, please remember this: Medicine is a business. If you want to go above and beyond and really blow your income numbers out of the water, you are going to have to start treating it as such. Even if you choose a low-paying specialty like family medicine, you too can make much more than the salary figures you see quoted, but you must first put yourself into the right mindset.

In the end, it’s all about what you want. Do you want to be somebody else’s employee or a 20% shareholder in a partnership track for the rest of your life, always having to pull your own weight to make your quota?

Or do you want to be the CEO?

Popularity: 7% [?]