Successful Medical Practice - winning strategies for doctor

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Successful Medical Practice – Winning Strategies for Doctors

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Index
Preface 4
Chapter 1 - Planning your career – carve out a niche for yourself 6
Chapter 2 - Beginning practise – get off to a flying start ! 11
Chapter 3 - Designing your clinic - make it patient-friendly 20
Chapter 4 - Assessing your practice – take a critical look at what you are doing 25
Chapter 5 - Marketing your practice – how to get more patients 29
Chapter 6 - Business management 101 - basic business skills you need to know 35
Chapter 7 - Financial planning and management – boosting your bottomline 40
Chapter 8 - Making your money work for you 43
Chapter 9 - Hiring the right people – your most valuable investment 46
Chapter 10 - Creating superb employees by taking good care of them 50
Chapter 11 - How to keep good medical records - worth their weight in gold 54
Chapter 12 - Scheduling patients – how to manage appointments efficiently 58
Chapter 13 - The telephone – your clinic's lifeline 62
Chapter 14 - Buying medical equipment – getting value for money 65
Chapter 15 - Going digital - using computers to enhance your efficiency 68
Chapter 16 - www.doctor.com - setting up your virtual clinic on the internet 70
Chapter 17 - Information therapy - how to educate your patients 73
Chapter 18 - Communicating with your patients – polish your bedside manner 77
Chapter 19 - How to listen to your patients – so they will listen to you! 81
Chapter 20 - Treat your patients as valued customers – how to win their lifelong loyalty 83
Chapter 21 - Improving your emotional intelligence – honing your people-skills 89
Chapter 22 - Keeping upto date – learning how to learn 92
Chapter 23 - Time management – making the most of your day by working smarter 96

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Chapter 24 - Managing mistakes in medicine – what to do when you err 99
Chapter 25 - Steering clear of malpractise threats – how to avoid legal battles 103
Chapter 26 - Risk management – keeping problems at bay 105
Chapter 27 - Crisis management – how to cope when the chips are down 110
Chapter 28 - Health v/s Wealth - the danger of (mis)managed care 114
Chapter 29 - Making your marriage work – keeping your better half happy 118
Chapter 30 - Parenting – bringing up the next generation 122
Chapter 31 - Retiring – from medicine, but not from life 126
Chapter 32 - Medical ethics –how to do what is right 130
Chapter 33 - Preventing burnout – manage stress efficiently 134
Chapter 34 - The impaired physician – healing the wounded doctor 139
Chapter 35 - Professionalism in medicine –striving for excellence 142
Chapter 36 - Physicians as leaders – aim to be the best ! 146
Chapter 37 - Spirituality in patient care – looking at the bigger picture 153
Chapter 38 - The joy of practicing medicine – how to be a happy doctor 156

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Preface
The education of the doctor which goes on after he has his degree is, after all, the most important part of his
education. John Shaw Billings (1838-1913)
Running a successful private practice can be hard work ! While medicine can be a very fulfilling profession, one
out of every three doctors reports that medical practice leaves them dissatisfied because they have too little
time for themselves or their families. Doctors suffer from depression four times as often as the general
population ; and many doctors hate their jobs and dislike the majority of their patients. While most doctors
acquire a high degree of medical expertise during their long years of professional training, unfortunately few
learn anything at all about the nuts and bolts of running a practice. While some have a natural flair for
entrepreneurship, many end up doing badly in real-life.
In fact, many doctors are now quitting practice because of too much work, too much hassle, too much
competition, too much despair, and too little reimbursement. They are increasingly feeling the pressure of
having to see more patients, do more in less time, discount their fees, and face more competition. Like the
White Queen in Alice in Wonderland, they find they are having to work harder just to remain in the same
place. However, working harder (which is often the only solution most doctors can come up with to cope with
this problem) is not the answer – after all, there are only 24 hours in a day ! What doctors need to learn is to
work smarter, more efficiently, and more productively—and with less hassle and more satisfaction. The secret
is to learn how to manage yourself. The problem is that certain skills—especially time management,
knowledge management, and relationship management—are not taught in medical schools and most doctors
have to learn them the hard way. Unfortunately , the majority never do, and they fail to live up to their
potential, leading lives of quiet desperation
Like them, do you find that you are fed up of:
• Long energy-exhausting hours and crushing workloads leaving little or no free time?
• Demanding dissatisfied patients?
• Inadequate payment for all your hard work?
The purpose of this book is to help you find a truly satisfying way of practicing medicine which would:
• Give you control of your time;
• Allow you to do work which you felt was worthwhile, for patients that you enjoy seeing; and
• Pay you well for your effort, so that you enjoy going to work every day.
Many doctors feel they are very productive because they see patients all day long. However, there is a
difference between being busy-which almost all physicians are these days-and being productive. This is the
difference between inputs, which is how busy you are, and outputs, which is how productive you are - and the

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smart doctor will focus on improving his outputs ! The better your practice fits with what you really want to
do, then the more productive-and happier- you will be.
A hundred years ago , when life was much simpler, the successful doctor was said to need three things; a top
hat to give him Authority; a paunch to give him Dignity; and piles to give him an Anxious Expression. Today, a
doctor who wants to run a successful private practice needs to be far more accomplished ! He needs to be a :
• Clinician , who has polished medical skills, a reassuring bedside manner; and a high personal standard
of medical ethics and professionalism;
• Academician, who is a constant learner , and keeps upto date;
• Manager , who understands the business aspects of running a profitable clinic, and is knowledgeable
about marketing and networking;
• Financial expert, who can manage his money and his investments;
• CEO, who understands how to motivate staff and lead people;
• Family provider, who is a good father and husband; and a
• Self caretaker, who know how to look after himself and fulfill his personal needs .
While this may seem to be an intimidating list, there are many techniques which can help you become more
successful. While many of these are based on simple common-sense, this book will allow you to think about
them clearly, so you can apply them to your own life. The best practice management advice is disarmingly
simply : "Patients are the practice. Everything else is just paperwork'."
All doctors have a different definition of success. For someone, it may mean having lots of patients; for others
it may mean a new car every year; others may find it in publishing high quality papers in academic journals;
while others find happiness in teaching students. There are as many ways of having a successful private
practice as there are doctors, because everyone’s definition of success is very personal and private. You need
to create your own path, because success is internal , and is achieved when you reach your own goals. We are
privileged to be doctors – let’s make sure we enjoy doing what we do, so we can all be happy and successful in
our own lives !
Dr Aniruddha Malpani, MD
Dr Anjali Malpani, MD
Medical Director
Vital Signs, Medical Practise Management Consultants
Bombay. India.

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1-Planning your career – carve out a niche for yourself
"If you don’t know where you are going, you’ll probably end up somewhere else !"
- Lawrence Peter
Many doctors naively believe that once they start earning lots of money and have a long line of patients
waiting for them, they will have it made. Once they reach this point, many are quite happy to cruise on their
reputation and skills for the rest of their lives. However, to judge the health of your career, it’s not enough to
just look at your income statement – you need to assess your personal balance sheet as well. You are a
professional and your major assets are your medical knowledge and skills. You need to keep on building these
if you want to remain successful. The Japanese call this kaizen, which means constant improvement. If you do
not actively work at it, your career prospects will decline, even when (or perhaps especially when) you are
making lots of money. In fact, the more “successful” you are in later years, the greater the temptation to
exploit existing skills - and the harder you need to work to make sure that you don’t just rest on your laurels.
You have to find ways to continue to develop the knowledge that your patients value. Doctors get paid for
their time, but that's not what we sell. We sell our medical knowledge and skill, and left untended, these
depreciate in value surprisingly quickly ! This is especially true in medicine, where the knowledge base
expands exponentially every year, and new discoveries are being made all the time. We all need a personal
strategic plan for our careers, and the sooner you formulate this, the easier it will be for you to progress.
Most doctor’s careers have the following five stages:
• Entry, when you are starting out;
• Establishment, when you have created a name for yourself;
• Exploration, when you look for new fields to conquer;
• Specialization , when you settle down in your niche; and
• Mastery, when you establish yourself as the Expert in your area of interest.
Whether you are 25 or 55, you always need to think about where your career is headed. The one constant in
life is change – and as medical technology , governmental regulations, insurance reimbursement policies and
patient expectations change, you will need to change with them. As you think about your career, here are
some questions to ponder:
• In what way are you personally more valuable to your patients than last year?
• What specific new skills do you plan to acquire or enhance in the next year?
• What is it that you want to be famous for?

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Traditionally, doctors have adapted themselves to their jobs – and most have uncomplainingly and blindly
done what the rest of their colleagues are doing. However, many are increasingly finding that this is a difficult
burden to bear. This is why, rather than change yourself, it is better to create a job which is especially
designed for you. A niche is “ any position specially adapted to its occupant” , and if can find your niche where
you can practice effectively , this will help to make your career in medicine enormously rewarding. After all,
we all have different interests and talents. Why not use these to stand out and shine - you need to play from
your strengths ! Find your special interest as soon as possible. What turns you on? What do you enjoy most?
What part of your work would you be happy to do daily without pay? The secret for success is to find
something you love doing and very good at – and then to attract patients who will pay you to do this for them
! A niche does not need to be some new thing imposed on you (unless you want it to be) nor does it need to
be a whole new aspect of your life (again, unless you want it to be).
If you want to make yourself a truly valuable asset, then you have to focus your attention on building a highly
specific set of knowledge and skills – you have to carve out a niche for yourself. With ever increasing
sophistication in medicine, patients value specialization, and you have to consider what your patients define
as value. For your patients, your asset is valuable only if you have technical skill as well as the ability to apply it
in a customized way to their situation. It is important to make a distinction between knowledge and skill.
Knowledge is relatively easy to accumulate, but it depreciates. Skills are harder to win, but keep their value a
little longer. For most doctors, technical skill alone is rarely enough. To be a valuable doctor in the eyes of
patients, you need to learn a wide variety of interpersonal skills as well, which allow you to communicate
effectively with your patients.
Each patient encounter can teach you – if you are willing to learn. Many good surgeons will take time at the
end of an operation, for example, to ask themselves, “What went well, and why? What didn’t go so well, and
why not? ” . This self-imposed discipline allows them to critically analyse their performance, so they can come
up with ideas that will help them get better the next time. Keeping notes will also help you remember and
apply the lessons next time. Take every opportunity to discuss your work with colleagues, so you derive value
when they ask “Why did you do it this way? What would have happened if you did that?”
Although creating a niche for yourself can be a lot of hard work, there are ways to make the job easier. For
instance, if you want to be known as an expert in a specific area of medicine, it helps if you give professional
talks on the subject. Start locally and expand your horizons as word of your expertise travels. If you are
inclined to write, publishing articles in peer-reviewed journals or the lay press will help to further establish
your credibility as an expert. Join professional organizations that can provide valuable information in many
forms, including publications, seminars and formal coursework. For example, if you are interested in writing
on medical topics, you can check out the American Medical Writers’ Association (AMWA). If you are interested
in becoming a hospital administrator, you can contact the American College of Physician Executives (ACPE).
Having a niche allows you to differentiate yourself from other doctors, so that you can attract more work .

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Being different can be very helpful in becoming the leader, so don’t waste time trying to be everything to
everyone and ending up becoming nothing to no one !
The secret for planning your career is to pick a clear focused personal professional goal. As physicians, we
aren't used to choosing our own professional goals because they were usually chosen for us. Throughout our
training, we were told what we were going to do, and when and how we were going to do it. But by not
setting our own career goals, we have no direction—which is why, after 10 or 15 years of practice, some
physicians end up saying, "Is this really what I wanted to do? Did I train 16 years to do this?" When you set a
goal, and every day do some work toward reaching that goal, you begin to take control of your professional
life. That's why choosing a professional goal is the most important single thing you can do—it starts to put you
back in control of your career. Each year, perhaps on a specific date such as your birthday, you might want to
reflect on the path your career is taking. Think about what things you can do in the coming year to further
define your niche. As time goes on, you will develop new interests. At some point, you may even want to
move in a completely different direction. Taking the time to reassess what you are doing on a regular basis
allows you to incorporate these new interests into your life , and to get rid of things that you really don’t want
to continue pursuing. Discovering your true mission in life, and then allowing that to frame a career that is
specially designed for you, can help to make you a true healer. Both you and the people whose lives you touch
will reap the rewards of the careful thought and planning that go into creating your own personal place in the
world—your niche.
The most important factor in your career design is to shape your practice around your abilities. In doing your
self-assessment, five areas are key:
• Values: What motivates you? What would make you feel you were devoting your time and talents to
something extremely worthwhile?
• Skills: What's your strong suit? Which strengths do you have that complement your medical skills? Are
you skilled at something you don't enjoy doing? If so, you'll want to de-emphasize it so you don't
gravitate toward something you won't like.
• Behavioral style: How do you approach problems, people, rules, and procedures? What kind of pace do
you like to keep?
• Cultural preferences: Do you like the intimacy of small medical groups or the anonymity afforded by a
larger organization? Are you a traditionalist, or an innovator who prefers a fast-moving,
entrepreneurial culture?
• Lifestyle: Are you a family- and community-oriented person? An outdoor enthusiast who needs the
right setting to pursue other passions? A travel bug who needs to take vacations on your own
schedule?
Thus, if you are an orthopedic surgeon and find you are technically clumsy in the operation theatre, it’s better
to stay out of the OR and not botch up surgical operations. Instead, you could choose to specialize in medical

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legal work, by providing advise to lawyers in medical compensation cases - a very remunerative field. If you
enjoy what you are doing, you will do a much better job at it !
You don’t have to limit yourself to medicine either ! Many doctors have successfully pursued careers in many
other fields, such as information technology, writing, law and business management. Some start coaching
classes to teach medical students, while others serve as consultants to the pharmaceutical industry. In today’s
world, your options are limited only by your imagination. Other doctors have been even more enterprising and
have a portfolio of careers – after all, there is no rule which says that you have to slavishly do one job all your
life ! Having a career portfolio can add colour to your lives , because it ensures you have multiple interests to
pursue, which keeps you on your toes; and also allows you to create a financial buffer, in case one career is
not doing well at a given time.
Remember that you are your most important asset . You can think of yourself as a small company – You, Inc,
which you need to nurture. It’s no longer enough to just become a doctor and work hard anymore. You must
do something you love, have outside interests, participate in your community and continue learning
throughout your life. These are investments in your future, which help you lead a life full of purpose and
meaning. Unfortunately, too many doctors (especially those with successful careers) have forgotten that there
is more to life than just earning money. Finding a second source of income, which comes from something you
love to do, will make life much more interesting – after all, medicine can become very monotonous if you
don’t explore new options. As you get senior, it’s the quality of your patients which counts, and you are not
going to be very excited about doing your 500th appendectomy.
Finding a mentor who can give you the benefit of his experience can also help you achieve your goals. This is
why every athlete has a coach – to drive them, to make suggestions, to help encourage them to better their
best. Coaches know exactly how to get their "stars" to work a little harder, to stretch their horizons, to try
things that they ordinarily wouldn’t have tried left on their own. Many doctors hate the business side of
practice, but that is exactly where profits are made or lost! So, what’s a doctor to do? Simple - put a
knowledgeable coach on your success team, and maybe you’ll win the Olympics of success in practice ! How
do you find such a coach? If you have a friend or relative who is a successful businessman, ask him for help.
Many successful people are very happy to share their secrets of success with others. Another useful source is
your patients. Pick your most successful patient, and ask for help. Most patients are more than happy to help
their doctors !
In his book, Finding Your Niche, author Laurence Pino suggests trying this exercise. “Visualize your own
funeral. There will be four speakers at the service: a family member, a friend, a colleague , and an associate
from your community. What would you like these speakers to say about you and your life?” This might seem a
morbid thought to some, but it’s worth considering Pino’s point. What exactly is it that you hope to
accomplish in your lifetime? You then need to plan your life so that you can achieve these goals. Planning

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backwards works much better than stepping forward into the unknown. If you plan well, you can lead a life
which you can look back upon with pride and joy.

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2-Beginning practise – get off to a flying start !
"The starting point of all achievement is desire. Keep this constantly in mind. Weak desires bring weak results,
just as a small amount of fire makes a small amount of heat."
- Napoleon Hill
Starting practice can be difficult , because so many things need to be done at exactly the right time, and it’s
easy to get overwhelmed. Often, it’s difficult to know what to do and when to do it, because this is the first
time in your life that you will be handling a job of such complexity entirely by yourself. A little advance
planning can go a long way toward giving you confidence when your clinic actually starts. It’s helpful to have a
timeline and use basic project planning techniques to ensure that everything goes off smoothly. A good start
will boost your chances of long-term success considerably !
When to start?
When should you cut the umbilical cord of training and start practice? How do you know when you are ready
to start off on your own? This depends upon lots of factors, such as your career goals and your field of
specialization. Thus, while a family physician may be comfortable starting within a few months of graduating,
many specialists will want to work with a senior specialist for some years before starting out on their own.
Other factors such as marriage and bearing children can also play an important role in this decision.
Where to start?
Deciding where to practise is one of the most important decisions you will need to make. Sometimes you may
not have much choice in the matter - for example, married women may have to settle down where their
husband chooses to locate. But if you do have a choice, then how should you go about selecting the best
location for your practise? Most new doctors mindlessly choose to settle down in large cities, because this is
where the “glamour” and “action” is. However, often the competition here is intense, and you may be much
better off looking for alternatives. Remember that the place where you eventually practise will, to a certain
extent, determine the pattern of the practice. It may take months of research and effort before you find a
town, which is not only suitable for your practice, but also optimal for your personal life and bringing up a
family.
There is an axiom in business that there are three keys to success: location, location, and location. The best
location for your practice is in a convenient, highly visible, and easily accessible office. The easier you make it
for potential patients to find and use your services, the more quickly you will achieve the level of success you
desire. After all, if you want to deliver a service to the public, then you will be most successful if you are

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located where the public is willing to go. Selecting a location should be done with the same care as selecting a
spouse - you want a long, healthy, prosperous and happy lifetime together, so treat the decision with an eye
toward the long term. Chances are that you will spend many years building and growing your practice in the
location you choose, so it's important for you to consider where you would like to work and live for the long
term.
You should pay attention to the following points:
• The community's need for a doctor.
How many other doctors are there in the area? What are their specialties? Will the area support
another doctor? What is the density of the population? Is there anticipated growth or decline in the
population?
• Your needs and those of your family
Are buildings or office premises available for purchase? Will you lease or rent? Has the property plenty
of car parking space? Is there good access to public transport? What are the recreational facilities and
social opportunities? Are there good schools nearby? Will they suit the ages of your children? Will the
rest of the family be able to find work? Will planning permission be necessary to convert the property
for medical use?
• The local medical facilities
Is there a good local hospital or health centre? What other doctor are available for consultations and
referral? Are they likely to be co-operative?
Since this may be one of the most important decisions you ever make, give it enough thought and attention,
and don’t just accept the first opportunity which comes your way. It might be a good idea to serve as a locum
or an assistant to get a “feel” of what practice in the area is like.
Types of Private Practise
When you commence private practise , you will need to decide which form your practice will take. There are
three main options:
1. Single-handed practice.
2. A partnership.
3. A group practice.
Which method you choose will depend on your own physical and mental abilities, financial circumstances and
personal aspirations. All the methods have their advocates: it is up to you to determine and define your aims
in order to find out what you really want. It need not be an irrevocable decision: you may decide to start
working single-handed, and then meet a colleague with whom you feel you could work and form a
partnership.

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SINGLE HANDED PRACTICE
This is by far the most popular type, and allows you to be completely independent. You have to be dedicated
and confident, because you are responsible for everything connected with the practice, including obtaining
premises, fixtures and fittings, decoration, practice organization, financial planning and management; and you
will have to make all the decisions. Think of yourself as being an entrepreneur starting and running a small
company. Independence can prove a little daunting, particularly if you have been working in a hospital where
much of the support structure is provided and the responsibility is mainly clinical. However, you do have the
satisfaction of knowing that the success of the practice is all your own work and, of course, the patients are
entirely yours. This type of practice is very flexible: it can be started without legal formality and the accounting
requirements are fairly straightforward and simple. It gives great freedom, but it brings great responsibility.
Many practitioners enjoy working on their own and have highly successful and profitable practices. You can
make decisions yourself without having to waste time on committees and meetings – and you can mold your
practice so that it is as efficient as possible.
The disadvantages occur when you are ill or you wish to take a holiday, for unless you close the practice or
find a suitable locum, holidays become non-existent. You might also find it harder to compete with larger
group practices which have greater financial muscle, so you will have to work harder to attract new patients. If
you are ill and cannot practice, there is no income – effectively, you are a “daily wages” earner ! Solo practice
is still the commonest form of private practice in India today.
PARTNERSHIP
If you want shared responsibility, a partnership with one or more colleagues may be the answer. A partnership
is preferably a formal legal relationship rather than an informal agreement with no legal authority. A
partnership consists of two or more people, who join together with a view to making a profit. The partnership
is subject to certain legal formalities such as the sharing of profits. Each partner is personally liable for the
debts of the partnership or of the individual partners if they are unable to meet their own debts. Therefore,
there must be complete confidence and trust.
Partnerships have many advantages. Each partner may contribute capital and will devote time and energy to
the success of the practice. Special skills and expertise may be complementary, thereby expanding the range
of patients the practice can accept. Decisions, responsibilities and management of the practice will be shared.
A partner may well bring in valuable referrals and contacts. In addition, an older and more experienced
practitioner can be of considerable benefit to the practice. A partner is invaluable if you are ill, have an
accident or if you have to give time to a family crisis. Whether you personally are at work or not, the practice
will continue, the patients will be seen and you are relieved of the worry of finding a colleague to cover for
you while you are absent. Partners should not only be regarded as useful for the difficult times- it is also very
pleasant to share success with somebody else and to plan for the future.

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A partnership is, however, a close relationship and entails a great deal of tolerance and understanding if it is to
be successful. A shared decision can mean one, which is reached only through compromise and possibly
argument. Disagreements are rarely over patients, but usually center on management or financial matters.
Patients identify with a particular partner and there is occasionally a cross over during holidays, professional
courses or sickness, so the attitudes and behavior of the partners should convey an atmosphere of stability.
Take your time over entering into a partnership. It may be a good idea to work together informally for a while
to see how compatible you are before signing any agreements. A partnership, whether informal or formal, is a
social contract, and as in marriage, divorce can be expensive and upsetting.
GROUP PRACTICE
Group practise is becoming increasingly popular in India now. Here, two or more practitioners' join together to
share expenses such as rent, rates, electricity and water charges. In this type of practice, therefore, you would
have to access to all the facilities, such as the receptionist but remain independent, responsible for your
patients and with complete control of your own finances. This option has many attractions, particularly the
shared responsibility for the premises and facilities and the contact and friendship of your fellow practitioners.
This can be very useful for referrals, on call duties and holiday arrangements. In the US , after the advent of
managed care, most doctors have turned to group practise, because they found it difficult to meet the
bureaucratic hassles and paperwork demands of HMOs. Many US doctors want the protection of an
established practice, with someone else running the business, so they don’t have to cope with administrative
hassles, and can focus on providing good medical care to their patients.
The ideal size practice is represented by the fingers of one hand for specialists and the fingers of both hands
for primary care physicians. Specialists shouldn't try to grow much beyond four or five because they start
acting like employees and refusing to compromise for the good of the group. And, there's nothing to be gained
by getting bigger. All the subspecialty skills can normally be covered by four or five colleagues and there are
few economies of scale to be gained by further growth. The statistics are clear: the larger the practice, the
higher the overhead.
HOSPITAL PRACTISE
There are additional options too. Many doctors now prefer to work full-time for large corporate hospitals.
While this provides the prestige of being a consultant in a reputed hospital, a steady stream of patients, an
established infrastructure, access to the latest medical equipment, and no administrative responsibilities, you
need to pay a price for this. While the job satisfaction can be tremendous, since you are working in a “state of
the art “ medical facility which attracts challenging patients from all over the country, and serves as a referral
center for difficult cases, since the hospital retains the majority of the patient’s fees, your financial benefits
are capped as compared to doctors in private practice. Also, most hospitals are hotbeds of petty medical
politics, and the amount of backbiting and bitching which goes on amongst the medial staff can be frustrating.

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You also need to know how to butter up the hospital’s administration and trustees to keep them happy. Many
doctors find that not only does the hospital administration retain the lion’s share of the profits, leaving them
with chickenfeed, they also force them to admit a minimum number of patients and to generate a certain
amount of income every year , as a result of which they lose their medical autonomy. Since competition for
these hospital attachments is intense, the fear of being thrown out of the job is always present.
GOVERNMENT PRACTISE
Many doctors find practicing in a government hospital satisfying. They do not need to worry about attracting
patients or raising money to start practice. They usually have the pleasure of being able to teach the next
generation of doctors, and this interaction with medical students and residents keeps them young. Job
satisfaction can be considerable, since the sickest and most complex patients often end up in government
hospitals. One is also on many government regulatory bodies and committees and can wield considerable
power in public health, government projects, and professional medical societies. As a Professor, many doctors
are leaders in their profession . However, dealing with the bureaucracy and government machinery can be a
uphill task. One needs to keep the VIPs in power happy, and buying new equipment can be a frustrating
exercise. Also, promotions and professional opportunities are restricted; you are forced to live with limited
budgets and miles of red-tape; and many doctors find the chores associated with administering a department
very unwelcome.
Key advisors you will need to help you start
When practicing medicine, you will need advisors to help you with your various business, legal and accounting
needs . Rather than solicit informal advice from friends, family or others, you will be better served if you select
professional advisors in the very beginning. You may want to seek recommendations from other physicians
concerning these advisors. Interview each of them. Once you are convinced that they have the experience you
need, determine whether you can establish a rapport with them individually, and if they can work with each
other. Choose these advisors with great care and forethought – they will play a vital role in the future growth
of your practice. Perhaps one of the most important characteristics to look for should be how well you can
relate to him, because this relationship requires a high level of trust and understanding. Once you have found
an advisor you are happy with, you can ask him to recommend another advisor in the other fields you need
help. Thus, an accountant you are happy with may recommend an attorney, or vice verse.
The accountant
The accountant will be responsible for the following:
1. Setting up and monitoring financial record keeping
2. Establishing sound financial guidelines on expenditure, salaries and pensions.
3. Advising on, analysing and projecting the growth and development of the practice.

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4. Preparing the annual balance sheet and income statement.
5. Dealing with all tax matters.
The lawyer
A lawyer is another necessary advisor. You must ask his advice in connection with all legal matters. Lease
agreements, conveyance documents, partnership, limited company and insurance agreements must all be
seen by him. A small legal practice with two or three partners is usually the best option for most doctors, to
ensure that your lawyer has enough time for you.
The bank manager
A sympathetic and helpful bank manager is essential in financing the initial capital expenditure and providing
you with a reserve to pay continuing expenses until the practice begins to generate some income. It is a good
idea to have a talk with him before you begin looking for premises or take the first steps towards starting a
private practice. He then knows what you have in mind and can advise you on a number of matters. He may
even put you in touch with the other professional people who may be of help to you. Banks, on the whole, are
kindly disposed towards applications for professional practice facilities, because doctors usually have a good
track record in repaying their loans, and are considered to be excellent credit risks. Unless there is a serious
problem, you will have no difficulty in obtaining the money you need for the practice.
There are other advisers you will need as well, and one of the most important is an insurance agent. Don’t
even dream of starting practice without ensuring that you have a valid professional indemnity insurance policy
to protect you from malpractise claims. You will also need to insure your clinic ; and the expensive medical
equipment you buy. Other advisors may include: financial consultants, to help you manage your money as
your practice grows; and marketing consultants, to help you grow your practice. In the US, medical practice
management firms will often provide these services under one roof.
Getting referrals
The first few months after you start practice are usually the most difficult for most doctors. You are full of
enthusiasm and your technical skills are finely honed, but you may find that attracting patients is very difficult.
If you are fortunate and come from a family of doctors, this will help you immensely in getting off to a flying
start – but what happens if you have no doctors in your family? Most doctors will go through three stages in
their professional life.
1. No work, no money, lots of time
2. Some work, some money, some time
3. Plenty of work , plenty of money, no time

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Unfortunately, many doctors who start practice end up falling prey to the temptation of giving cuts and
kickbacks to referring doctors. They are so desperate for patients, that they are willing to stoop to any depth
to allow them to make ends meet. They justify their approach by saying “ Everyone does it anyway”; and are
worried that if they don’t, they will starve. However, this is a very short-sighted tactic, which will end up
hurting you in the long run. Not only will it reduce your self-esteem because you are behaving unethically; it
will also force you to do things you are ashamed of doing ( for example, unnecessary surgery, because the
referring GP insists you do it). Also, you could devote the same energy more constructively to building direct
referral channels to your patients, which is far more satisfying and rewarding in the long run !
So what can you do to get more patients? Actually, quite a lot ! Sitting and waiting for patients to come to you
will not help – you are going to need to get out and let people know about your skills, so they will want to
send patients to you. In order to get referrals , you need to rely on an ever-widening circle of friends,
colleagues, and contacts. In order to do so, you need to learn to "network" , that intangible collection of skills
that successful businesspeople seem to use effortlessly. Networking, when handled skillfully, is, more art than
science , just like medicine is. Whether its simple rules are followed by either a new doctor or veteran
physician, networking can produce decided benefits. You first need to start by networking with colleagues.
Unfortunately, most doctors still treat colleagues as competitors. They are seen as rivals, and petty medical
politics often result in rivalry and pulling each other down – energies which could have been constructively
used instead to build each other up ! United we stand , divided we fall is as true today as it was centuries ago.
Networking allows you to pool your skills with others, so that the sum of the parts is greater than the whole.
Just like some doctors naturally acquire a polished bedside manner, others have excellent networking skills.
Most of these doctors are politically very active, and their “people skills” are excellent -learn from them how
to network efficiently ! Treat your colleagues well and trust them . Do not bad-mouth other doctors – word
gets around ! Make it easy for them to get in touch with you and update them about their patients. If you are
computer-savvy, offer to help them update their skills, so they are grateful to you. Attend medical conferences
and use these as opportunities to meet as many of your colleagues as you can. At social occasions, instead of
hanging out with old friends, fraternise as much as you can so you can develop new contacts.
Successful networking is about meeting people and forming relationships – you help them so that they will
help you. Try to do as much good to others as you can ! If you want to increase the number of referrals to your
primary-care practice, interact with potential sources of new patients. Determine who the relevant people are
- you need to perpetually scan your environment and mentally tuck away the names of people and
organizations that will eventually be of use to you. You also need to be able to give them good reasons as to
why they would be better off sending their patients to you, rather than anyone else. They key to networking is
to follow up and stay in touch. For example, sending a personal note of thanks is one task that many of us fail
to do. The benefits of such a simple act are incalculable.

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Networking involves honing your interpersonal skills and the following acronym will help you network more
efficiently.
N: Remember their names.
E: Eye contact is key.
T: Talk less and listen more.
W: Write follow-up notes on a consistent basis.
O: Be open and ask open-ended questions.
R: Become a resource to others.
K: Knowledge is power; know people and know their work.
Your patients can be very helpful in your networking efforts. You can capitalize on their goodwill to make new
contacts and explore new opportunities. Most patients are grateful towards their doctors, and are more than
happy to help them ! Many doctors have made good use of their patients to build up their practice and so can
you ! Learn to speak in the local language – this simple act will help to set your patients at ease, and increase
your practice
manifold !
Here are simple techniques successful networkers use
1. Speak
Take every opportunity to speak about your specialty – both on a one-on-one basis, to making presentations
to large groups. Be enthusiastic and willing to talk – and have ready-made presentations for those “last-
minute” invitations ! Eloquent doctors are always in demand !
2. Participate
Join medical organizations. It is better to belong to fewer organizations and take an active role in them than to
belong to many with superficial connections to the membership. Truly participating allows you to really get to
know people and thereby supports your desire to build professional relationships with them. If there isn't an
organization that fits with your objectives, create one. It can be a physical organization or a virtual one. Being
the founder of the organization gives you instant credibility with your entire membership and gives you an
opportunity to define and mold it.
3. Publish
Write articles ! While this can be difficult, it will get easier as time goes by – and the more you write, the more
you will be asked to write ! Doctors who can express themselves clearly are always in short supply !
4. Volunteer
Volunteering is a great way to build professional relationships while giving back to the community. Take a

19
volunteer position that allows you to use your skills and express your passion. Your network will grow along
with your sense of accomplishment.
5. Socialize
Socialising is great way to build and nurture your network . It’s very useful to host an event. This can be a party
at your house or a recurring event at a chosen meeting place. This will provide an informal way to get together
and connect the members of your network with each other. If each member brings a member of their
network, it will also help to significantly expand yours. Remember, the secret for success if often not knowhow
, but know who !
As with any job, well begun is half-done, and while your first few years in private practice can involve a lot of
hard work, this investment of time and energy can pay off in spades for the rest of your life. Don’t get
disheartened when things don’t seem to be going well in the beginning – remember that everyone has to
struggle to establish themselves !

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3-Designing your clinic - make it patient-friendly
"Always design a thing by considering it in its next larger context—a chair in a room, a room in a house, a
house in an environment, an environment in a city plan. "
- Eliel Saarinen
Most doctors starting practice have a limited budget, so your options when constructing your clinic are likely
to be limited. However, since this is one of the most important decisions you will make, you need to give it a
lot of thought. Don’t hesitate to raise funds or take a loan to buy more space than you think you can afford.
Not only will your investment in real estate be sound, you need to leave yourself enough space for expansion
for the future as you become busier, since changing your location is so difficult once you are established.
Unfortunately, most doctor’s clinics are still very depressing places – and most look just like any other doctor’s
clinic. Spend some time and energy in designing and building a better clinic - after all, you will be spending
most of your life here ! If you prefer practicing medicine to going on weekly sightseeing excursions to look at
suitable sites, you need to find a reputable, commercial real estate broker to help you find space for your
clinic. Based on an evaluation of your needs and budgetary requirements, the broker should produce three to
five prime sites in your target area—containing information on traffic, photos, locations of competitors, and
details on leases and/or purchase options.
Try to locate your clinic in a site which is close to public transport, so you are easily accessible to patients.
Most cities have their equivalent of a “Harley Street” , which is considered to be the “medical heart” of the
city where many doctors practice. If you can afford a place here, this is a useful “high-profile’ address to have.
Being located in a busy area will help to attract patients, many of whom prefer doctors who are close to where
they live. Practising in a “medical office building” along with a lot of other doctors will help to put you in the
heart of all the medical action, facilitating networking with doctors, and getting and providing referrals. Of
course, it may also mean that patients may go to your “competition” in the building, rather than to you !
Try to stay as close to your residence if this is possible – commuting can be hell in many cities today. Many
young doctors start many clinics all over town, and take as many hospital attachments as possible, in order to
attract as many patients as possible. While easy availability is important, often this means that they waste a
lot of their time commuting. Not only does this drain their energy, it also is frustrating for patents, who may
find it very difficult to get hold of the doctor when they need to. Hospital attachments can be a valuable
source of patients , and also allow you the opportunity to network with colleagues and establish yourself
professionally. The admission and operating privileges they provide are essential for doctors in surgical
branches, who need theatre facilities.
When you start your clinic, make sure you have all the required permissions. For example, not only will you

21
need permission from the society if you practice in a residential building, you will need to make sure this
permission is in writing, so you do not have problems in the future.
While purchasing the premises can be expensive, you can look upon this as an investment in real estate, which
will usually appreciate in time and is a valuable asset. A less expensive option is to lease or rent a place to start
your practice . Young doctors who are just starting practice may not be able to afford a clinic of their own. In
such a case, starting practice in a polyclinic is a very useful stepping stone. Study the owner’s policies and
decide whether they are good for you and your patients. Does the polyclinic offer any services apart from a
consulting room? Do they have an efficient receptionist? Is the receptionist capable of handling your patients?
After how many years will the rent increase? Are the current doctors practicing in the polyclinic happy with
the owner?
Be careful in selecting an architect for designing your clinic. Remember, experience counts. It’s a good idea to
actually visit the clinics the architect or interior designer has built in the past, to ensure that his work is
reliable. Also, keep an open mind, and friends, doctors and patients for suggestions for your new clinic - they
may have seen novel ideas elsewhere which are worth incorporating.
Strategically placed sign boards outside the building are extremely important in helping your patients find your
clinic. Illuminated sign boards are even better, since they will increase awareness of your clinic in the
community . If you work in a large building, make sure that the entrance to your clinic stands out in the maze
of doors and corridors. Keep your building security guards and lift operators happy ( perhaps by providing
them with free medical care) , so that they take better care of your patients.
In order that your clinic functions efficiently, rooms should be built to allow optimal traffic flow of patients,
and medical and clerical staff The designer’s goal should be to make patient "flow and function" run smoothly,
with a minimum of disruption and noise. Space is always at a premium, and you will need a skillful architect to
help you make the most of every inch. Your time is precious, and your availability is often the bottleneck in
your clinic’s functioning. This is why it may be a good idea to have two or more examination rooms, so that
you can examine more patients in a shorter time . Thus, while you are examining one patient, your nurse can
help the other patient get ready for you in the other room. A time and motion study has shown that three
treatment rooms are the ideal number for a medium-sized practice. Visiting the clinics of senior doctors (
especially those in large cities),as well as the newer 5-star hospitals will also give you lots of ideas as to how
you can create a pleasant ambience in your clinic. If you can afford it, go abroad to see the world’s leading
clinics, so you can use these as a model when designing yours. Remember to wire your clinic for the future, so
that it is ready to accept the newest telephone and computer networks.
Medical clinic designers have started to introduce a new and exciting interior design format called the
"therapeutic environment." These designers feel that healing and recovery are dramatically affected by colors,

22
finishes, lighting, views, furnishings, open spaces, and even sounds and smells. These are referred to as
"positive distractions" and have actually been shown to be healing agents. The practice décor must project a
professional image. Interior designers and decorators are expensive, but if you do not have a good,
imaginative sense of colour and design, then you will need the help of a spouse, a friend or a professional.
Pictures can be useful assets in addition to the colour scheme, especially in the reception room where patients
are waiting, since they provide a talking point with other patients. We have put up the pictures of some of the
test tube babies which have been born in our clinic, and many patients enjoy looking at these, since it gives
them hope that they can succeed to. You can put up patient educational posters; as well as a bulletin board,
which has articles on medical topics your patients will find of interest. Attractive information signs are
extremely useful since they help direct the patient and save a lot of questions. Many signs are mass produced
by firms, or you can have them custom designed. Such examples include: No smoking; Details of clinic timings;
and payment schedules.
A good way of finding out how your patients feel when they arrive in your office, is for you to sit in your own
waiting room ! Are you comfortable? Would you be happy to wait in this room? Design your clinic by always
keeping the patient's viewpoint in mind, so that you can build an office that maximizes your productivity
without losing the warm human touch that characterizes the best practices. Many physicians now have TVs in
their waiting rooms, so that their patients don’t mind waiting.
Provide for a welcoming atmosphere by positioning your receptionist with direct eye contact with anyone
coming through the door. To make the reception area seem more "friendly," don’t place the receptionist
behind a wall or behind glass. Pictures of you receiving awards, and photos with famous personalities and
celebrity patients can reassure your patients ( and their family members) that you are a competent doctor.
Putting up your medical diplomas and certificates will also help to reinforce your credentials , ability and
learning. You might also want to put a file which contains testimonials from patients about your services. A
press cutting file which contains articles by and about you is also impressive. Keep your practice brochures and
patient education pamphlets in your reception area. Encourage your patients to read these– and to take them
home – this is an excellent way of marketing !
Patients expect the clinic to be clean, and you need to be obsessive about this. Make sure all the cleaning is
completed by the time the first patient arrives. If you fail to find anybody to do the cleaning, you will have to
do it yourself ! The ambience of your reception area creates clues for people about what they should
realistically expect from the care and service in your practice. Too elaborate an area may send a message that
care will be expensive, while an overcrowded room full of grouchy looking people signals a long wait and a
rushed physician. The seating and the size of your reception area must be adequate, not only for the patients,
but also for the relatives and friends they frequently bring with them. As a rule of thumb, if you see four
patients in an hour, you should have twelve seating spaces ( three times the seating capacity for the number
of individuals you have scheduled to see in the hour) .

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A telephone line should be available for the patient's use, as they may wish to ring their office or home. The
best option is to install a pay-phone service, to ensure the phone facilities are not misused. A rack or table
carrying an adequate supply of general interest magazines is essential. Do not let your magazines become
dusty, torn and two or three years out of date. Flowers and plants in tasteful arrangements have a welcoming
effect. Silk flowers and plants are a good way of avoiding continual worry about watering, providing they are
not allowed to become drab and dusty. Background music is popular and can provide a pleasant and relaxing
atmosphere for patients who are sometimes tense when they arrive. Have a supply of tea, coffee , biscuits ,
sweets and soft drinks for your patients and visitors. A supply of drinking water should always be available, as
should toilet facilities. The toilet is often the best indicator of a facilities’ focus on cleanliness and hygiene –
make sure yours is spotless and kept clean . It’s a good idea to use it frequently yourself to ensure this is done
! A collection of small toys and children's books is a good idea to prevent boredom.
If you can afford it, airconditioning your clinic is one of the best investments you can make. A comfortable
environment will not only keep your patients happy, it will also dramatically enhance the productivity of your
staff ! Carpets have become more affordable, and offer a touch of class to your clinic.
If you use assistants in your clinic, try to provide a private seating area for them, where they can talk to
patients in private. Patients must have a small private area in which to change. A simple curtained-off space in
one corner is adequate; or screens may be used if curtaining is not possible. Some very busy doctors try to
improve their efficiency by seeing more than one patient at one time. This is terrible, and should be avoided.
The least you can provide your patients is your undivided attention – even if it is only for a few minutes.
Patients understandably hate talking about their problems in front of other patients !
Your front office is your public face but just having a comfortable reception is not enough. Your staff is vitally
important, and they can literally make you or break you. It’s a good idea to provide uniforms for your staff.
Not only does this help your clinic look much more professional, it also helps your patients identify your staff
members. Staff should wear name badges; and having pictures of the staff with their names and designations
on your bulletin board can help to enhance their self-esteem, because it sends a message that every person on
staff is a respected member of the team. It also makes it easier for patients to approach a staff member when
they can recall the person's name. The best feature of a good reception area is an immediate acknowledgment
of people as they arrive. A warm welcome creates a positive expectation about the care and service that will
follow and builds trust and rapport. You need to constantly motivate your staff to present your practice in a
positive light. Staff-patient interactions are crucial because the reality is that your staff spends much more
time with your patients than you do –an average patient spends 45 minutes to one hour in the office and only
five to 10 minutes with you. Every interaction that patients have with the practice has to be managed and
made positive. Investing in good employees involves more than wages — you also need to provide them with
the best tools for the job, including computers and Xerox machines, depending upon your practice needs.
It’s a good idea to create an office manual which describes commonly performed office procedures, such as

24
answering the telephone . It is useful to have “cheat sheets” and reference pages, which summarise the
common queries patients have . While establishing these systems may seem like a lot of trouble , having a
defined system will help your practice to grow. The primary responsibility of the front office is to greet
patients— period. Remember that you never have a second chance to make a first impression, so make sure
you make the most of your space, funds and staff to make the best impression possible !

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4-Assessing your practice – take a critical look at what you are doing
"Good criticism is very rare and always precious. "
- Ralph Waldo Emerson.
After practicing for a few years, we tend to get into a rut. This is why it’s a good idea to step back and critically
appraise your practice every year . You can use the following criteria in order to do so objectively. If you can
request another doctor to do this for you, this is even better. Critical patients can also help you improve ,
provided you don’t get defensive when they censure you. Use their feedback constructively to improve the
care you provide to your patients !
a. General Clinic Facilities
Is the area big enough? What about the design, atmosphere, cleanliness, maintenance?
Are the waiting rooms comfortable? Do the patients feel pampered?
Do the examination rooms offer privacy? Are they well-equipped?
Are the toilets clean? easily accessible?
b. Telephone System
Are their enough incoming lines?
Are phones answered promptly and politely?
Are fax, e-mail services available?
Is there a scheduled call back time or other means of returning calls?
Is there a system to ensure incoming messages are appropriately directed and acknowledged?
Do patients know how to contact you after the clinic is closed in case of emergency?
c. Appointment System
Does it satisfactorily accommodate patients? Is there a very long waiting list?
Do you keep to your appointment schedule?
Is there a system to accommodate urgent or emergency appointments?
Is there provision for coverage after the clinic is closed?
d. Filing System
Is the filing system efficient and accessible?

26
How are the charts coded?
Is there a system to avoid mis-filing?
e. Medical Instruments and Equipment
Is the equipment modern and uptodate?
Are appropriate sterilization procedures in place?
Is there a system for managing biomedical waste?
f. Drug Supplies and Samples
Are appropriate drugs available and properly stored?
Is there a proper system for maintaining current list of drugs on hand and monitoring expiration dates
Are narcotics and other controlled drugs stored securely?
g. Emergency Facilities
Is the emergency medical cart appropriately stocked, centrally stored, and readily available?
Does the staff know what to do in the event of an emergency or disaster?
h. Laboratory Investigations
What type of investigations are available?
Are they accessible on-site or close by?
Is quality control maintained? Are the results verified? checked? recorded properly?
i. Personnel
Is there enough staff for running the clinic smoothly?
Are they well trained?
Do they work well with each other?
Are regular staff meetings held to trouble shoot problems?
Are there documented job descriptions and office policies?
k. Miscellaneous Observations
Is there a system for handling incoming medical reports and test results?
Is there a system for handling consultations and referrals?

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Are educational and medical reference materials available for the
doctor? for the patients?
It’s also a good idea to pretend you are a new patient, and subject your clinic to the following First Impressions
Test . This can help you identify deficiencies in your present practice, so you can work on improving it
First Impressions Test.
-------------------------------------------------------------------------------------------------
1 Is the practice easy to identify from the street? Yes No
2 Once inside the building, is it easy to find your office? Yes No
3 When you enter the office, is the air fresh? Yes No
4
If a glass partition separates the reception are and the
receptionist, does the receptionist open it immediately
when a visitor arrives?
Yes No
5 Is the reception area furniture free of stains and tears? Yes No
6 Is there some individual seating in the reception area? Yes No
7 there current issues of different magazines? Yes No
8 Are patients greeted with a smile? Yes No
9 Do staff make eye contact with the patient? Yes No
10 Are first-time patients welcomed to the practice? Yes No
11
Does a staff member ask the patient about the name
he or she prefers to be called? Alternatively, are all adult
patients addressed by their last names?
Yes No
12 Are patients afforded privacy to explain why they are there? Yes No
13 Are patient names and records accessible to staff only? Yes No
14 Do staff orient patients about what will happen next? Yes No
15 Does the patient meet his or her physician before disrobing,
giving a urine specimen, having blood pressure checked, and
Yes No

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so on?
16
Do staff or physicians apologize for waits longer then five
minutes?
Yes No
17 Do staff members listen without interrupting? Yes No
18 Do physicians and staff appear to be happy in their positions? Yes No
Don’t get disheartened if your score is low – this checklist can give you a goal you should aim for !
Benchmarking Your Medical Practice
While the term benchmarking may be unfamiliar, it’s something doctors do all the time to improve their
clinical skills. We compare and observe skilled and experienced surgeons, for example, so we can learn their
superior surgical techniques - and in exactly the same way, benchmarking is a business technique which
analyses successful competitors to determine the indicators of business success , and then applies that
information to achieving business growth and improvement for yourself. For doctors benchmarking is a way of
taking a critical look or "snapshot" of your practice's health. It provides you with an objective way to measure
your practice's performance, and to compare it with others’, so that you can learn from the best practices of
the leaders.
Historically, physicians have not formally benchmarked their practices. However, benchmarking is not such a
new concept, and it’s something all of us have been doing informally for years. For example, when we
compare our past year’s income with our present year’s performance, we are using internal benchmarking.
Has your income gone up or down? Have expenses remained steady, or have they spiked up? Looking
internally will show you how well you are progressing.
Clinics have also used benchmarking to improve their clinical protocols. Thus, leading IVF clinics collaborate
with each other and compare their techniques and pregnancy rates, so that they can learn from each other,
and adopt the techniques which give the best results.
Benchmarking is an excellent tool for assessing the health of your practice and detecting problems as early as
possible. Remember that you can learn a lot from other successful doctors – and benchmarking will allow
everyone to improve ! Thus, if you are reluctant to share information with your local “competition”, you might
want to benchmark with a colleague in another city, whose specialty and practise size is similar to yours.
Rather than compete with each other, you can collaborate to create a win-win situation !

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5-Marketing your practice – how to get more patients
"Everyone lives by selling something."
- Robert Louis Stevenson
The word marketing is still taboo for many doctors, and many physicians confuse marketing with advertising.
We need to remember that the role physicians play is unique, and that marketing techniques adopted by
other industries are not appropriate for doctors. What you need to concentrate on is “practice building”–
which is a perfectly ethical activity of promoting your practice that successful doctors have been using for
many years. Traditionally, the only acceptable marketing allowed was “word of mouth”, but today doctors can
use additional avenues to promote themselves ethically. The purpose of practise building is to let potential
patients and referral sources know who you are, what you do, and when and where you do it.
Why should doctors worry about promoting their practice? After all, if you are good then won’t the patients
automatically come to you? If you are the only provider of your particular expertise in the region, then you
may not need to worry too much about marketing. But today, doctors compete for patients and if you want to
see your practice grow and flourish, you need to market yourself.
Satisfied patients are the best word-of-mouth marketing tool a physician can have because they tell others
about the positive experiences they have had with you. In fact, the major premise of this book is that if you
can make your practice patient-centric and focus on keeping your patients happy, you will become a
successful physician. You should make every effort to exceed your patients’ expectations regarding their
health care. For example, if you phone patients at home after surgery and check on their conditions, you can
create a “wow” experience for the patient. Patients who receive a personal phone call from their physician will
almost certainly tell dozens of other people about it, generating word-of-mouth referrals. This strategy is easy,
costs nothing, and is extremely effective.
Should you attempt to market directly to the public? If you want your practice to grow, the simple answer is -
Yes ! The real question is not “should we do it?,” but “how do we market to patients?” Since doctors in India
cannot advertise , you need to select your marketing tools carefully.
There are many avenues open to you. For example, volunteering at the community level can bring positive
attention. As an advisor or board member for a public service agency, your name can become recognized as a
resource for health -related information. Thus, the local media are more likely to seek a quote or an interview
from an Indian Cancer Society board member than from a less prominent oncologist in town. The best way to
market is to give something away every day – and giving away your time, services and expertise for free can be
very effective !

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One of the best and least expensive way to market your practice is to attract media attention. This can allow
you to attract free public relations that would normally cost thousands of dollars if you had to pay for it and,
more importantly, can attract even hundreds of new patients to your practice. Remember that the media are
always looking for news – which means that if you want them to cover you, what you do should be new ! For
example, if your clinic has bought the first laser for tattoo removal in the city; or you have devised and
successfully performed a new operation, you have a story that will be of interest to the readers of
newspapers.
You need to understand what the media wants when trying to pitch your story to them – remember that
thousands of stories are competing for the limited space in a newspaper. Try to look at things from the
reporter’s point of view if you want to succeed in getting coverage. You need to be aware of their job and
their needs ( for example, what the difference between a news story and a feature story is; and what their
deadline is). They are professionals too, and if you help them to do their job well , they are much more likely
to turn to you when they need information for a health story. Many doctors now also employ PR (Public
Relations ) firms to ensure that their name appears in the media as often as possible.
Creating an event can help to create a buzz if you do it properly . Rather than just sending a press release like
everyone else, if you have a new state-of-the-art piece of medical equipment, invite the media for a free
demonstration. Make it exciting by inviting local celebrities . Whenever possible, have a patient who has used
or experienced the equipment or technology – this makes it more newsworthy.
Contribute articles on health to magazines and newspapers. The public is usually thirsty for well-written
information. If you can arrange to write a health column for the newspaper, do so ! A regularly contributing
author to the local newspaper can become a household name.
Offer to give lectures to the public on your areas of expertise . Forums like Rotary clubs and Lions can be very
useful. Print patient educational brochures on the common medical problems you see in your practise.
Encourage your patients to take these home – this will help to increase awareness in the community about the
services you offer . You can also publish a newsletter and distribute this free to your patients. This will help to
keep them aware of what’s new in medicine – and about the new services you offer. In today’s wired world,
your website can also be a very effective avenue of marketing your practice.
If you are attached to a hospital , use the hospital as a marketing partner. Since both doctors and hospitals
want to attract patients, you should develop the kind of relationships that will allow you to share in the
benefits of hospital marketing activities. Hospital marketing departments recognize that the best “product”
available for them to promote is their physicians. You should want to be the one they call when they need an
expert to be interviewed on the local news. Being interviewed as an expert in your field is one of the lowest

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cost marketing avenues open to a practice. Learn what your hospital wants and likes in a physician. Volunteer
to do screenings and public lectures. Keep the hospital marketing director informed when you do something
noteworthy so they can promote your actions through their public relations efforts. Hospital marketing and
public relations departments struggle to find material to promote to the press and to include in their own
advertising. By keeping them supplied with this material which highlights your expertise, you will become their
“go-to” person, and their promotions will benefit you.
Finally, if you are a consultant, remember that marketing to your referral base – the doctors who refer to you -
is extremely important . Even with today’s educated and choosy consumers, tertiary care is still largely driven
by referral. You must work to retain your referring relationships and to develop new ones. The most important
aspect after ensuring that referred patients are returned to their original doctor’s care is promptly reporting
the consultation results to the referring physician. Referring physicians appreciate hearing promptly from
consultants and many are likely to discontinue sending patients to you if they do not hear back about their
consults from you . Remember that referring is often a question of building relationships and once you receive
the referrals, you need to ensure that the relationship continues. Share your accomplishments with your
referring physicians. For example, send a copy of an article in a professional journal with a personal note
relating it to a referred patient, if possible.
It is helpful to keep in touch with referring physicians in a positive fashion, for example by sending a
congratulations note on something that the physician did or even something the physician’s children
accomplished. This creates positive name recognition and will encourage the referring physician to continue
the referral relationship. Remember to be friends with your referring doctor’s office staff as well ! It’s a good
idea to give them a guided tour of your clinic, so they are familiar with your practice . If you know their names
, this can help you considerably – so cultivate them with care.
Marketing is a continuous process, and a true marketing initiative involves educating patients, public and
referring doctors as to why you are their best choice !
Branding Yourself
When we think of brands, we usually think of consumer goods, such as Coke , Pepsi and Nike. Manufacturers
of fast moving consumer goods have learnt that letting customers know who you are is critical to expanding
their position in the market place. While branding strategies have long been used in large industries, they are
being increasingly employed by today's medical practices. The large internationally renowned US medical
centers, such as Mayo, Johns Hopkins and the Cleveland Clinic have done an excellent job in selling their
“brand”, which is why rich Indians spend lakhs to fly down to these centers for their treatment. In India,
corporate hospitals such as Apollo Hospital have started following in their footsteps. However, you don't have
to be a large center to create a brand identity that sustains your practice over time. You too can develop a

32
singular identity through branding and create an edge over the competition.
Branding is the big picture view that a doctor presents. It's who you are - and how you look to the community,
your professional colleagues, employees, patients and future patients. Branding is about your image, and
developing and delivering a perception that you create. Traditionally, a doctor’s reputation has always been
his “brand “.As a doctor , your brand is you, and branding is a marketing strategy that works well if you follow
these basic principles.
Focus on what you excel. The first step to creating a brand is to identify who you are and what you do best.
Analyze the scope of services and explore your options. What is it that your practice does best and who do you
want to attract? For example, in our clinic, we would like to focus on infertile couples who need advanced
reproductive techniques such as IVF and ICSI. Not only are these much more challenging patients, treating
them gives us more satisfaction, as we can use the cutting edge of medical technology to treat complex
problems – a task few other infertility clinics can handle.
Understand the existing markets. When you have clearly identified the service and image you want to focus
on, it is time to get a better understanding of the market. If you are a primary care physician and care for a
large number of patients with addictive disorders, this may be your brand venue, whereas another primary
care practice may focus on obese patients and nutrition and diet.
Be consistent. Creating a branding strategy and maintaining brand identify require an enormous long-term
commitment. This is not a one-shot deal. Once you imprint your brand on the public you must support it
consistently. It needs to become the overriding philosophy of your practice. Remember that it takes
considerable time to penetrate the market and create brand recognition – and once this is accomplished, it
must be continually reinforced.
Though branding has been used for large health systems and corporate America, it is a new concept for
private practice physicians. It is a powerful tool that will soon become commonplace in the future. A number
of enterprising individuals in India have successfully branded themselves ( names such as Amitabh Bachchan,
Shiamak Davar, Anjali Mukherjee readily come to mind) and doctors such as Dr R K Anand are now following
suit.
A strong brand identity that is built and protected over time can create a long-term, consistent image of
quality and value. Inevitably, you will attract more patients, based on how you have influenced them with your
branding strategies. Those doctors who take branding action now will be tomorrow's leaders.
What about using advertising to attract more patients? It’s well known that the most effective form of
advertising is word of mouth. How we care for our patients and how they perceive our care is what brings us

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more patients. The next best form of advertising is to our colleagues, by communicating our experience and
expertise via scientific presentations and/or publications. In the past, this much was enough. The Code of
Ethics of the Medical Council of India still does not allow doctors to advertise , and most senior doctors in India
look upon advertising with suspicion. After all, doctors are professionals – why should they behave like
shopkeepers in order to attract customers?
However, times have changed, and we need to change with them. Gone are the days when patients had a
family doctor whom they could blindly trust, and who would provide medical care for them from cradle to
grave. Today’s reality is that medical care is often provided on a fragmented , piecemeal basis by numerous
specialists, and the patient needs to learn to get the best medical care for himself. This is why it is so
important that he has access to information on available doctors, so that he can select the best one for
himself .
Most doctors feel that advertising is unethical , but we need to look at the reality more carefully. How are
young doctors who have just started practise going to get patients? How will patients know of their skills and
their expertise? Many young professionals, who have spent long years to qualify and taken loans to start
practise, simply cannot afford to sit back and starve till patients arrive on their doorstep. This is why new
doctors feel they have to resort to unethical practices like cuts and kick-backs today – many of which have
been institutionalized by their seniors. It is more honest to allow them to attract patients by allowing them to
advertise – at least this is open and transparent.
Preventing advertising favours senior doctors – those who have an established reputation, with many hospital
attachments, and lots of patients. They will do their best to maintain the status quo by prohibiting advertising
– not to protect patients as they claim, but to prevent new doctors from competing with them, thus
safeguarding their own interests.
Since senior doctors form the “ medical establishment” , which sets the rules for all doctors , the Medical
Council of India code on ethics still prohibits advertising by doctors. However, this code was developed many
years ago, and needs to be updated so that it is responsive to the needs of today’s patients and doctors. It is
worth remembering that doctors were not allowed to advertise by the powerful American Medical Association
( AMA) in the US as well, many years ago. The reason this changed is that some courageous doctors took the
AMA to court, and the Supreme Court ruled in their favour, declaring that not allowing doctors to advertise
was unfair on them – and also unfair to patients , who need access to information on doctors, so they can
select the best for themselves . Today, the AMA has promulgated guidelines for ethical advertising by
physicians, and these guidelines permit physician advertising , provided it is not false, deceptive or fraudulent.
Maybe we could learn from them !
To keep readers abreast of new medical guidelines worldwide, this is what the Council of the College of

34
Physicians and Surgeons of Alberta says about physician advertising in its Code of Ethics. “ The
Council…believes that clear and accurate information about physician services benefits all parties in the health
care system. “Advertising falls within the definition of "freedom of expression", and any constraints to this
freedom should be minimal and reasonable. “ They clearly specify what is acceptable , and state that
“Advertising is just one of the professional activities subject to the Code of Ethics”.
It is true that advertising has a downside . For one, advertising may cause doctors to start treating their
patients as clients or customers , rather than as patients – and this is a shame. For another, some ads will be
dishonest, but at least they will be in black and white, where they can be refuted and debated – and a doctor
making false claims can be taken to task. This is far better than making tall claims privately within the four
walls of a clinic and taking the patient for a ride.
What about the risk that patients would be lured to the doctors with the fanciest ads, rather than the “best
doctors”? To answer this, think about how patients select doctors in India today . Usually they do so either by
reputation or referral , and neither of these are reliable criteria ! Allowing reputed and reliable doctors to
advertise will help to enlighten and educate patients – and a good example of such educational
advertisements are the ads placed by the Cleveland Clinic, USA in the Times of India. However, advertising can
be very expensive – and may not be cost-effective at all. You need to experiment with different options, and
track how effective they are, so that you know what works best for your practice.
We live in a fast changing global village, and we can no longer afford to cut ourselves off from the rest of the
world ! Since India has an abundance of qualified and skilled doctors who can provide state of the art medical
care at a fraction of the cost which doctors in the West charge, there is tremendous scope to export our
medical services. If we learn to advertise Indian medical services worldwide effectively, we will be able attract
patients from all over the world , and medical services can become a big foreign exchange earner for India.

35
6-Business management 101 - basic business skills you need to know
"The conventional definition of management is getting work done through people, but real management is
developing people through work."
- Agha Hasan Abedi.
Every medical practice is a small business, and being a successful doctor is not just a question of having the
requisite medical skills or purchasing the newest medical equipment . You also need to be an 'entrepreneur'
and to learn basic business skills in order to run a private practice successfully.
Many doctors adopt a self -oriented rather than a patient -oriented approach to their activities. This means
that they decide what medical services to provide, and at what price to sell them, without analysing what
patients want and need. They try to sell their skills, rather than try to provide what sells. They blindly follow
tradition rather than look for market opportunities – and as a result , they are more likely to fail.. They are
going against the law of business, which says that businesses exist in order to satisfy demand, not to satisfy
their owners.
Physicians often fall into two distinctly different profiles: "healers" and "dealers." The healers prefer to
practice medicine free of management, financial and administrative demands; they see business as a
necessary but unappealing part of health care delivery. The dealers, on the other hand, are energized by the
business of medicine; they apply their entrepreneurial energy to building organizations that can compete for
business in a demanding market.
For many physicians, management is not a pleasant role. They don't see management as being consistent with
their altruistic mission of helping patients. They are simply not motivated to manage, since they don't derive
any satisfaction from being efficient administrators. However, doctors must learn that they need to manage
their clinic efficiently, if they hope to achieve their final goal of providing good medical care to their patients !
Remember that it’s not possible to provide good care to your patients unless your employees are happy.
Instead of focusing solely on patients, you also need to focus on the satisfaction and happiness of your
employees. Physicians can derive immense satisfaction from knowing they have created an environment in
which their employees enjoy work – because this is the sort of practise in which their patients will be well
looked after ! As more physicians get the sense of satisfaction that can be derived from caring leadership ,
they will no longer perceive management as being at odds with patient care but instead will recognize their
unique position to enrich the lives of their employees – and through them their patients.
The principal issue facing most medical practices is simple: Will you succeed or perish? The business,

36
regulation, technology, and profession of medicine are quickly evolving. Your medical practice needs an
advantage, and you need to act upon the advantage to assure your continued success. A well thought out
strategic business plan will provide that advantage. While most doctors just muddle along, and grab
opportunities as and when they come, strategic business planning can help you improve your chances of
becoming successful. Use this basic business tool to help improve your practice.
Typically, strategic planning is performed in five stages.
Stage 1: Analyze Your Practice and Its Environment
You need to evaluate several factors, including :
Patients: Where do your patients come from? What attracts them to your practice?
What do they expect from you? Are you satisfying all their needs, providing all the services you should?
Referring physicians: Visit your top referrers personally, and find what they like and, more importantly, dislike,
about your practice.
Services: Know which medical procedures you offer make money and which lose money. Understand where
your profitability lies and try to maximize these.
Competition: Find out what competing doctors are doing for their patients and referrers. Know which ones are
forming networks and what kinds of deals they are offering. Most importantly, know each competitor's
strategy and philosophy.
Regulation: Know what legislation has been recently enacted, what is proposed, and how your practice may be
affected by it. Keep tabs on changes in practice patterns and standards of care.
Stage 2: Analyze Your Strengths and Weaknesses
How is your practice different from anyone else’s? You should assess your practice in the following key areas:
patient friendliness; referrer convenience; "clinical" quality (outcomes); technology (state of the art);
price/cost (economic advantage); and allies and barriers (competitors, financing, networks, etc.). A candid
analysis of these factors will help you determine the strategy for your practice. You may be a technology
leader, or have an inherent price advantage. Whatever your strength, go with it. If you have no strengths, seek
a way to obtain one. As for your weaknesses, instead of ignoring them - do something about them.
Stage 3: Establish Goals
You must establish objective goals to monitor your success. Establish practical goals in income, patient visits,
referring sources, and procedures performed. Your plan should include: a prioritized timeline for adding
specialists, equipment, and administrative support staff; a continually updated (every year) list identifying

37
possible expansion sites; and multiple, contingent funding options.
Stage 4 :Implement Your Plan
Your plan is absolutely worthless if you leave it in the computer or in a desk drawer and expect it to
implement itself. Most strategic plans fail because they are ignored or forgotten. Involve your staff in the
planning, execution, and monitoring phases.
Stage 5: Monitor and Adjust Your Plan
Don’t expect all your plans to become reality. Just like complications can occur after surgery, often through no
fault of yours, you need to handle business complications the same way – don’t ignore them, but correct them
and keep going without altering your core strategy.
If you are planning to offer a new service, you can use the following formula to develop a business plan.
For (target customers - your main market segment only)
Who are dissatisfied with (the current market alternative)
Our product/service is a (new product category)
That provides (key problem-solving capability)
Unlike (the product alternative)
We have assembled (key whole product features for your specific application/solution)
Here's an example of how it might work for an infertility clinic, for example.
For infertile couples
Who are dissatisfied with running around from gynecologist to sonographer
Our medical practice is a new personalized, integrated infertility clinic
That provides couples with complete clinical services under one roof
Unlike current gynecologic clinics
We have assembled a complete service including sonography, specialists, lab tests and counseling
Sometimes it’s hard for a doctor to understand business terms . Just like doctors use medical jargon,
administrators too use management jargon. This can be easy to understand, if you remember that managing a
business is very similar to taking care of a patient ! The following “ translator “ can be a useful guide.

38
Thus, if you read: ” The alternatives, as a result of this audit, are to coordinate a plan, delegate to our
department managers or develop a solution on my own. “, in your mind, you can translate this as: “ The
treatment options, as a result of our annual checkup, are to integrate a service care plan, refer to specialists,
or to treat the situation myself.”
If you encounter a business problem while running your practise , think of it as a patient with an illness and it
will be much easier for you to develop a treatment plan to solve it ! Thus, if you are losing money, then this is
the illness, and your balance sheet is the equivalent of the pulse and BP of the patient ! Just like you ask your
nurse to monitor the patient’s vital signs to ensure he is getting better, you need to ask your accountant to
monitor your cash flows to ensure your practise in improving. Think of a bank loan as the equivalent of a blood
transfusion for your practise’s financial health; and just like stopping smoking helps to improve your patient’s
vital capacity, getting rid of surly and inefficient staff can help to boost your practise’s profitability . One can
Management word Clinical synonym
Act Treat
Advise, recommend Consult
Audit Annual checkup
Bottom line Outcome
Delegates Refers
Difficulty Symptoms
Eliminate Cure
Gut feeling Hypothesis
Implement Manage
Pilot study Research
Organization chart Anatomical structure
Problem Malady
Reduce impact Reduce side effects
Strategic plan Service plan
Goal Outcome

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carry the analogy even further. If you have a patient with a difficult problem and find that you are stuck, what
do you do? Ask a specialist for help, of course ! Similarly, you can use a tax consultant to help you to reduce
your tax liabilities. As a doctor, you are used to managing patients with complex medical problems. You can
apply this expertise to managing your practice’s business problems as well !

40
7-Financial planning and management – boosting your bottomline
"Money is a terrible master but an excellent servant. "
- P.T. Barnum
Your medical practice , like all businesses, needs to make a profit to survive. All the idealism and medical skills
in the world are of no use if you cannot make both ends meet. You cannot afford to be ignorant or careless
with figures , since you are self-employed. No one can run a business without financial control and private
practice is no different from any other business. Many doctors are uncomfortable with financial figures, but
you need to attain basic financial literacy if you need to run your own practice and grow it successfully.
A profit and loss account
This account sets out the income earned ( patient fees) and the expenditure of the practice, the difference
being your profit.
Budgeting
Budgeting is the process of estimating your income as it is earned and expenditure as it is incurred. It helps
you to plan for the future; and to compare what you achieve with what you had expected to achieve. Every
business experiences ups and downs in expenses and income, so careful forecasting is essential, and it is
advisable to always allow a margin for inflation in the forthcoming year.
Cash flow
The cash flow statement sets out what is happening in cash terms. It tabulates the money going out of the
practice to pay for expenses, and the money coming in . If the outgoing is more than in the incoming, you have
a cash flow problem.
The balance sheet
The final accounting item is the balance sheet. This shows what the practice is worth and is usually set out at
the end of the practices' financial year, showing what the practice owns and what it owes.
When you are starting practice, or when you want to offer a new service , buy new equipment or expand, you
will need to raise money. The most convenient source is your bank. Many banks do have special schemes for
doctors, in order to help them buy new equipment or expand their practice. Doctors are usually excellent
credit risks, and most bank managers will be happy to lend you money. Go well prepared with the information
your manager requires , and anticipate a series of questions. The main questions will be as follows:
1. Why do you want the money?

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