Be patient
While it is well known that the first few years of your private practice are critical in determining your practice’s long-term success, do be patient as it can take many years for your practice to achieve a steady state of income. No matter how superb a clinician you are, you should not expect the activity and income levels of your established colleagues, only a few months into your business.
Impatience for natural practice growth is one of the many factors that have allowed managed care organisations such a significant role in private medicine in recent times. The key concept in managed care is that a third party organisation attracts referrals or patient activity in bulk, before dividing the work among consultants. Crucially, it also dictates the fees payable to the clinician, which are typically considerably less than an independent consultant could command, as the referral / activity is ‘owned’ by the organisation. Such organisations can be private medical insurers, who direct their patients to certain clinicians, or organisations who advertise their services, for example, certain private hospital groups or clinics.
For a new consultant, it is easy to see the attraction of managed care. It allows the opportunity to achieve some additional income quickly after starting as a consultant, with no marketing and often minimal administrative support. Unfortunately, unless you are able to develop your own brand
either in addition to, or alongside the organisation, you are unlikely to develop your own independent private practice very well. Furthermore, future reductions in fees paid to consultants are commonplace and should be expected if more consultants join such an organisation.
Alternatively, you can invest a great deal of time and energy in developing a quality NHS service, as well as marketing your nascent practice through meeting your potential referrers and establishing links, giving talks and lectures to groups of referrers at key local meetings and so forth. Choosing this path will lead to a slower start in terms of income, but will allow a solid foundation for sustained, higher income, independent private practice; critically, this will be a practice that you will be in control of, rather than being a worker bee for another organisation.
Establish the growth (& income) areas – geographically & clinically
Some areas will naturally be more prosperous than others, both in terms of clinical procedures, but also geographical location.
While the wealth of particular areas may be obvious to the naked eye, private hospitals may often happily inform you of their highest referring GP practices, information which may surprise you. It is clearly in your interests to target these practices with your marketing efforts above other practices. Out of courtesy to your colleagues, you may wish to avoid overt marketing in areas where they have a presence in a peripheral clinic, however, towns at the edges of your catchment areas should naturally be seen as target areas for growth; this should be particularly the case if you are aware of negative feedback concerning your rivals further afield. You should ensure, however, that you do not agree with your colleagues to avoid marketing in certain geographical areas, as such activity would be considered anti-competitive.
Certain procedures will attract higher fees than others: it is important to bear this in mind when you start your marketing efforts.
Example A. If you are a hip arthroscopy expert, while this is laudable you will be far more successful if you market yourself
as a hip replacement surgeon (& arthroscopist): (i) hip replacement is a much commoner procedure; (ii) it is often faster to perform; and (iii) even if patients need an arthroscopy, they will probably perceive
that they need a replacement!
Example B. A general ophthalmologist with a special interest in paediatric ophthalmology joined a department where she was warmly greeted by her colleagues, none of whom practised paediatric eye care. She took them up on their suggestion that she market her special interest through the local private hospital, but a year later had only developed a very minor private practice. In general ophthalmology, the majority of the private work undertaken is cataract, but she had successfully labelled herself as a paediatric specialist. Of course, if she had pursued the cataract market, the paediatric referrals would have come to her regardless.
Be aware of new referrers in your area
You may encounter many established relationships between referrers and your rivals, but these will only rarely last an entire career. In many cases, referrers will retire, move practices and there will definitely be new blood in the area: this is your opportunity to establish relationships early before the competition. Initial introductions can potentially be a little awkward, but can of course come from the NHS setting, prompted perhaps simply by a new name on the bottom of a referral letter.
The personal touch
Flyers and memos from your private hospital regarding your arrival are useful, but fade into insignificance compared to the personal touch. A well-timed, useful visit, discussing all aspects of your practice – not just your private practice – can create a lasting impression. Try and create the right impression first time: while not everyone’s cup of tea, wearing a smart suit rarely fails.
Don’t restrict yourself to GPs
In much of private practice, GPs act as the gatekeeper for referrals, however, self-referral is increasingly common and referrals from other health professionals can be a useful source of business. If patients are planning on using health insurance, then often a referral needs to be ‘rubber-stamped’ by a GP at some stage, but it would take a brave GP to overrule the referral’s direction. Other health professionals such as dentists, physiotherapists, osteopaths and optometrists all mainly practise solely privately and are happy to refer privately. Your local private hospital may facilitate a local health professionals’ day: if you can become known as, e.g. the local ‘skin man’, then such connections may subsequently prove very useful.
Don’t denigrate your colleagues
Professional jealousy can be a powerful force and it is never worthwhile getting enticed into passing judgements on others. Maintain the moral high ground, praise your colleagues to others - including potential referrers - and try hard to grow your businesses together. When people hear you speaking ill of another, or see a written statement in a clinic letter that you believe a bad job has been done, they will potentially form negative opinions of yourself, as well as the third party. Clearly, if patient safety is at risk, or you uncover frankly illegal activity, then you must act, but remember that we all make mistakes.
Trying to break into what you perceive as a closed shop can be daunting. It can also lead to changes in relationship with the person you are competing with. If you can show that you are attempting to grow your business - not by attacking theirs but by positively marketing your own – you should be able to maintain a good relationship. Such relationships and friendships can be of extreme importance when it comes to dealing with the threat of managed care and third party organisations.
Other strategies
Clearly, you must not provide incentives to referrers for sending work your way, however, both you and your hospital can provide appropriate payments for work undertaken, for example, the completion of audit data / patient satisfaction surveys or PROMs (patient reported outcome measures), for which you would otherwise might have incurred an expense. In addition to rewarding referrers for work that they undertake on your behalf, this also shows that you are interested in the quality of work undertaken, which is a positive attribute. You may wish to consider whether your colleagues may view such practices as divisive, as this could potentially lead to difficult inter-personal relationships. Is there a way that the private facility you work in can produce the data you need without you personally incurring costs and the wrath of your peers?
Before initiating any such activities, you may wish to try and establish current practices locally, particularly if you can ascertain the level of fees currently paid. In many cases, the NHS has already set a precedent for payment for postoperative data. Bear in mind that paying significantly higher than an established market level could be considered incentivising referrals, and hence illegal.
Marketing Another page
is devoted to the many different marketing techniques available to you. Try and establish which ways your colleagues have marketed themselves and see if you can offer a fresher approach. In the first instance, your local private hospital may be able to help.