The terms marketing and advertising are often used synonymously in error and it is important to understand the differences between these activities:
Marketing
is the planning and implementation of a wide range of business-related activities, the common goal of which is to try and improve your business(es). Advertising is just one small part of your marketing campaign, but is often the most expensive and controversial. Other key aspects of marketing include:
o Market research
o Product pricing, i.e. setting your fees
o Public relations, including community involvement and media planning
o Customer service, including from both you and your private hospital
o Careful consideration of your product itself and its unique selling point (USP)
Marketing is effectively everything that you do that facilitates your interaction with your consumers, demonstrating to them why they should choose your services – and you - over the available competition. In private medical practice, it is crucial to remember that your consumers are your patients, but also your referrers, including general practitioners, physiotherapists, optometrists etc. As you will see from the examples later, the remit of marketing is vast and extends well beyond the private hospital flyers announcing your arrival.
Advertising
is but one component of marketing. It is broadly defined as a public announcement of a (hopefully) persuasive message typically from an identified source - usually requiring investment - in order to raise awareness of a particular product to existing and potential customers. There are clearly many ways in which one can advertise, including:
o TV & radio advertisements
o In / on your clinic letters
o Advertisements in newspapers and magazines
o Posters
o Billboards
o Leaflets
o Emails
o Website based
o Social media
A common misconception among doctors is that you are not allowed to advertise. This may have been true in the past, but recent GMC guidance clearly states: “When advertising your services, you must make sure the information that you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of knowledge” (Good Medical Practice, paragraph 70, 2013). In most cases, a private hospital will advertise your services for you, but you should help guide their placement.
Marketing & advertising in private practice: a case-based example
It would be very wrong to assume that you can learn all relevant marketing techniques from a web page written by a consultant surgeon! Indeed, marketing has been the focus of many degrees and entire tomes have been written on the subject. Nevertheless, provided you have the interest and the energy, many of the activities described below can be quickly adapted to your practice, hopefully with good effect and with surprisingly little financial investment. Many of you will already have started to market your nascent private practice without realising it.
In order to try and bring the various concepts involved to life, for the rest of this page please imagine that you have been recently appointed as a consultant orthopaedic surgeon in an NHS hospital, in a relatively affluent area. You have some NHS peripheral hospital commitments in surrounding market towns and face stiff competition at the local private hospital. It is a relatively long way to neighbouring NHS and private hospital competition. While the specific examples below may not apply directly to you in your speciality, consider how equivalent options may be relevant; for example, if physiotherapists may initiate orthopaedic referrals, who typically prompts ophthalmic or maxillofacial referrals, above and beyond general practitioners?
Some initial questions to consider:
• What is your service? I’m an orthopaedic consultant with special interests in hip and knee surgery, especially for the sports-injured.
• Is there a unique aspect to your service over other similar consultants? I’m recently trained, use new smaller and less invasive incisions, and discharge patients faster. I am aware of my outcomes from a recent audit.
• Within your speciality, what generally pays well, in terms of procedure and volume? Some complex redo procedures pay very well, but the overwhelming income will be from knee arthroscopy and joint replacements.
• Who are your customers? Patients, but I also need to reach out to my referrers; patients may be recommended to see me by general physiotherapists, osteopaths, chiropractors, sports massage therapists and sports injury clinics. In addition, I may receive referrals or recommendations from my consultant colleagues (tertiary referral and second opinions), both within my speciality but also all those practising at the private hospital, even in other disciplines.
With very little effort, you have defined your service, a potential unique selling point, areas of your service which make sense to market actively, as well as your target market, which is not simply local general practitioners. In some cases, a USP can be as simple as knowing what your outcomes are and being prepared to publish them in the public domain.
Bear in mind that, in medicine, a lot of what follows is either free or of very low cost, although you may have to invest considerable time.
You should arrange to meet with your marketing representative at your local private hospital as soon as you have considered entering private practice. Private hospitals and consultants have a symbiotic relationship, with consultants being the customer in many senses - you are responsible for bringing the activity to the hospital of your choice - and you can usually count on their strong support.
From your private hospital, you should try to find out:
• What is currently going on at the private hospital in your speciality?
• How many patients are being seen annually with hip / knee problems?
• How many of them are undergoing surgery?
• Are many being referred to other private hospitals for other procedures?
• Who is doing the lion’s share of the work?
• How long do patients wait to see them?
• How much do they earn per procedure and what are their consultation fees? (Remember that you should not discuss fees with your colleagues due to constraints of competition law).
• How long do patients stay in for?
• Find out the proportion of patients that are self-funding compared to those that are funded by insurance. There may be a large employer nearby that is responsible for a lot of the local insured market.
• Where are patients being referred from (location and top referring GP practices)?
• Is the hospital equipped to perform the type of procedure that you wish to perform? Does it insist on a particular type of implant that you may have to use?
• Who are the physiotherapists at the private hospital and can you meet them all? Knowing how they work will be vital, and they may of course suggest to patients that they seek a consultation with you.
You also need to find out:
• What do patients need, above and beyond what your colleagues are delivering?
• Would they potentially like their consultations closer to home?
• If so, can you see private patients in your peripheral NHS hospital to save them travelling? Consider radiographic facilities.
• Can you see private patients in local GP practices? Doing so may save patients long journeys and may also forge connections with general practice colleagues.
• Can you see private patients in local physiotherapy practices? Doing so may save patients long journeys and may also forge connections with physiotherapist colleagues.
• Are there any services lacking locally that you could perhaps take on, for example, getting attached to the local rugby or football team as a specialist, possibly pro bono.
• Are there any new procedures for which there will be a demand? Younger consultants are generally able to adapt to newer procedures than more established consultants.
Regarding yourself:
• Think about your NHS job plan and the rest of your personal life / commitments. How will your private practice fit in around it? Consider postoperative ward visits, clinics and theatre lists.
• Do you mind working in the evening and at weekends (perhaps just initially)?
• How much do you want to work?
• How much do you want to earn?
• Are you able to team up (legally) with another consultant - whom you trust - to work together to market your practices in a symbiotic way?
• Are you amiable to every patient? Could you make yourself available to see new referrals quickly?
You should:
• Visit in person the leading referring GP practices. You may know one or two of the partners through connections, but if not, perhaps the best way to approach them is via their practice manager. All practices will run continuing professional development meetings and typically welcome the chance to meet you, and hopefully hear a talk by you.
• Mention both your NHS and private practices, carefully explain your scope of practice and try and impress on them why referral to you is beneficial for the patient (e.g. smaller incision surgery, and daycase procedures).
• Ask them what they want and see if you can deliver; this may be as simple as improving feedback from clinics, or streamlining pathways.
• See if you can establish to whom they normally refer for private consultations and why. Many GPs will have a default option for generic referrals.
• Take special note of new / younger GPs; over your entire career it is likely that the younger ones will contribute greater to your earnings than older ones, who may well be peers of your colleagues.
• Praise your colleagues, if appropriate. It will never do you good to speak ill of colleagues, indeed, they may well be related to, or be friends of, the very people you are talking to!
• Also visit local physiotherapists, osteopaths, chiropractors, sports injury clinics etc. in the same way. If all goes to plan, they will recommend referral to you when a suitable patient comes along and are perhaps more likely to recommend a private referral than a GP, as typically they work full time in private practice themselves.
With respect to the local competition (your colleagues), you should try to find out:
• How long do patients wait to see them? Is it worth your while offering to see all patients within 48 hours of referral (at least initially)? Rapid access will be more important to some than a name.
• Do they use older techniques / larger incisions / longer lengths of stay?
• Who has commitments in peripheral clinics, where are they, and are these in affluent areas?
• Do they have a web presence? What happens when you type their names into a search engine?
• And what happens when you type in knee / hip and your town into a search engine?
• Do they have any information leaflets that you can peruse? You may find these in the clinics, or may be able to download them from their websites.
• Are their outcome data published? If so, are they any good? And are they honest..?
Public relations
For the overwhelming majority of consultants, having an NHS practice in addition to a private practice is a huge advantage. You need to remember that your exposure to sheer numbers of patients will be considerably larger in the NHS setting and - provided you do a good job - your local reputation will develop in a positive way.
Countless letters from you will be sent at the NHS’ expense to all surrounding referrers over decades, every one of which can carry subliminal messages of authority, maturity, intelligence and most importantly, empathy with your patients. Enquiries from GPs require a more personal response, which may potentially lead to a personal introduction and hence a connection.
Within the NHS setting:
• Develop a good, solid and quality-based NHS practice. Remember that you must abide by your Trust’s code of conduct for private practice and that your NHS service must never be compromised by your private work.
• Be pleasant to all your patients; this may involve invoking the chameleon at times, but remember the privilege that it is to be a doctor.
• Write clear, helpful but concise letters. Having a template for letters (e.g. “Diagnosis, Treatment, Follow-up”) may demonstrate to the reader that you have an organised brain.
• With your patients’ consent, copy your letters to all relevant parties. For example, the referral may have been initiated by a physiotherapist. Involving them can certainly be justified on the grounds of education and feedback, but is also useful to improve connections.
• Do you have juniors and middle grade doctors seeing your patients on your behalf? If so, you should insist that their name on the letters should be suffixed by “Registrar in orthopaedics to Mr KN Eebone MA MRCP FRCS FRCSEd… etc.” This is useful to the GP, as they will then know whom to address subsequent correspondence to once the junior has rotated onwards.
• Ensure your email address and NHS secretary’s telephone number appear on all correspondence - this will enhance your availability for queries.
• Develop good information leaflets for procedures / diseases; they can always be used in your private practice too, but demonstrate a certain quality of service.
• Contact local organisations and offer to do evening talks. The local WI, Lions and Rotary associations will often be delighted to host you. You are often paid an honorarium for such events, but you might wish to openly donate such monies to your local orthopaedic charity.
• Set up and take part in refresher days / courses for GPs, physiotherapists, osteopaths etc. Collect data such as email addresses from such events to gauge feedback for subsequent appraisals, but consider sending follow-up emails asking for suggestions on service improvement, or to announce changes in service etc. Please remember your ICO responsibilities if you are storing email addresses for commercial purposes.
• Take the time to improve / set up your service’s NHS website.
• Never be shy to front charity events for your organisation, which can, of course, be great fun.
• If your arrival at the hospital does lead to shorter lengths of stay for patients, suggest to the Trust’s press office that they could announce this in the local paper: these days, the NHS is a competitive place and such suggestions will likely be warmly received.
Outside your NHS practice:
(i) Via your private hospital:
• Ask them to send out an introductory letter / flyer to local GP practices, as well as potentially to other referral sources too. If you have developed your own leaflet / brochure, it may potentially be sent out at the same time. There is an optimum size for leaflets, A4 typically being too large, unless folded into thirds. Consider having them professionally printed.
• Consider enclosing business / contact cards.
• Ask the hospital when it last updated its distribution list; and can you have a copy (email preferred)?
• Volunteer to write short pieces for your private hospital’s regular newsletter, e.g. “Small incision knee replacement: the choice for the 21st century…”
• Hold open events for the public.
• Hold open events for your referrers, some specifically for GPs, some specifically for physiotherapists etc.
• Ask your hospital to arrange a health professionals’ day to forge links between consultants and other health professions.
• Ask your hospital to advertise on your behalf, including in gyms (sports injuries), the newspaper, magazines, radio etc, explaining your USP of shorter length of stay, quicker recovery etc.
• Your hospital may organise corporate functions for groups such as your referrers. Be sure to let them know that you are keen to host at such events.
(ii) Via yourself / your administrative team:
• Don’t turn down an early referral. Doing so sends a very clear message that you do not practise privately, even if you are planning to in a month or two.
• Set up a website, describing your services, USP, outcome data (with comparators nationally), contact details for referrals, and easily downloadable information on the conditions that you treat.
o Video podcasts of you discussing common problems and treatments may be particularly effective.
o Optimise your website, so that typing Knee / Hip and your town into a search engine produces your name quickly. Ensure that your private hospital web page is linked to your personal page in a clear fashion.
o Regularly update the news section of your website with information, e.g. courses that you have recently attended, new equipment at the hospital etc.
o Consider using social media, e.g. Twitter / Facebook, gearing it towards the younger end of your market (i.e. sports injuries rather than hip replacements). Beware having social media feeds and not using them or failing to respond to public posts / queries.
o Consider a password-protected online CPD programme for GPs, physiotherapists etc. You can invite people to join by email and then, by regularly announcing updates, you have the perfect excuse for emailing them again, possibly introducing an item of news (and hence marketing) each time.
• Consider facilitating the return of audit information about your patients. For example, physiotherapists may be perfectly placed to feedback to you the final results of your surgery. This will be vital information for you, which will help you to develop your techniques / practice, help you revalidate and forge greater links with your extended team. In the face of bad feedback, engage, actively investigate and learn from your errors: no-one will achieve perfect results for all patients.
• Facilitating the return of such information may be as simple as providing a stamped addressed envelope, an online form on your website or an online survey, however, you must remember that completion of such surveys will take time. While you must never make payments for referrals (which would be bribery), conversely, covering the expenses of someone completing audit data on your behalf is entirely reasonable and would be a bona fide taxable expense.
• Consider sponsoring appropriate local projects, for example, particularly if you want to develop a named brand such as “LimptownKneeDocs.com”, you could pay for the rugby shirts for a local team, with your logo emblazoned upon them.
• Consider making appropriate named donations for charity auctions (depending on the likely clientele of the event).
• Print quality business cards and stationery for your private practice. Ask your administrative team to attach a business card with a paperclip to every letter that is ever sent. This means that patients (the community) and your referrers will always be awash with your name and contact details.
• Ensure all your qualifications are clearly visible after your name. Some patients are very impressed by what others would term ‘diploma-itis’.
• Producing personalised stationery such as pens can be very cheap (but beware poor quality products), items which are very much in demand in GP practices, but also provide subliminal advertising.
• Consider whether you should include an information leaflet - summarising your services and USP - with every letter, or whether such information can be assimilated into your routine stationery.
• Organise talks and visits to local referrers’ practices, as in the Market Research section above.
• Are you able to register yourself or organisation as a provider of continuing professional development (CPD) points for GPs, physiotherapists or other relevant health care professionals?
• In many GP practices, doctors are potentially new, itinerant, locums or trainees and consequently may not know the names of consultants to whom they should refer, leaving the decision / homework to the administrative teams. Arriving 30 minutes early for your talk, introducing yourself to the practice manager and in particular the medical secretaries can pay huge dividends, particularly if you bring a box of chocolates, a friendly smile and some calling cards.
• Put together a dossier / brochure of your services, USP, possibly testimonials and your recently published scientific papers to be left in the waiting room of your private hospital while you are doing your clinics (and hopefully at other times too…).
• Consider whether you wish to provide gifts or your own corporate entertainment for referrers, but you should discuss with your accountant the nature of such expenditure if you wish for them to be considered as expenses for taxation purposes. Some organisations employ marketing and events companies for many purposes, including these.
(iii) In your life in general:
• Remember who you are in public and behave appropriately.
• Private patients are generally more affluent than NHS patients and as such will have different styles of life. As a result, if your children attend a private school, other children’s parents may well be future patients.
• Consider your hobbies carefully. For example, if you enjoy golf, you could either play locally and remember that every game you play is potentially a marketing event, or you could travel further afield and enjoy being more anonymous; you may not wish to be at ‘work’ all the time!
• While you should not let private practice take over your life entirely, you may wish to socialise with key players in your local referral market.
• Enjoy your holidays away from your local area: only then can you be completely off duty!
The product itself
In private medical practice, the ‘product’ is time spent with you, the knee / hip guru, plus the patient experience of this and your treatments, the results and aftercare. The whole experience begins a long time before you greet them in the hospital waiting room and you should consider every step in the patient pathway from web browsing, through initial contact with your secretary and subsequent letters, to treatments and beyond. To some extent, you are very much at the mercy of your private hospital for some aspects of the product, for example car-parking issues and potentially unprofessional receptionists. The more polished the whole experience, the greater the chance of the holy grail of private medical practice: word-of-mouth generated referrals.
Before meeting the patient:
• Your media presence should be professional and impressive.
• Avoid prospective patients stumbling across unflattering stories or photographs of you online.
• Your website should be easily accessible, clear, well-written and informative, without any outrageous claims about abilities.
• Consider the environs of the private hospital and anything that irritates you. Can it be changed?
Your secretarial team:
• Your secretary should answer the telephone in a professional and friendly manner, and ring patients back promptly if they have left a message. Remember, the customer is (nearly) always right if you are trying to make a sale.
• You should spend as much time as possible briefing your secretary about your business, explaining to him / her key concepts that will allow them to be able to sound informative about the patient experience, even before meeting you. For example, useful suggestions might include patients wearing clothes that are easy to remove for examination, perhaps the need to bring a urine specimen, and that every patient should expect to spend at least an hour in the hospital because of the need for X-rays to be taken.
• Consider a “mystery shopper” style phone call to your secretary to assess their performance. Do you like what you hear? What would you change?
• Ensure that your secretary is appropriately remunerated for his/her services: you pay peanuts, you get monkeys. Apart from your spouse, your secretary will rapidly become the most important person in your life.
• Be sure that your secretary works for you, not for the private hospital. There will be occasions when you may wish to see / treat people elsewhere and the team needs to be loyal to you, not the bigger fish.
• Ask your secretary to be precise about the financial arrangements for the consultation and tests, e.g. payment is expected on the day, either in cash, by cheque or debit card, unless insured. Many complaints pertain to money and a lack of clarity regarding arrangements. Although British society is increasingly consumerist, many older patients would view allowing your secretary to deal with all the financial arrangements as a very professional characteristic.
• Fixed prices, e.g. including follow-up visits, are good and help patients relax about the financial aspects of their treatments.
• Ensure that appointment letters and quotes are sent out in advance of the consultation, as per CMA guidance, requesting all relevant information to be brought along, e.g. drug lists etc.
• Ensure that invoices are sent out promptly, with clear instructions regarding payments.
You and the clinic experience:
• You should try and ensure - at least when getting started - that you are forever available to see new patients, which might mean the occasional evening visit to the hospital.
• Ensure that you are smart and well-dressed. Invest to impress: a made-to-measure suit smacks of success.
• At your first meeting, be affable and charming to all. Use clear English, avoid long words and do not speak too fast. If English is not your first language, you may wish to consider elocution lessons to create a more polished impression.
• If you do not know the answer to a patient’s question, admit it, say you know how to find out and if appropriate offer a second opinion.
• Some clinicians allow patients to use first names, others do not; this is a decision for you, but is often guided by patient personality.
• Be open about the risks of procedures, and your results.
• Give more time to tricky customers, something that requires an element of surreptitious clock-watching if you are seeing other patients too. If required, you may need to arrange a follow-up appointment to cover more ground.
• At the end of the consultation, it can be helpful to write a few words down for patients such as their diagnosis. If this is on headed paper, listing other procedures / services that you offer may whet their appetite for more information.
• If you find yourself running late, it is helpful to personally approach patients in the waiting room and let them know of the slight delay.
• Write clear and concise letters promptly, and ask patients if they would like to receive a copy.
• If patients cannot decide how to proceed and wish for thinking time, ask your secretary to contact them after an appropriate delay to see if they need more information / another appointment.
• If patients wish for NHS treatment rather than private treatment, be non-judgmental and ensure that they are aware of the following, if appropriate, which you may wish to condense into a leaflet:
o You cannot guarantee who the surgeon will be
o Trainee doctors may be involved in their care (from a consent perspective, the risks may therefore change)
o The approximate waiting list time
o Bed pressures may lead to cancellations
o Follow-up visits will not necessarily be with a consultant / you
Treatments and procedures:
• Think about what would you expect if you were a patient.
• The experience should be as bespoke as possible. Even if you are doing ten knee arthroscopies in a row, the patient in each procedure should feel as if the entire team is there for them - and them alone. Patients will often be on edge and their perceptions - rather than the reality of what goes on around them - will be key.
• Nothing should come as a surprise to them on the day. Clear information leaflets and a thorough consultation should see to that. Take note of questions that patients ask and incorporate these into subsequent versions of your leaflets.
• All staff involved in the procedure should be briefed in advance, so that they can answer simple procedural queries on the day. There is nothing worse than hearing a member of staff say - and I have (!) - “I don’t know... This is Mr KN Eebone’s first day with us and I feel like a fish out of water…”
• Adopt a zero tolerance attitude to unprofessional behaviour, e.g. nose-picking, poor hygiene, smelling of cigarette smoke, bad language etc. While you clearly want an amiable relationship with staff, let them know early on what you expect of them. Remember that you are the customer of the private hospital and the staff’s employment depends on you choosing to bring your patients there.
• Supplies issues - which can beset many private theatres - need to be anticipated in advance and certainly prior to starting a case. This is especially true for patients under local anaesthesia.
• For patients under local anaesthesia, consider playing music - of their choice - to help them relax. A tablet connected to the internet solves most requests.
• Do local anaesthetic patients need a hand-holder throughout? Ask them. What about a sedative?
• Review patients before discharge if appropriate and issue them with an information leaflet and clear information regarding follow-up. Consider whether you wish to divulge your phone number at this point. It can be a great USP and is reassuring for patients. I routinely give out my number after procedures and am amazed how infrequently it is used (about four times per year).
• Consider a telephone call to the patient on day one. This does not necessarily need to be done by you yourself.
• Consider whether you or a nurse should be reviewing the patient in the outpatient setting and who will remove sutures.
• In the face of a complaint / complication, be honest, apologise if necessary and adopt a positive attitude, e.g. “so we have the following options to put this right…”
Advertising
In most cases, your local private hospital will organise formal advertising for you, officially for their brand but supporting your services and skills. The hospital will often carefully monitor the response to advertising, through web-based visit counters and dedicated telephone numbers. If you see a swell in activity following adverts. you could consider asking for more and - if the budget is limited - whether it is worth your while advertising yourself.
Advertising campaigns can be generic for the hospital and its brand, specific to the type of patient (typically self-pay), speciality-specific, or clinician-specific, especially if you have a USP that is desirable.
There are multiple different media for advertising, each with advantages and disadvantages, and each the subject of extensive study, in some cases over centuries. Different media include:
• local newspapers
• local magazines – especially the more expensive back covers, which get a disproportionately greater exposure
• national newspapers and magazines, often in the form of an interview
• leaflets and flyers
• radio
• television
• internet and podcasts
• viral adverts
• billboards and posters
• yellow pages or equivalent
• events, such as consultant-led open events for the public
• telemarketing - and cold calls (this is not suggested!)
Usually in conjunction with your private hospital, you will need to consider the relative merits of each of these, as well as the specifics, e.g. which radio station best suits your sports injury persona, should your knee injury poster go up in local gyms or in libraries etc.?
Of all the differing marketing techniques, advertising is typically the most expensive; involving a professional in an advisory capacity early on is a sensible move. Costs are often significantly less than you might imagine.