"Flaunt your creative ability to improve your
practice income. You know you can do and
are skilled to do many things you now refer out."
I ask you, is this idea a mind twister or not? For those medical professionals who haven’t found out about how to do it, most, no doubt, will think it’s another of those quasi-medical unethical strategies that get physicians into trouble, or something pulled up from the past with a new name on it. If you know you are capable of doing those procedures yourself, there is minimal
malpractice risk.
Well, whatever your fears are, there are thousands of physicians without those fears who are pumping up their medical practice income, exponentially. Sound too good to be true? Let’s circle around the idea for a minute or two and see what comes up for you.
It would not be far-fetched to believe that primary care physicians are not only one of the lowest income earners in the medical profession, but are placed in a position of having to refer many of their own patients out to other specialists who make all the money off that patient referral. And, the general practitioner is left holding their diagnostic code sheet wondering how much income they just freely forked over to the other physician.
Many of your patient referrals could easily be kept right in your practice. If the physician spent a little time and money learning medical and minor surgical procedures that are easy to learn, easy to do, and easy to implement into their practices, these money-making additions will enable almost any physician to significantly improve their practice income.
In the past, the Internists and family physicians who do general practice were making enough income to feel comfortable about referring their patients to specialists because it used up office time when they could see several more of their own patients during that time. Surgical type procedures or special testing or procedures you previously referred out very likely brought in more income than your seeing three or four of your patients during that same time period.
Have you ever examined that time + income factor to see which would give the best bang for
the buck?
How many skin lesions do you refer to dermatologists? How many breast lumps do you refer to general surgeons or gyn doctors? You likely saw how such procedures were done while in medical school. If you feel you have forgotten the process, all you have to do is watch one of those specialists do the procedure on your patient--or even assist at the surgery--to see the technique, what they use instruments are needed, and what drugs or materials they use using--all of which you can purchase and get started doing the procedures.
Per patient, per surgical or other procedure, you are aware that there are higher fees and income from doing them compared to treating a head-cold or cough. Often those procedures are a quick as seeing one of your usual medical patients.
"The willingness to do whatever it takes is infinitely
more important than knowing everything there is to know
about how to do it." ---Dan Kennedy, business expert
Such procedures as Botox use, fillers, anesthetics, pain management, liposuction, tattoo removals, breast biopsies, dermatologic surgical procedures, can skyrocket your practice income. A great advantage today is that there are licensed medical organizations that teach physicians how to do all those things in a safe and competent manner.
Empire Medical Training.com is one of those. Not only are these techniques legal and well within the parameters of normal medical practice, but also are well within the capabilities of any physician.
If you take a close look at the reasons you referred your last 50 patients to other physicians and began tracking referrals, it’s likely that most of those medical problems were minor things you could do yourself, and probably you know that. Why not do it yourself? You would be sacrificing the time needed to see one or two patients for the more income productive time of doing special procedures that in the past you have chosen to refer out. You judge for yourself.
Remember, your own medical patients much prefer that you do those procedures yourself. Who wants to go to a strange medical doctor to have those procedures done. Especially if that physician was in a bad mood, didn't socialize at all, had a twist in his or her underwear, and was wearing a golfing hat.
It’s obvious that surgical procedures can be billed for far higher fees than a simple office visit, or an extended visit. You surely understand it’s sometimes a practice to nudge up the coding scale for a higher visit fee at a time when the government fee restrictions are increased each year, while you are trying to remain solvent. Better to stay within legal bounds.
Wouldn’t it be better to convert those patients of yours into a surgical or special medical issue visit, where nudging wouldn’t be necessary? Imagine how many of your patients would have a procedure done if you would do it yourself—and not have it done otherwise, especially if they had to be sent into your referral network.
Many patients of mine had minor problems, like a continuously sore skin lesion that fell right under their bra strap and kept putting up with it, until I noticed that it was a problem for them, and removed it—same with bothersome sebaceous cysts. You truly will be making your patients' lives more tolerable by relieving pain and medical frustrations. Everyone has at least one medical frustration about their own body.
From a medical practice marketing and medical practice business management business perspective, once you tell your patients you are now able to take even more care of more of their medical problems, you’ll be surprised at the number of your patients who will request things be done that they are sick and tired of tolerating. And, they know that specialists charge a lot more than you do—often also with a higher co-pay.
You build respect and loyalty with your patients when they are aware that you continue to learn more, train more, keep up in medical care, get better at medical care, and are able to provide them with quality care beyond the ordinary. You are just as capable of healthcare business management as anyone else, just learn to apply the medical practice marketing as well as management.
It’s not always the big things you do for your patients that they love you for. Just your noticing small things while examining your patients, and can do something about if they approve, tells patients you care about them and their health... things they may have considered benign or never even had noticed... but you did.
Physicians who step out of the ordinary medical practice management and business management techniques, will always be sniped at by other physicians who feel that their turf has been invaded. I can remember back when liposuction done by a local gynecologist created a verbal war from the surgeons who felt that a gynecologist wasn’t competent to handle that procedure safely.
How a single specialty surgical procedure can rapidly change your medical practice income far beyond your expectations.
My associate Rafael Del Valle and I loved doing surgery. Kurt Semm, MD in Germany created and perfected the safe laparoscopic surgery procedure. Rafael traveled to Germany to learn the procedure and I attended the first Laparoscopic surgery work-shop given in the USA in California.
We were the first two Gyn physicians in northern California to start doing laparoscopic surgeries, if not in our nation. We self funded all the surgical equipment which the hospital refused to do for us, fought to obtain surgical privileges to do laparoscopic procedures because it, in the USA, was a new and unproven procedure, were supervised for six months, finally granted privileges--we taught others how to do the procedures.
I remember when an ophthalmologist went to Europe and came home with his expertise in treating vision problems with lasers, first in the region, and began collecting most of those patients for miles around. Do you think that the local ophthalmologists were happy about that? When you are the first physician that does a new surgery or procedure in your area, you will get and maintain a surge of patients for years. Those patients will not be referrals for the most part--they are self-referred.
Another example, a general surgeon, young doctor, started his surgical practice locally. When Gynecologists were already doing laparoscopic surgeries and we were being criticized and envied by the surgeons, none of whom in our area did laparoscopies. This young surgeon was trained in the procedure and performed the first cholecystectomy by laparoscopy.
Almost immediately the word spread and all patients needing the procedure made appointments with him. Having the procedure done with about three puncture wounds and going back to work in a few days was like a miracle--rather than a six inch incision and back to work in 6 weeks. When the very resistant surgeons recognized the profitable advantages, it took about a year for them to learn the procedure and do their own laparoscopic cholecystectomies back in the 1980s.
I happened to be the only gynecologist in town, out of 20 or so, that preferred to do breast biopsies on my own patients in out-patient surgery centers. Suspicious lesions removed under local anesthesia in a surgery center is something most physicians can do safely.
I discovered that my patients preferred that I do the procedures because they trusted me, rather than seeing another doctor who might disagree with me, or the patient didn't know, or have to wait 4 weeks to get the procedure done.
Of course, I was accused many times of doing unnecessary biopsies to earn more money--half of that was true. Even though I used the same criteria as the surgeons did for doing breast biopsies, it still upset them. I did my own biopsies because I found that many patients fit the criteria for a suspicious lesion, sent them to a surgeon, and the surgeon felt that a biopsy wasn’t needed.
One patient was an OR nurse that at age 22 had breast cancer, diagnosed by biopsy by a surgeon. Most surgeons would have not done a biopsy at that age of patient and followed it, and followed it, and followed it, until it had spread everywhere.
After I had done biopsies on a few patients who had negative mammograms, lumps that persisted, sonography showed no fluid, and the biopsies came back with a breast cancer pathological diagnosis, I felt justified in doing what I did. I felt it was better to be accused of doing unnecessary breast biopsies than to have a patient die of breast cancer spread because of procrastination in
doing biopsies.
You'd be surprised at the wide variation of criteria used by physicians to do breast lump biopsies, or not. That factor may be the reason that cancer has already spread by the time a biopsy is done. Even waiting for the radiologist to see the actual cancer signs on a mammography film, may be responsible for maternal deaths from breast cancer.
Women die because of “following a persistent lump” and because of a “normal mammography.” Needle biopsies miss 10% of cancers. Biopsies (lumpectomies) are 100% diagnostic when
done properly and early.
All those who throw cheap shots at you are either envious or insecure with their own practices. The one thing that should remain in your conscious mind is that fact that not one of those who criticize you gives a damn about you and what happens to you. If you are struggling as many physicians are, to earn enough to stay in practice, learn to disregard the insinuations because you know you are doing the right thing by protecting your patients and practice the best way you can without stepping outside ethical practice bounds.
Where I practiced, several "general practitioners" were trained to do, and commonly did, major gyn and ob surgical operations themselves. In this age of medical care it would be wise for all primary care physicians (not Internists) to seek training in major gyn-ob surgery. Some primary care residencies offer that in their curriculum.
In small towns, surgeons are the ones doing the major gyn procedures and there is no reason that a primary care physician can’t do the same. Isn’t it true that surgical specialties bring in the most income? So, having a surgical side to your practice is a great advantage... no matter
how small it seems.
Another mysterious practice effect I became aware of as a result of my patient referrals, points out a good reason for you to refer your patients to yourself. It became clear to me that every patient of mine that I diagnosed a malignancy in, then referred to another physician for proper treatment, never came back to my office again. I lost those patients permanently... and not because they all died from the malignancy.
As strange as it may seem, when you diagnose cancer in one of your patients and you refer them to the proper cancer management doctors, be aware that the patient may fear you, because
of superstition.
There is a small but significant attrition rate among the patients you refer out to other physicians for permanent care or just for consultations.
Perhaps, the few general practitioners who complain about their insufficient income would be well advised to follow some of my advice within this context.
Remember, even the specialists may need to expand their skills in new procedures as well to fight against the increasing healthcare restrictions on practice income. It would be far better and less expensive than moving a medical practice elsewhere.
“Wherever you see a successful business, someone
once made a courageous decision.”
---Peter Drucker, world famous business expert
----Professional Probe----
"Follicle intervention (pulling your hair out) is needlessly surrendering to the pressure of our economy"
"Whenever physicians come face to face with conflicts of judgement, action to take, and decision making, the bread of idleness is the greatest handicap for physicians. I'm increasing amazed that so many physicians are willing to trade their focus on practicing medicine for the consequences associated with living a life of professional poverty.
There is no vaccination against medical practice poverty. But being ill-equipped for battling the fee restrictions, the government mandates for the practice of medicine, and the probability that these issues will become worse over time, is no excuse for for failing forward. When challenges are left to be resolved by our circumstances, the end game isn't pretty.
When these challenges are hitting you in the face, don't walk away. My solution was to find and keep a view of the consequences that my family would suffer if I stood still, made no choices to fight back, even if I had no weapons to use. You were stripped of all those weapons by the medical schools that refused to provide you with those weapons (business education). Don't you hate it when you see the truth for the first time?
When you finally are able to gain access to those weapons on this website, does it give you a sense of security about your future in medial practice?
Just the fact that these tools are available to you in one place, that the tools are not difficult to understand or implement into your medical practice, that these tools are specific for medical practice management and physicians' marketing, and that it requires hardly any money or abuse of your practice time, should be a profound enlightenment you have been shown that can and will save your private medical practice, your medical career, and your family in the long run of the process."
Articles © 2013-2022/CGG INVESTMENTS LLC. All rights reserved. #14 3-16-22
