HEALTH R FOR PROFITS

Doctors begin to sell themselves

NEED A NEW toaster oven? A good laugh? Your teeth cleaned? Have we got news for you. Just as you were resigning yourself to living in a world where no one but the Internal Revenue Service made housecalls, doctors are changing their ways again.

As the medical world begins to feel the pinch from an increasing surplus of physicians, fixed Medicare payments and more competition from prepaid health plans and walk-in clinics, many physicians are suddenly willing to do whatever it takes, whether it’s keeping later office hours or launching a full-fledged public relations campaign, to make themselves more available and appealing to their patients.

Take Dr. Ronald McConnell, the Richardson dentist whose assistants happily take turns dressing up as Bippo the Hippo, and who sends out a booklet, “Bippo Visits the Dentist,” to new young patients. A gimmick born three years ago, Bippo once graced Dr. McConnell’s office every day, but now, says a member of the doctor’s staff, “We’re just too busy and Bippo only appears for special speaking engagements and programs at schools.”

Then there’s Lemmon Avenue eye doctor Charles Key. Although some patients complain they don’t see him on the day of surgery (Key often doesn’t arrive until after his assistants have done the prepping, anesthetizing and sometimes even made the initial incision), he’ll make sure you receive flowers and a large basket of fruit with a Bible verse attached after your lens implant or cataract removal. Key’s business is a boon for some lucky florist; he’s been known to do 36 operations in a day’s work.

Oh, and about that toaster oven… At Red Bird Dental Associates in Oak Cliff, patients get a $10 credit on their bill for every new patient they refer. After recruiting two new patients, they’re invited to choose a gift from a slick, four-color “referral catalogue,” a wish book of small appliances and house-wares on the order of an S&H Green Stamp catalogue.

The idea, says the 40-employee firm’s director of public relations and personnel, is that “referrals are the practice’s number-one marketing tool. We simply ask our patients, if they are pleased with the care they receive, to replace themselves. And when they do, they get a little reward.”



SUCH SELF-PROMOTING tactics were unheard of until recently. Thirty years ago, the American Medical Association decreed that physicians “should not solicit patients directly or indirectly” and limited doctors to posting their names on the exteriors of their offices in letters a maximum of two inches tall.

Further, AMA guidelines held that “The most worthy and effective advertisement possible, even for a young physician, especially among his brother physicians, is the establishment of a well-merited reputation for professional ability and fidelity. This cannot be forced, but must be the outcome of character and conduct….”

Although a U.S. Supreme Court decision in 1977 held that attorneys, and by extension physicians, have a constitutionally protected right to advertise, and although we’re all familiar with chiropractor Ty Talcott’s Central Expressway billboard, the great majority of Dallas’ private physicians don’t place ads boasting anything beyond their names, addresses and credentials. Even that information is now in larger, bolder type, however, and in the phone book physicians often list their names under more than one heading. Most physicians here remain mightily disgusted by out-and-out advertising, and there’s hardly a better way to ruffle a doctor or her public relations specialist than to confuse marketing strategy (what they do) with, God forbid, advertising (what others do).

Marketing, as defined by the AM A, seems beyond reproach. It’s “. . .an ongoing process of finding out what your patients need… and what they perceive their needs to be… and then matching your services to those needs.” Advertising, as best we can tell after talking to physicians, is a component of marketing, but includes a public announcement of some sort lauding the quality, service, prices or success ratio of a particular doc, and may even stray into more blatant, midway-barker hype. Dr. Bob Lanier, Channel 5’s medical reporter who is now syndicated on 150 NBC affiliate stations, says such advertising by physicians is a “knee-jerk reaction to a failing enterprise, a quick fix for a long-term problem.”

Dr. Jane Admire, an ear, nose and throat specialist, says she looks on advertising “in a dim fashion” and that she doesn’t know any reputable physicians who advertise. She cites the most common objection doctors and others have about advertising: It tends to attract patients with unrealistic expectations. “People who are not medically trained cannot be well educated enough to know exactly what their medical needs are,” Admire says. “It’s like me calling the service station and asking what it takes to fix my car before the mechanic has ever seen it.”

The Texas Medical Association’s most recent opinion survey on the subject of marketing shows similar attitudes: 87 percent of physicians questioned opposed or strongly opposed advertising by physicians in newspapers and on radio and television. Eighty percent said it would lower their credibility and professional standing.

This dim view of self-aggrandizement is apparent also in the Dallas phone book and newspapers. Although chiropractors (always considered tasteless imposters by the AMA) continue to advertise with aplomb, the mentions of physicians there remain surprisingly muted compared to cities on the East and West coasts. One obstetrician-gynecologist says he tossed and turned for weeks over whether to list his name, address and phone number in the yellow pages in boldface type, an extra that costs $261 annually. He decided to take the plunge; in the past year, the number of new patients he sees who have chosen his name out of the phone book has tripled.

By contrast, ads in Los Angeles and Manhattan phone books boast of doctors with hot tubs in their waiting rooms, specialists “as seen on TV” and lean silhouettes of men and women with a plastic surgeon’s phone number and the caption, “Bodies by Fischer.” Business Week recently reported that in Southfield, Mich., a 10-physician psychiatry-neurology group doubled its patient load in two years to 3,000 through television advertising. Those promotions resulted in ill will from the medical community; at a party, Innervision’s founding physician extended his hand to another doctor and was told to get his “dirty, filthy, advertising hands away.”



NO DOUBT MANY will continue to scorn physicians who advertise. But if marketing trends follow tradition, according to Barry Nash, who handles marketing and public relations for local doctors and clinics, we’ll witness a slow progression toward more self promotion among doctors. And for that doc whose bedside manner needs a little cultivating, the AM A, which long shunned the marketing idea, now offers seminars, several publications on marketing strategies and videotapes on business techniques to make it unnecessary for doctors to advertise. The American Academy of Family Physicians sends its members a kit, “Honing the Competitive Edge,” which includes tips on such tactics as writing an article for the local newspaper.

Some of these suggestions can make for obvious improvements in the way medicine is practiced, while others seem superfluous. At any rate, happily for the consumer, doctors are beginning to cater to their patients, keeping evening and weekend hours and traveling to meet them. Appointment times are more carefully honored, with many physicians making sure that they spend more time with their patients. At the advice of consultants everywhere, they’re establishing eye contact and calling their patients by name.

If a doctor wants more help than that, plenty of public relations specialists like Barry Nash are available to help develop just the kind of reputation the AM A prized some 30 years ago-for fees of up to $5,000 per month. Nash emphasizes the need for subtlety while working to build a patient base. One of the primal laws of marketing: A doctor should never be any more aggressive than he has to be, Nash says. He encourages doctors to develop a marketing umbrella, so that their practices benefit by their association with a particular professional society, hospital or referral service; that way, doctors don’t have to starkly sell themselves.

As with a comedian or a condo, a physician who somehow manages to stand out from the crowd will be easier to market. Some unusual expertise in a field such as sports medicine, or a special interest in treating patients with chemical dependencies may give a doctor a “marketing hook,” but consumers of medical care would do well to view some of these “hooks” with wariness.

Although he may not consider them as such, Dr. Al Kincheloe, a family practitioner at the Mansfield Family Clinic near Fort Worth, makes use of several marketing hooks in his advertisements on KPBC, an AM Christian radio station. A born-again Christian, Kincheloe plays up that fect in his commercials, thus fostering trust in an audience that shares his beliefs and whom he describes as “very loyal.”

Kincheloe’s other, more dubious distinction is that he has chosen to call himself a specialist in PMS-premenstrual syndrome, which he describes as “probably the oldest and most common illness in the world, the only cyclical illness that exists” and a disorder that could “theoretically affect a woman every day of the month.” The long list of possible symptoms read over the air includes clumsiness, irritability, headaches and a craving for chocolate.

The problems with this type of advertisement are legion, and pretty easy even for a layman to spot. It seems to be misleading; PMS, as defined by Kincheloe, could be responsible for every malaise a woman experiences. But worse, the research is hardly complete on PMS. David Guzick, an obstetrician-gynecologist on faculty at South western Medical School, complains that Kincheloe’s advertising is somewhat unprofessional in its style. He says that the best study done on PMS showed that a placebo worked as well as the progesterone treatment. Guzick says, “He’s taking an illness that is difficult to identify, that any woman can have, and presenting a cure that hasn’t been proven or documented as being effective in controlled scientific studies.”

Nash’s more benign marketing prescription for one North Fort Worth osteopath, Dr. Jon Spain, is centered on an educational effort, three-minute health information programs aired in Spanish on a Hispanic radio station. Another part of Spain’s marketing program has been a demographic survey of his patients. Knowing more about each patient’s average age, family size, financial situation and education has helped Spain organize his practice to better suit his patients’ needs. The survey led Spain to make some changes, such as lettering the sign outside his clinic in both English and Spanish. He also installed separate windows in his reception area for payment and appointment scheduling in order to maintain privacy.

Spain says of his decision to hire a public relations specialist: “I wanted to do it all myself, but the days are too short and I don’t have enough expertise. I very much want to be guided so that my message is delivered effectively. The physician who continues to feel he can sit back and the public will come to him will have trouble, because as people become more educated, they’ll become more choosey.”



THEN THERE ARE the physicians who, perhaps by instinct rather than design, conduct brilliant marketing programs. Dr. Charles E. Dyer, a Beaumont dentist, has garnered a fine reputation throughout the state (as well as a feature on PM Magazine) for stunts that began when he decided to “break the monotony and have some fun.” Dyer put on some makeup, some green felt cut-offs and a torn shirt and went barefoot to his office as the Incredible Hulk. Since that day seven years ago, Dyer has been the tooth fairy, the Easter bunny and George Washington. He is currently working with his seamstress wife on a Smurf suit. His office staff joined him in reassembling the whole group from Oz and lately, on holidays, his younger patients are likely to dress up for their appointments.

Dyer’s motives, those who know him say, are pure. “It keeps me more human, not just doctor or dentist,” he says. “I’m violently opposed to advertising. You don’t have to be out there with flashing lights passing out flyers, but I guess if everyone begins to advertise someday we’ll all have to. Maybe when it gets to that stage I’ll just quit.”

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