“I am a young (mid-30s) physician who has just completed his residency and wants to buy a suburban general medicine (internist) practice.
“I have been a fan of your YouTube videos for years and wonder if you have any advice for me — not so much on how to buy the practice but how to keep the patients on board after I do.”
First of all, let me congratulate you on making the difficult decision to become an internist; far too many young doctors are seduced by the siren call (and higher income) of specialty practices, to the point where in many parts of the country, there is a shortage of general practitioners.
This is an extremely timely message for me: I recently terminated my relationship with my personal care physician after almost 15 years. I had been a patient of the physician whose practice he acquired 15 years ago and I stayed with the practice despite a very rocky transition in which I understand almost 50 percent of patients went elsewhere within a year.
Here are some of the things he did wrong which you should avoid:
He Didn’t Have a Good Attorney Representing Him. He bought the practice without the assistance of an attorney experienced in business sales. By conceding too quickly to the seller’s demand for an “all-cash” deal, he left the seller without any incentive to stick around, introduce patients to the new doctor and otherwise smooth the transition process.
There Was No Commun-ication with the Patients. The seller’s longtime patients were never notified of their doctor’s retirement and became aware of it only when they called to schedule an appointment and a total stranger answered the phone. There was no letter from the retiring doctor announcing the sale and encouraging patients to stay with the new doctor.
He Changed Too Much, Too Fast. He fired the seller’s office staff and moved the practice from a convenient ground-floor location (preferred by senior citizens) to a cramped office on the fifth floor of a nearby building with only one creaky elevator.
He Made His Spouse His Office Manager. To save money, he appointed his wife — a nonpracticing lawyer with zero experience in managing a medical practice — as the practice’s office manager and hired only part-time nursing and office staff. Employee turnover soared, to the point where patients never saw the same nurse or physician’s assistant more than once.
He Made Lifestyle Changes the Practice Couldn’t Keep Up With. Shortly after buying the practice, he bought a $2 million house in a wealthy neighborhood and proceeded to have three children in almost as many years.
But that’s not all. After settling into the practice, he began doing things that at first were merely irritating but ultimately cost him many more patients.
He Withdrew into An Ivory Tower and Became Unresponsive. His voice message discouraged patients from calling after hours, saying that if they had an emergency, they should call 911. There was no answering service or other means of contacting the doctor directly after noon two days a week or during the staff’s daily lunch break. If a patient went into the hospital, the doctor never visited on his rounds and did not call to ask how the patient was doing.
When the COVID-19 pandemic hit, instead of sending out information bulletins to his patients with advice and reassurance, he changed his voice message to say, “If you suspect you have COVID-19, please don’t visit the office.”
He Went into an Unrelated Specialty That Ate Into His Practice Time. He began offering Botox treatments and marketed them aggressively as a higher-margin service.
He Performed Unnecessary Services to Maximize Medicare Reimbursement. When a patient turned 65, the doctor insisted on making monthly “wellness” calls that rarely lasted for more than a few seconds but generated more than $100 each for the practice. If a patient refused the calls, he or she was required to visit the practice at least once a month or else the doctor wouldn’t approve prescription renewals. The doctor’s bills to Medicare frequently included services the patients didn’t recall receiving during their office visits.
He Ignored His Reviews on Social Media. Patients complained, even to the point of questioning whether the doctor was engaged in Medicare/Medicaid fraud, but the doctor never responded. He ended up with the lowest ratings on social media of any doctor in the county.
Don’t get me wrong: I understand completely that a medical practice is a business and that physicians should be entitled to a decent living after the grueling apprenticeship they go through. But always remember that most patients still see you as a professional, not an entrepreneur. They expect you to care about them as human beings and to make decisions based on what you think is medically right for them. This is especially true of older people, who account for most of a typical medical practice’s revenue.
This doctor is highly competent and (when you finally get to see him) has a good bedside manner. But by sending his patients strong signals that he cares more about his practice’s revenue than his patients’ well-being (intentionally or not), he continues to struggle after 15 years by driving patients away. Including — finally — me.
Cliff Ennico (crennico@gmail.com) is a syndicated columnist, author and former host of the PBS television series “Money Hunt.”
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