Happy Birthday to The Entrepreneurial MD

We are one year old today!

I say "we" because I and my blog and website have spent a wonderful year getting to know each other, sometimes wrestling to create content, and more often, deeply absorbed in the act of writing, selecting images, and creating the experience I want my visitors to have.

Thank you to all those of you who have commented on various posts and written separately to share your thoughts and questions and appreciation -- I love what the act of blogging has stimulated.

I am eager to discover what is in store for me and my blog this next year -- one of my core values is "adventure" and every day seems spiced with excitement, not knowing what the next communication in my Inbox will be.

Here's to blogging!

PS: I'm taking a short end-of-summer break to slip away to Seattle for a few days, and while I will be silent here until next week, my brain will not stop thinking and observing and reading. All in preparation for Year 2.

Entrepreneurial medical practices dispense more than just advice

When last did you see your own physician or specialist?

How much of your time was involved in getting your prescription filled, the last time you got one from your doctor?

A recent national survey reveals that 3 out of 4 patients in the US would prefer the convenience of having their medication prescriptions filled in their own doctors office. And an argument can be made that, since one of the reasons for non-adherence to medication prescriptions is not getting a prescription filled, patient "compliance" would increase as well.

One solution that has worked well for many physicians for many years is to dispense medications in the office using prepackaged medications, typically generics, of the medications most commonly prescribed for acute conditions. Good examples might be antibiotic courses, analgesics, topical creams and ointments, oral corticosteroid courses, antiinflammatories, injectables etc.

So how does this all work?

Today, I asked Andy Shea, Marketing Communications Director Manager for Purkinje, to share some facts about their Medication Dispensing programs:

PK: What are some of the benefits of prescribing "in house"?

AS: Improved medication compliance, affordable medications for those patients who lack insurance coverage, patient convenience, reduced pharmacy call backs, and additional practice income with no extra physician effort.

PK: What does this cost a physician to institute?

AS: Nothing other than the actual cost of inventory and, if the order volume is below a certain amount, a modest shipping fee. 

PK: Can you explain further please?

AS: The place to begin is to spend a month or so tracking your most common prescribing habits to determine what you want in your "formulary".

Alternatively, we have developed our own formularies based on past experiences of our customers. These formularies are specific to the type of medical or dental practice looking to dispense. A family physician, for example, who isn’t sure which medications s/he should order, could use the experiences of thousands of other family physicians to determine the “best” medications to include in the first order.   

Once you sign up with a "basic plan" medication dispensing program like ours, you place an order for the medications you want to stock and we ship them to you, pretty much overnight. You will also receive all the materials for any reporting that might be required by your state.

PK: Talking of states and state law, can you do this in all states?

AS: Currently, in-office medication dispensing is allowed in all states except Utah.  There are special restrictions in New York, Texas, Arkansas and New Jersey … we’d always let potential clients know about these restrictions before signing up for our services. We do all the research for you about your state requirements, and you follow up, according to your state. Some states require you to pay an annual dispensing fee which is again modest -- in the order of $75.

PK: What does this all cost and what kind of profit can a practice expect to generate? 

AS: The average cost for a generic prescription to the physician is $4.50 and the typical profit is $6.50, meaning you would sell it for $11. Now the profit margin can be as high as the physician chooses, and can range from $5 to $15 or even higher. So, for example, if you are dispensing 2 prescriptions per patient to 20 patients a day, your practice can bring in an extra $5000 a month.

There are no equipment costs for the more basic programs -- you merely need a lockable cabinet. Even one of our premium program that uses software to track your dispensing is free if you maintain an average monthly order minimum. We send you a laptop computer loaded with the easy-to-use software, a barcode scanner, a thermal label printer, and a laser printer for printing receipts and patient literature.

PK: What about insurance coverage?

AS: In our model, there is no insurance coverage for these medications, but consider two things:

• If you consider pricing your medications at the level of the patient's medication co-pay, you are offering them convenience at no extra expense, and
• How valuable is a patient's time? Wouldn't they rather pay you $10 or $15 for a prescription medication than drive to and then wait in line at the pharmacy?

There are many other companies supporting medication dispensing programs as well - amongst them, Allscripts, Industrial Pharmacy Management (IPM) and Physicians' Pharmaceutical Corporation (this latter company appears to offer a way to work with patients' insurance programs if preferred).

One little item I came across piqued my interest:

"A 1999 study by the Institute of Medicine estimated that every pharmacy call-back cost physicians practices $5–$7 to pull and review the chart and return the call. With the average physician writing 30 prescriptions a day and handling nearly another 30 requests for refills, the dollars add up quickly. (Tipping the Balance of Power with Digital Patient Information, Pharmaceutical Executive, March 2002, Mary Johnston Turner)"

And that was in 1999!

What appeals to me about this kind of program is it meets many of my criteria for a sound entrepreneurial practice activity:

• it provides real value to patients
• it is easy to institute
• it focuses on generating higher revenues for a practice, instead of the pain of cost-cutting!

What do you think?

(Thanks to Reed Tinsley of Reed Tinsley CPA Blog for drawing my attention to this topic!)

Blogging for business - how to get attention as an entrepreneurial physician

For the small-budget marketing plan, blogging is a near-miracle. Costing little more than your time, you can leverage the extraordinary power of the Internet and search engines to communicate your message to the world - or at least your target market!

Consider this -- a few days ago, a physician in Hungary accessed my website and downloaded the "Crack the Code" report. How amazing is that! 

This event came about as a result of having a blog in which I attempt to add fresh relevant content, targeted to entrepreneurial physicians, at least three times a week.

Here's how a blog becomes so search-engine friendly:

• Every blog post generates a new web page, and search engines like to deliver rich deep relevant content to the searcher
• By knowing the key search terms people use to look for and find you, you can incorporate these terms into your blog post titles and the body of your content, and therefore be more easily found
• Being consistent in your posting encourages the search engine "bots" to visit and index your blog content (or blog/website such as mine) regularly - this can be almost immediately once you write frequently. What this means is that if you have a new product to offer, or content to promote, this will almost instantly be available to the search engines, unlike static websites whose content might be changed once every 3 to 6 months.

So how do you begin blogging?

First, let me reassure you that you do NOT need to be technologically proficient to handle a blog. If you can write an email, you can manage a blog!

Second, you can set up a blog at no cost. Good examples include WordPress (their basic package) and Blogger. Or a hosted blog for less than $5 a month such as TypePad.

And third, you can set up a blog in less than an hour.

Here is an excellent list of blogging resources to get you started.

Two books and resources I recommend to guide you are:

Blogwild: A guide for small business blogging
Build A Better Blog System (walks you through all the steps to set up a Typepad blog)

And finally, here are some examples of blogs being used to create community, generate a discussion and market healthcare services and products:

Kevin MD Medical Weblog
What's new in Plastic Surgery?
The Independent Urologist
Vegan Heart Doc

Of course, no matter what your business is, if you have a "voice", an opinion, 30-40 minutes to write 3 or 4 times a week, and valuable information to share with your target market, you are a natural blogger - and you will have a very powerful marketing and branding tool at your disposal!

Update on Tuesday, September 4, 2007 at 12:18PM by Philippa Kennealy

Here is an additional podcast from HealthLeaders Media on the value of blogging for a healthcare business. It's somewhat hospital-centric, but it contains insights into the impact of blogging - generating conversations, building trust, increasing transparency, breaking down barriers and even increasing referrals.

Make a deliberate move to become a physician entrepreneur

During his UCLA Masters in Public Health Program, Gregory (Greg) Dorn MD MPH was drawn to many different sectors of the healthcare industry. He also knew that it was up to him to figure out which one best matched his interests and skills.

He set out to do some informational interviewing and serious networking to land his ideal job. And he accomplished this!

What made my conversation with Dr. Dorn so remarkable is that he is one of the few physicians I know who executed a perfect career-finding plan.

Most career guidance coaches and counselors recognize that the most satisfying jobs are not found through Monster.com or some other job board, or even a recruiter. Instead, they are obtained through a careful and highly strategic search process that targets ideal companies, jobs or industries and lays the groundwork for being invited to become a member of the team.

Listen to Dr. Dorn's story (28.5 minutes) in this week's podcast as I explore with him how he turned a very deliberate, intentional search for a fulfilling career into an exciting, entrepreneurial physician opportunity that has allowed him to help grow a small clinical decision support company, Zynx Health, into a clinical business large and important enough to be acquired and then maintained by Hearst Corporation. 

Pay close attention to his job search strategy - this informational interviewing works equally well for physicians with an idea for a business who want to check with potential customers if there is a real need for their product or service.

Retail medical clinics revisited

Physicians' reactions to the arrival of retail clinics in their communities is varied but largely negative.

These are the walk-in convenience clinics affiliated with large stores and pharmacy chains such as Walmart and CVS Pharmacies. I've examined the trends in prior posts here and here.

Now, in one of the most balanced and factual articles I've seen in a while, comes another piece detailing the potential impact of these walk-in health clinics.

Retail Clinics Can Be a Valuable Source Partner by Erin Callahan, writing for Medical Staff Briefing of HCPro, takes the stand that there's plenty of room for all in our crumbling healthcare system that is failing the less well-insured, as well as those whose time is too precious to sit on waiting lists or in waiting rooms.

The article gives an overview of the history of the retail clinics, as well as a peek into the dramatic future. It also outlines the many forces shaping the trend, such as a primary care physician shortage, and consumers picking up more and more of the healthcare tab.

The author reiterates one of my themes - what are the opportunities that this trend presents for the entrepreneurial, marketing-savvy, skilled networker physician?

In my opinion, defending against the inevitable explosion of clinics is like trying to push back the winds that precede the arrival of one of this season's hurricanes!

What's your opinion?