I usually get Twitter DM or text messages every now and then from people who have heard about my story and express an interest in starting their own OBLs. I always get excited to field these inquiries because I love sharing my story, getting to know my colleagues, and ultimately making new friends. Interventional Radiology is a small world.
Many of my colleagues I chat with express a keen interest and desire to enter the OBL world for many of the reasons I’ve highlighted on the blog. Largely, most are unfulfilled with their current professional existence and want to have more autonomy when it comes to taking care of patients and doing more meaningful procedures. If this can be done in a setting without any call and with a greater financial upside than a hospital-based radiology position then why not?
Naturally, many of these same people have some level of anxiety or concern about the notion of breaking free from their current situation and starting fresh, especially when there is no guarantee for success. People want to know many things like: 1.) How much does it cost to start an OBL? 2.) How long does it take to become profitable? 3.) How much money could you make? 4.) is it safe to do these procedures on an outpatient basis? 5.) What do you do if you have a complication? 6.) Who handles various tasks including HR management? ….and probably the most important question which should be the first question anyone should ask…how do you get referrals?
While I’ve dedicated an entire post about getting referrals, I want to highlight what it takes to succeed in a competitive marketplace. The reason this matters is because competition is inevitable and it often scares those who may consider starting an OBL. Many have a dream of moving their family to a new location and starting an OBL there. This is especially pertinent since most will have some restrictive covenant which prevents them from setting up shop where they currently live.
So how do you succeed in a competitive marketplace? Here’s how.
- Establish Yourself In A Market With A Clear Purpose, Mission and Mindset.
You can’t go into any given city, build an OBL, advertise yourself as an IR and expect the floodgates to open with referrals. It takes a significant amount of time and energy to obtain referrals. People need to know who you are, what you can do and how you can make their lives easier and/or better.
To that extent, you must have a clear mission. This mission can’t be, “Hi I’m Dr. LineMonkey and I’m an interventional radiologist who specializes in minimally invasive image-guided procedures which results in less morbidity and mortality than traditional surgeries.” If this is your mission you might as well just go work on that G-Tube waiting in Room 2 and be sure to clean that list when you’re done getting that case done.
Your mission needs to be succinct and people need to understand what you can do. Pick 1 thing to be safe. Try this:
“Hi I’m Dr. LineMonkey and I’m a vascular specialist. I help patients with blood vessel problems outside of the brain and heart using both medicines and minimally invasive procedures through pinholes in the skin. If you have patients with leg pain, foot wounds, vein problems or leg swelling, I can help. I own my own clinic and I can get your patients in very quickly. Here’s my cell phone number. Call me anytime.”
You can imagine similar pitches for fibroids and prostates.
Ok, so you have your clear purpose and mission set, now you need to work on your mindset. Your purpose is to provide a valuable service to both patients and referring physicians. Provide this service and financial success will follow. There are shortcuts, but it won’t result in organic growth and as I have mentioned in prior posts there will be tradeoffs with respect to return on your investment, personal satisfaction regarding taking care of patients, establishing meaningful relationships with referring physicians and just having the satisfaction of creating something awesome.
- Make It Easy For Patients And Their Physicians.
The common refrain in physician practice growth is the 3 As: Availability, Affability and Ability. As trite as this is, it’s true. People will want to work with you if you can take work off of their plates. To this extent, you are no longer too important to answer anyone’s phone call. You must make yourself available at all hours and you have to be willing to provide value even if there isn’t immediate reciprocity.
When you prove that you are available, you must provide the best customer service and patient care with a smile on your face. You need to be genuinely caring and compassionate. If you’re the type of IR who got into this line of work to do some cool procedures and retreat to the reading room when it’s done, I’d suggest you stop reading here and go back to your current life because this line of work is not for you. Being affable with patients means listening more than talking. It means taking your time. It means conveying information in a clear and concise fashion. It means being honest when you don’t know the answer to something. It also means getting to know them and their families. Do not leave a clinic visit without knowing 1.) where the patient lives and 2.) name of one immediate family member and ideally 3.) what they do for a living and/or what their main hobby or passion is. Do that and you will easily stand out among a sea of robot RVU collectors in healthcare.
- Be A Capable Interventional Radiologist
This really gets to the third A, which is able. Interestingly enough, in my experience this is the least important thing. No one cares how good you are technically, because honestly unless there are other IRs around you to critique your work, no one really cares how your wire skills are, or how long you take in cases. You don’t need to be a wizard to succeed. You should certainly aspire to that level of technical excellence, but you really just need to be good enough. That means being comfortable in your own skin, understanding what it takes for you to get a given case done safely and effectively. Your main goal is to get this patient treated and out the door safely, only to return at follow-up feeling great that you helped them out. It takes time to develop technical skills. Anyone who comes out of fellowship thinking they are on top of the world is frankly full of it. Speak to any experienced IR and most will tell you they didn’t hit their stride until at least year 5 post training. I’m still a work in progress myself and I’m not afraid to admit it. More on this in a future post.
- Promote Yourself With No Shame
Get referrals. Ask your patients to write reviews. I had one patient who was so happy, he went to his job as a greeter at Wal-Mart and handed out my PAE flyers to every man who walked in. Follow-up with referring physicians regularly regarding procedures. Quick text messages are fine. Phone calls are even better. Host dinner presentations. Have open houses in your OBL. Engage in charity events in the community. Go to churches, temples and mosques. Work hard, communicate and build your reputation. It’s not easy and it isn’t quick but it can be done.
- Engage In Continuous Quality Improvement.
Everytime I have a patient see me for follow-up after a procedure, I ask them to grade me and ask me if there is one thing I as an individual or my team could have done to make their experience better. Oftentimes, they may not have much feedback for you as a physician but they’ll point out important things with respect to your office process which could be improved. Take that advice to heart and implement changes to refine the patient experience and make your OBL a place patients love to come to. If things don’t go well, and many times they may not for reasons outside of your control (scheduling errors, transportation issues, insurance concerns etc.), make it right. Apologize, fall on the sword and take full responsibility. This is your office and the buck stops with you. You are now more than a physician. You are a business owner. Act like it. More importantly, process the events and establish what could be done better to prevent issues going forward. It’s a constant refinement process and perfection will never be achieved. Those who fail to adapt and implement changes will fail. Your competitive advantage is your organization is nimble, allowing for changes to be made quickly unlike larger rivals like hospital systems where 30 emails need to be sent over 2 weeks to establish a meeting to address something minor only resulting in nothing getting accomplished.
- Embrace And Invest In Technology.
This is something we did not do in my OBL because of cost concerns, which frankly was stupid because we had plenty of money to do this. But I do believe investing in a good EMR and PACS system is critical. Patients love seeing their images and they love it even more when you explain it to them. Patients expect email reminders and want access to their electronic records. Yes this all costs more money, but if you provide a service and meet the demands of your patients, the money will come. Don’t be a penny pincher unless you’re really that hell bent on providing an inferior product and experience.
- Promote A Workplace Culture Superior To Your Rivals.
People work at LineMonkey MD OBL because LineMonkey MD is the best boss ever. He is a cool dude who loves taking care of his patients. He is positive in his interactions and creates a great vibe. People feel that vibe. They feed off of your energy and enthusiasm. They love seeing you happy. You treat your team well, they will return the favor provided you hired the right people. Let your employees eat lunch. Treat them every now and then. Give them holiday bonuses. Pay them rates that are at market or higher. Provide them with good benefits. Get to know them and their families. They are now your work family. You have a responsibility for their well being and professional development. Sometimes work-relationships don’t go well and people may need to be let go or they decide to move on. Stay positive and remain supportive. Do not hold grudges. People will remember who you are as a boss and that reputation will carry forward into the community you serve.
- Choose Your Partners Well.
If you decide to share equity with others in your business, make sure they are with people who you trust, share your same goals and offer something that you don’t. Be fair and get on the same page before signing anything. Failed partnerships are a set back to any organization. They result in workplace negativity, poor reputations and are the catalyst for rumors in any given community. Never bring on a partner for financial reasons only.
If you do these 8 things, chances are you will succeed in due time, provided you establish systems and are able to collect payment for services rendered. These last two things are two big ifs.
So with this all being said, opening any business is a risk. Opening a healthcare business focused on the delivery of healthcare is especially risky seeing as your ability to collect payment is tied to insurance. Nothing is guaranteed. I believe the benefits of opening your own practice are tremendous. The value we add as IRs to any given community is huge. There is tremendous potential, but you have to be willing to take the chance. I’ve done it with a partner and I’ll do it again either on my own or with new partners. This road though is not for everyone. Hopefully this post gives you more insight on what it takes to make this dream a reality.