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A Marketing Update:
What Works Best Today to Build Your Practice
BY JOHN B. PINTO

Marketing is one of the most confusing, under-appreciated, complex, vexing, bungled and unaccountable dimensions of business management. But marketing, for all its frustrations, is vital to practice survival now more than ever. Every practice "markets" (well or poorly, whether they know it or not) and all practices, even ones that are good at marketing, waste at least half of their promotional budget every year, though they rarely know which half.

Although markets have been changing drastically in eye care for the last generation, the definition of marketing has stayed the same. Marketing is nothing more, and nothing less than establishing and maintaining exchange relationships with customers.

These "customers" come in a wider array than just patients, of course. Customers also include affiliates of patients (like the daughter who brings her mother in for cataract surgery and perhaps helps her pay for lens upgrades), distributors of your care (including all manner of referral sources) and third-party payers.

Since 1977, when the U.S. Supreme Court reversed efforts by the Arizona State Bar to prohibit professional advertising, doctors in America have had the same opportunity as any other vendor to build their business. And among doctors, ophthalmologists have been in the vanguard of both marketing expenditures and marketing sophistication. This has occurred for a number of reasons:

► Ophthalmology has a wider array of services than most other specialties. There's more to promote and get the word out about.

► Ancillary opticals and surgery centers, providing passive income, provide a strong incentive to build market share and patient volumes.

► Patients can self-refer for most eyecare services, so a direct-to-consumer approach can be used. Many of these services are elective and paid for out of pocket.

► Ophthalmology is a relatively competitive field with an excess of providers in many markets.

► Ophthalmology is a largely fixed-cost business. If you are in a 500 patient-per-month practice, the profit margin derived from seeing patient number 501 is nearly 100%, so it is easy to justify material outlays for practice-building.

► Relationships with patients in eye care are generally longitudinal. Gaining a new patient is on average not just another exam or procedure this year, but an annuity stream that can represent tens of thousands of dollars. This substantiates marketing outlays that are a lot higher than in practices that treat brief disease episodes and then discharge their patients.

► The significant co-management intersection of ophthalmology and optometry is not present in any other specialty; this form of marketing is uncommon in other specialties.

► Ophthalmology is a financially robust domain of medicine; there are more discretionary dollars available to experiment with.

► Ophthalmology is an unusually well-connected specialty of medicine, with strong communication ties crisscrossing the nation. What works, marketing-wise, in one market is rapidly shared around the nation, even in the international community.

► Unlike many other surgical specialties, where providers need to master several new procedures and maneuvers a year, the pace of change in eye surgery is relatively tame, allowing practice owners a little more free time to focus on the business side of medicine.

Although this article comes nowhere near to being an instructional guide, let's discuss what's working in ophthalmic marketing today in broad terms — and then let's talk about what flops.

Internal Marketing

We always need to start with internal factors before considering external promotion. How's your current practice "product?" So-so? Awesome? Really pretty bad? Remember that nothing makes a flawed practice fail faster than great external promotion.

Your facility is the "packaging" for what you're trying to sell. You can be the most credentialed and caring provider in the world, but patients won't come — or at least come back — if your office quarters are shabby. As a general guide, let's examine what hotel chains have done in recent years. Even down-market and mid-market chains, if they're successful, have great curbside appeal, adequate parking and a nice lobby. It's perfectly acceptable to have the guest rooms be a little "industrial" looking, so long as the front-end of the outfit is sufficiently swank.

Signage should be as large and as well lit as local ordinances will allow. Signs should include provider names and principle services. If you are able to mount a sign large enough to accommodate a changeable marquee, all-the-better. Change the copy every week. Driving by and seeing "Floaters and Spots Mean Your Retina's Kaplotz" will get more attention from patients than a tasteful, unlit brass plaque on the door.

Doctor appearance and affability are key. You are your practice's product. And you are judged at every turn. Do you have a nice photograph in your brochure? Are you well groomed? Do you dress successfully? Do you greet patients warmly? Remember some point of trivia from their last visit? Address the chief complaint? Provide ample reassurance and praise? Treat staff like respected colleagues — at least within earshot of patients?

Professional customer service by lay staff is paramount, and can make up for almost any facility gaps — even doctor deficits. Your staff is responsible for far more patient contact than you are. Formal, ongoing efforts to hire friendly staff and continuously improve customer service are critical even in the smallest practices.

Recall and continuity of care constitutes great medicine, great medico-legal prophylaxis and incredibly effective marketing. If your established patient base is not growing in rough sync with the number of new patients, your practice is leaking customers. External marketing in such settings is like bailing a leaking boat instead of simply patching the hole.

The secret weapon of internal marketing is for you, as the doctor, to overtly ask every patient to refer to you. Every departing patient should be handed three cards with the phrase, "Please tell your friends about the importance of regular eye care." I have had clients who double their practice on the strength of this one tactic alone.

External Marketing

Your practice will be more successful with a "brandable" name. "Curtiss Eye Care" is a unique, brandable name. "Hudson Valley Eye Care" is generic and not very brandable. "Curtiss" may only have to spend about half as much as "Hudson" promotionally to get the same name recognition.

Although paid advertising in general/geriatric care settings has diminished somewhat with the drop in allowable fees, there is still an important role for such promotion. In the right market, with the right message and the right long-term commitment, advertising — especially testimonial ads — are still highly effective.

Publicity has emerged as an important adjunct to ever more expensive paid advertising for larger practices that have interesting stories to tell. The larger the market, the more you have to turn to a seasoned local publicist for support.

The Internet continues to emerge as a low-cost/high-yield marketing tool, although much more effective for refractive surgery and primary care patients, than for seniors. In another 20 years, we will be vastly more dependent on the Internet for all age groups than legacy communication channels, although I believe that print and broadcast media will continue to play a role.

The most savvy practices have tapered their yellow pages' advertising budgets in recent years. A smaller boxed listing in just one dominant book is generally sufficient unless your practice is regionally dominant or wants to be.

Building and sustaining your refractive surgery practice continues to require much more sophistication and budgetary support than any other practice segment. It is common for old-line practices to spend 10% and more of LASIK revenue to promote this service in an established practice, while newcomers to the market commonly spend far more. In today's tough market, you have to get price, product and promotion precisely right — for many years — and even then local nuances, provider tenacity and luck are the critical co-factors.

The advent of accommodative lenses has opened a whole new world of promotional demands and opportunities, and "what works" is still coming to light at this early stage. Although price wars are breaking out in a few vanguard markets, this is still the era of early adopters, where pricing considerations are secondary to internal and external promotion. If you want to enjoy a larger segment of this market for the next 10 years or more, now is the time to be ramping up your efforts. The best and most aggressive practices have been doing so for the last year. The bottom line? Those practices which have been successful building elective refractive, plastics and primary care businesses are the same ones today that are off the charts in the percent of cataract patients opting for lens and treatment upgrades.

Marketing Budgets

Subspecialty, referral-based practices need to spend very little on overt marketing, aside from outreach and a few special events throughout the year. As a very general rule of thumb, an established/general/geriatric practice with modest growth goals in a benign market with little competition can get by spending 1% to 3% of annual collections on marketing. If your market is tough, or your growth goals are higher, you may need to spend 3% to 5% in the same kind of practice. Marketing refractive surgery requires +10% in most settings.

The Biggest Marketing Errors

There are many more ways to get marketing wrong than right. Here is a checklist of the most common errors:

► A lack of goals. You should know what specific, numeric outcomes you desire from your marketing efforts in financial, case volume and market share terms.

► A mismatch between goals and resources. You probably cannot build practice revenue 15% a year spending 1% of revenue on marketing.

► Inadequate staying power. It can take years to build traffic. Typically, just about the time you get sick and tired of seeing your own ads is when they are just starting to register with the public.

► Spreading your budget too thinly. You cannot take on numerous marketing projects with a limited budget. It is better to do one to two core tactics well.

► Inexperienced advice. While it is unlikely you'll find a seasoned eye care marketing expert in your hometown, try to at least work with someone who is experienced in health care or service-sector marketing. It is easy to waste a fortune on fees teaching your local, well-meaning marketing firm all about how health care works.

► No customer research. You must survey and poll customers and prospective customers avidly to find out where your next opportunities lie.

► A misapplication of funding. Using too much of your budget for ideas, creativity and production leaves little behind to actually disseminate your message through paid advertising.

► Not using the materials you produce. It is common to find perfectly serviceable brochures or patient pamphlets sitting in storage not being used. We are long past the era of being wasteful like this.

► Not trying new things. Marketing does not involve much science, but it is experimental. You should be constantly trying new approaches, and discarding things that do not work.

► Not learning from mistakes. Even after 30 years in the business, I am still making plenty of misjudgments about what might work in a given market or practice setting. Be as intrigued by what doesn't work as you are by what does. Keep asking, "Why?"

Marketing is an investment. The return comes in the form of near-term customers, to be sure, but even more in the form of long-term control over the volume, source and mix of your patients. Every practice markets, whether they realize it or not. And only about half of the practices in America do an above average job of it. What about you?

John Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country's most-published author on ophthalmology management topics. He can be reached at (619) 223-2233, e-mailed at pintoinc@aol.com or found on the Web at www.pintoinc.com.