In a seminar sponsored recently by Metropolitan Medical Center, Greg Korneluk, a nationally recognized health care consultant, told a group of Twin Cities medical specialists that business acumen will weigh more heavily than medical talent when it comes to deciding who survives the physician shakeout already under way here.
"The three A's in building a practice are availability, affability and ability — in that order," he told the group. "Successful physicians will be those who cater to their customers."
While many physicians will find that advice a bitter pill to swallow, there is logic behind Korneluk's assessment. Since most patients are not in a position to judge their physicians' medical abilities, they rely heavily on a physician's communication skills and demeanor in deciding whether he or she is a good doctor, Korneluk says.
Korneluk advises doctors to take advantage of that fact, rather than fight it, by adopting marketing and management principles learned decades ago in other service industries. Eliminate patient waiting time whenever possible, he says. Or, at the very least, make the wait more comfortable and less demeaning.
Read the patient's chart before walking into the examination room instead of after. Follow up with patients on diagnostic findings and recommendations. Send them birthday and holiday cards.
And don't stop with patients, Korneluk told the doctors. Work on winning the loyalty of other physicians who might send referrals. This should be a special consideration for medical specialists, who depend upon referrals from other doctors for much of their business.
Korneluk suggests that specialists distribute newsletters to referring physicians that include up-to-date information and relevant clips from professional specialty journals.
The marketing device requires little effort, he says, and sends two important messages to primary care physicians: that the specialist wants to help them be up-to-date, and that the specialist is current with research findings and new technology in his or her chosen specialty.
Korneluk also suggests that specialists stay in touch with the needs and wants of referring physicians. Generally, beginning physicians want comprehensive reports from doctors who have seen their patients, while doctors who have been in practice five years or longer tend to prefer abbreviated reports of diagnostic findings.
"They like to keep their files tight," Korneluk says.
"Ask the referring physicians what they want, and give it to them promptly."
Why the sudden interest in patients on the part of doctors, who in the past have equated marketing with hucksterism? In a word: competition. A growing surplus of physicians, and the increasing success of health maintenance organizations (HMOs), which pay their doctors a salary and compete with private practitioners for patients, have private doctors worried.
They are also concerned that they might be the federal government's next cost containment target. (Hospitals were the government's first target because they consume the largest share of the U.S. health care dollar, about 40 percent).
Korneluk predicts that next year the federal government will extend controls to physicians like those it imposed on hospitals two years ago for Medicare inpatient treatment. Medicare's regulations for Diagnosis Related Groups (DRG) set a payment ceiling for each Medicare patient treated by a hospital.
Korneluk also warns that, as early as next year, Medicare might require physicians to accept a set monthly rate for outpatient care.
The squeeze these competitive forces are putting on private practitioners, in addition to continuing rises in insurance and other costs is likely to get worse, according to Korneluk and others. They believe private practice physicians have no alternative but to practice medicine more efficiently.
Ironically, doctors are finding that a former foe has become an ally. The very hospitals that doctors often fought with for control of the old health care system are teaming up with doctors in order to survive the shakeout.
Korneluk's seminar (sponsored by Metropolitan Medical Center) and similar forums for physicians hosted by other Twin Cities hospitals reflect some of the newfound common ground hospitals and doctors have discovered.
The alliance stems from Twin Cities hospitals and private practice physicians both having lost patient volume as a result of HMOs' growth. Together, the two groups are working to find ways to compete with this new and powerful force.
In the past two years, the hospitals that have succeeded most have been those that have learned to manage themselves and market their services. Now, those hospitals are providing that management and marketing know-how — and, in some cases, even capital — to private practice physicians to help them maintain and expand their patient bases, says Richard Reece, a physician and editor of Minnesota Medicine, a magazine published by the Minnesota Medical Association.
What's in it for the hospitals? The hospitals, which are in their own battle to keep their beds full, are betting that the new alliances eventually will translate into patients.
While these shifting alliances will largely be invisible to health care consumers, patients can expect to see more effort by physicians to turn office visits into "health care experiences," as Korneluk puts it. Just a few of the conveniences he expects to see are coffee pots and televisions in waiting rooms, recorded telephone messages (similar to those that provide flight information for airlines) so patients can find out whether the doctor is behind schedule, and maybe even house calls.
Look also for the actual time spent with a physician during an office visit to shrink from the current 12 minute average to perhaps 8 minutes. As their costs rise and competitive pressures and government payment ceilings limit fee increases, physicians will have to see more patients if they want to maintain their current income, according to Korneluk.
But reducing the length of office visits need not undermine the goal behind these marketing efforts, which is to improve the doctor-patient relationship, Korneluk says. Quite the contrary: Marketing and management goals should be complementary.
For instance, he urges specialists who have just finished examining a patient not to sit there writing themselves notes for a letter to be dictated later for the referring physician.
"I'd say put a tape recorder in front of you, and tell the patient, 'This is what I'm going to tell your doctor in a letter,' " Korneluk says. Then, give the tape to a clerical person and let him or her write the letter to the referring physician.
"Physicians have to learn to be more efficient with their time," says Korneluk.
"[Medicine] is another service sector at the end stage of a cycle, having to pull up its socks, just like everyone else.
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