by Rachel L. Moore, MD, FACS, FASMBS
Dr. Rachel L. Moore is a Metabolic Surgeon and Obesity Medicine Specialist in New Orleans, Louisiana.
Bariatric Times. 2016;13(8):10–12.
Funding: No funding was provided.
Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.
Trauma call at Charity Hospital was an exceptional training environment that I am glad is in my past, and bariatric surgery bears little resemblance to it. It is a mixed blessing that we do elective cases, because the patient has the opportunity to see a competitor, or forego treatment entirely. To reach maximum success, healthcare in a bariatric practice must be viewed as both a business and a service.
The American Society of Metabolic and Bariatric Surgery (ASMBS) is comprised of surgeon and integrated health members who practice in the field of metabolic and bariatric surgery. Surgeon members of the ASMBS work in various settings, including “hospital,” “academic,” “university,” “ military,” and “independent/private practice.” The private practice group, of which I am a member, has a significant representation among the the ASMBS surgeon membership. In fact, the ASMBS Community/Independent Practice committee was recently created to better serve this subset.
During a session on private practice for Obesity Weekend (June 23–26, 2016, Las Vegas, Nevada) I spoke about increasing patient volume. Here, I aim to share and expand on that discussion, providing ideas for building your referral base and Internet and social media presences. While these tips are mainly directed toward individuals in private practice, those with other practice patterns may also find them useful.
Building Your Referral Base
Previous patients. It is appropriate to first think about where patient contacts originate. My group has been tracking this for years and has discovered that 51 percent of our patients are referred by previous patients. These satisfied customers entrust their friends and family to us, and we consider their referral to be the ultimate compliment. Your practice can contribute to a patient’s satisfaction by emphasizing pleasant interactions with your office, from consultation through surgery and postoperative follow up appointments.
Strive for consistent messaging, starting with the person who is likely to be a patient’s first point of contact—the receptionist or office manager. Be sure that all staff members are educated and trained on the following: practice information (location, directions, hours, surgeons, and surgeries performed), and knowledge of patient processes like consultation, support group offerings, and meeting with a patient advocate.
The American Society for Healthcare Engineering lists “a culture of caring, policies and procedures that support patients and staff, and physical environment” as the three most important factors for improving patient experience. Additionally, a survey in the Annals of Family Medicine ranked “appointment timeliness” second in importance after medical skill.
Other physicians. The second most common source of new patients for our group is referrals from other physicians, which account for 21 percent of our business. Physicians in other specialties play an important role by recommending surgical treatment, helping with health optimization prior to surgery, and postoperative care, too. We can help strengthen this resource by working to spread knowledge.
My strategy for increased referrals from other physicians is to say, “Yes” whenever I am asked to speak. This year alone I have spoken at gastroenterology grand rounds, a surgical assistant convention, and a CME event for primary care physicians (PCPs). I also talk to other physicians one-on-one wherever I see them, including the hospital, kid birthday parties, the ball field, and elevator. In my experience, people gather around and are eager to hear more about bariatric surgery. As Dr. Christopher Still said in a previous Bariatric Times article, “It can be easy to forget to share the basics with PCPs because we, as bariatric professionals, know the basics so well.”
This knowledge gap was recently demonstrated by Funk et al4 in an article that identified the following five factors that made primary care physicians hesitate to refer patients for bariatric surgery: 1) wanting to “do no harm,” 2) questioning the long-term effectiveness of bariatric surgery, 3) limited knowledge about bariatric surgery, 4) not wanting to recommend bariatric surgery too early, and 5) not knowing if insurance would cover bariatric surgery.
The bariatric community as a whole has been working hard to address all of these factors, especially in regard to knowledge and awareness. One such event that is focused on educating other specialties about bariatric surgery is the National Obesity Summit on the Provision of Care for the Obese Patient, hosted by the ASMBS and led by Dr. John Morton, Chief, Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, California. The 3rd Annual Obesity Summit is scheduled to take place in September 2016 and include representatives from more than 30 major health and medical organizations, including the following: American Diabetes Association (ADA), American Medical Association (AMA), American Society of Clinical Oncology (ASCO), American Heart Association (AHA) and American Academy of Orthopedic Surgeons. Collaboration with specialties can also be seen in the literature as we discover the ways in which bariatric surgery works on obesity-related comorbidities.
When speaking to another doctor, target your audience with the weight-related comorbidity that affects them most. For example, you could discuss type 2 diabetes mellitus (T2DM) with an endocrinologist, citing literature on the benefits of bariatric surgery in improving this condition. If talking with a specialist in obstetrics and gynecology, you might discuss the connection of obesity to infertility and polycystic ovary syndrome (PCOS). When conversing with an orthopedic surgeon, it is helpful to mention how obesity contributes to joint pain. Aim to educate physicians about the safety of bariatric surgery too, so that they can help patients make informed decisions. Share information about insurance coverage and the resources that exist for those who don’t have coverage for obesity treatment. In addition to data, your personal surgical outcomes can help colleagues feel more comfortable referring locally.
The Internet. After evaluating your physical referral base (patients and physicians), consider the new ways in which we search for information. Everyone throws away the big paper telephone book, and we search Google instead. Remember reference books like encyclopedias? What a blessing it is to live now, when information is so fluid and current and easily attainable via the Internet! According to the Pew Internet & American Life Project, 35 percent of U.S. adults have gone online to figure out a medical condition; of these, half followed up with a visit to a medical professional. While some information found on the Internet is accurate and useful, it is important to caution that it is a public, open venue. Remind both physicians and patients to be very careful about claims and specific recommendations found in Internet content. An office consultation and exam provides the most individualized and accurate information to each patient.
In the last three years, the Internet has gained in its importance for my six partners in New Orleans. In 2014, 17 percent of our patients approached the group online. Last year in 2015, it was 20 percent, and year-to-date in 2016 the Internet accounts for 26 percent of our volume.
Building Your Internet Presence and Strengthening Your Communication
Since research shows that potential patients are online searching for information, developing your own website is a crucial step for those in private practice. It is important to work with a reputable web designer to build a site that is search-engine optimized. A very pretty website that has no traffic is useless, and mistakes are costly to correct. Get recommendations from friends, compare web designers against each other, and ask former clients if they are still happy. Once it is built, you can use your website as an informational platform to teach patients about our work, and about your practice. Drawings and videos of procedures, photos of the practice and employees that are bright and inviting, patient success stories, and succinct data about bariatric surgery are all good ideas for website content.
As noted previously, the second most important place to invest is the person who answers your calls and e-mails. Just as the incision or scar is the only part of the surgery that the patient ever sees, these (often low-wage) workers are the public face of your practice and your surgical skill makes no difference if the caller doesn’t schedule a consult. Furthermore, patients are often still gathering information at the time of their first contact. Does the person who answers the phone in your office know the difference between a sleeve gastrectomy and a gastric bypass? They must be able to answer basic questions about every procedure that you offer.
A website and the contact personnel are the foundation upon which all further practice building stands. Once you have the fundamentals set, develop a marketing budget and method to track where your leads come from, then frequently reassess investments that you make to see if they are paying off.
Building Your Social Media Presence
Social media is vast, and it is here to stay. I use Twitter as an educational tool to disseminate information about bariatric surgery and obesity treatment. It has been fun to interact with physicians all over the world, but I have only operated on two patients that came from Twitter, even though I have more than 5,000 followers.
Facebook, on the other hand, has been an effective patient recruitment tool. I recommend setting up a Facebook site for your practice and posting regularly. Before-and-after photos are visually compelling, and are very popular. I also share recipes and motivational quotations, and sometimes get a lot of traction from something as simple as, “Free insurance check to see if you have coverage for treatment.” This is yet another opportunity to teach about our work, so post periodically about procedures and improved health after bariatric surgery.
LinkedIn was designed as a venue for businesspeople and its traction in medicine is much lower. One may be able to connect with other doctors and strengthen those relationships on LinkedIn, but patient attention is elsewhere.
There is an expression that says marketing is what you pay for, and public relations is free. Cultivating relationships with reporters in your community can be a wonderful source of PR. Set yourself up as the obesity expert that they can turn to when they need a quotation about weight loss. More traditional advertising practices are going to vary by community. Since the majority of bariatric surgery patients are female, it is a sensible move to ask the women in your life what magazines, newspapers, billboards or television that they see. Ads in local magazines that go to about 10,000 households have given me a pretty good return on investment, but I do not advertise in newspaper, television, billboards, or radio.
When evaluating your practice and considering how to improve its success, remember that different tactics work in different situations, and that finding the right formula may be a trial and error. If you approach your practice as a business and your patients as customers, while simultaneously providing excellent medical care, you will create successful results for both.
1. Health Research & Educational Trust. (2016, March). Improving Patient Experience Through the Health Care Physical Environment. Chicago, IL: Health Research & Educational Trust. www.hpoe.org Accessed August 1, 2016.
2. Kinchen KS, Cooper LA, Levine D, Wang NY, Powe NR. Referral of patients to specialists: factors affecting choice of specialist by primary care physicians. Ann Fam Med. 2004;2(3):245–252.
3. Still C. Creating bariatric surgery advocates: why it is critical to educate primary care physicians. Bariatric Times. 2011; 8(11):16–18.
4. Funk LM, Jolles SA, Greenberg CC, et al. Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study. Surg Obes Relat Dis. 2016;12(4):893–901. Epub 2015 Dec 2.
5. Fox S, Duggan M. Health Online 2013. Pew Internet & American Life Project; January 15, 2013. http://pewinternet.org/Reports/2013/Health-online.aspx Accessed August 1, 2016.