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Panel discusses the ethics of marketing an orthopedic practice

Issue: August 2013

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As the number of hospital-employed orthopedic surgeons continues to increase, private groups and hospital systems have increased marketing efforts to obtain improvement in market share in their communities. In the past, some medical licensing boards restricted advertising beyond stating the physician’s or practice’s name in order to avoid ethical concerns regarding exaggeration of a physician’s or group’s abilities. We decided to pose questions to well-known private practice orthopedic surgeons to share their experiences in marketing their practices.

Jack M. Bert, MD
Moderator

Jack M. Bert, MD: Have you noticed an increase in the marketing of orthopedic practices and hospital-employed orthopedists in your community?

Louis F. McIntyre, MD: I first started seeing individual and group practices advertising about 14 years ago in the metropolitan New York area. There were radio, print and news story advertising. Now, the advertising is done mostly by a few larger groups with the capital to commit to sustained programs. This takes the form of local print and billboard-type advertising. One area physician has used social media to a great extent in marketing and has been recognized as a pioneer in this area. Other forms of advertising have been done through the promotion of practice-affiliated foundations that do research in public interest.

Scott Powell, MD: In the Los Angeles area, we have seen an increase in the number of orthopedic surgeons employed by hospitals. By and large, hospitals in our area do not do a good job of marketing physicians. They have a phone line and website that patients can go to get a recommendation for a physician, but I have rarely seen patients from this resource. In the world of the Internet, I do not think patients look to a hospital first to make a recommendation and patients understand, just as happened in the 1990s with the fervor to form HMOs, that once you remove the incentive, the quality goes down.

In terms of other efforts for the marketing of orthopedic practices, there has been an uptick in the use of radio advertising to reach the public.

Kevin D. Plancher, MD, MS: Education of our patients is of primary importance when attempting to increase market share. It is important to first distinguish between two terms — marketing and advertising. Marketing is a global plan with a starting point and endpoint of which specific goals are set, while advertising can be a component of marketing and can consist of paid, non-personal announcements through the Internet, newspapers, literature, webinars, radio announcements, etc. In the tri-state area of New York City, hospitals have had a multi-prong marketing plan that has included weekly advertising in prominent newspapers and the purchase of multiple private practitioner groups. We have chosen, in this changing environment, to decrease marketing and focus on the delivery of premium patient care to avoid the adage, “I have only seen my doctor for 2 minutes.” We firmly believe the best marketing plan is to invest in our patients. If we were to advertise, we believe the Internet and a trustworthy organization, which is hard to find, would be the best place to invest in dollars at the present time.

Brian J. Cole, MD, MBA: I have noticed an increase in public relations efforts nationally and amongst orthopedic surgeons within our community. In addition, there appears to be an increase in efforts to enhance the Internet presence of surgeons and hospitals. It still remains difficult, however, to determine who remains as an independent practitioner or hospital-employee based on these marketing efforts. Having a hospital behind a physician likely enhances the physician’s ability to market his or her clinical practice given the scope of the physician’s resources and the more global approach typically available to an institution.

Bert: What are the techniques of marketing your practice that you employ in your locality?

McIntyre: I have used print and cable television advertising in the past. The print was in the local newspaper in the sports section and was an eighth of a page highlighting the sports medicine part of our practice. I did not find that this greatly added to market share.

I did some cable television advertising highlighting a new type of surgical procedure. Cable advertising can be tailored to various zip codes and time slots, which vary in cost to scale an advertising program. I put my commercial in the prime-time cable news programming and also during the U.S. Open tennis tournament. This was effective in promoting the procedure and our services. I also started a sports medicine hotline with 24/7 coverage and advertised this in print and on our webpage. It has been a modest success, but probably needs a more sustained promotion.

Powell: First, at Stetson Powell Orthopedics and Sports Medicine, we have worked to increase our presence on the Internet. Search engine optimization can be useful for patients in bringing your practice to the top of the page. Google, Bing and Yahoo have specific and ever-changing algorithms to determine which result reaches the first page. An experienced webmaster stays on top of these algorithms and makes modifications as they are changed.

Secondly, on insurance websites, they also have an algorithm for physicians who appear first on their list. For many insurers, if you offer extended hours, your name will come up at the top of the patient’s search.

Third, after analyzing our demographics, we saw that we were strong in the 40-year-old to 60-year-old age group where referrals routinely come from other physicians. However, we were weaker in the 20-year-old to 40-year-old age group. With children on their parents’ insurance until they are 27 years old, this is an important market. We created a presence on social media sites. We also ask patients who complete their care that if they enjoyed our service to post a comment on Yelp.

Fourth, we keep a database of email addresses from patients and colleagues and send a newsletter every few months. Finally, we send a handwritten note from the physician to each new patient thanking them for coming into the office. Of course, the best marketing is word-of-mouth from happy patients.

Plancher: We believe our patients are our biggest asset and our biggest markets. We invest heavily in the time spent with patients from the first phone call. All staff members, not just the clinical team, are essential in this process. Our patients are not just our patients for an episode of care for an ankle sprain or ACL reconstruction, but for life. It is for that reason, for example, we see all patients with a total joint replacement for life each year and our registry recalls patients by the Internet each year as well.

To market our practice, we had to interview several firms that specialize in medical marketing. We listened to five different presentations. Some encouraged the use of video; some believed a new website would be sufficient. But when it came down to a decision, it was believed we would rely on the companies that had assisted larger institutions. The redesign of an interactive website is underway and will provide answers to common questions posed by our patients and the public at large. Advertising through our patients and the type of care we deliver has brought us more patient referrals and indirectly has encouraged physicians in our area to refer to our practice.

Cole: As part of a larger group, we engage in a marketing strategy that is both local and national. Our greatest success comes from the appropriate management of patients and doing our best to create an environment where patients have access and the ability to communicate with our practice. We continue to believe that while marketing efforts are important; our last patient experience remains our most important asset for the draw of future patients.

As many of our physicians have leadership positions and perform clinical and basic science research, we try to educate our prospective patients on new developments at our institution. We publish a yearly journal that highlights these efforts and provide it to orthopedic surgeons and academic institutions nationwide. We have made increased use of social media for the dissemination research and clinical advances including Twitter and Facebook. We have retained a public relations firm to highlight interesting patient stories, educational events and published research that our followers might find interesting. We focus on community events, health fairs, high school coaches and trainers, physical therapists and referral sources by providing content we believe to be of value for them.

Bert: Do you think that the marketing techniques you employ have increased your personal market share in your community?

McIntyre: I think that in addition to marketing, there has to be a “buzz,” something different that sets you apart from others. I had the most success when I was promoting something no one else was doing. This was interesting to people as they are always looking for the “new” and the “best.” I think to have success in advertising you need that “buzz” plus a sustained effort to establish a brand. One group in our area has done this with sustained advertising. The city hospitals are doing a great job of this with patient testimonial advertising that pulls on the heartstrings with tales of their wonderful patient care.

Powell: No question. As part of their intake information, we ask patients how they heard about us. We periodically evaluate these statistics. More patients use the Internet, both to search for a physician and to vet him or her once they have a recommendation. In Los Angeles, where patients have many physicians to choose from, the Internet is where they can compare physicians and offices.

Plancher: We are able to track every patient encounter and identify the source of referral through our electronic medical record system. We have done this process since 2003. We inquire at the initial encounter how every patient arrives at our practice. We have invested in a sophisticated electronic data outcomes registry, which has truly increased our market share, but more importantly, we believe shows the patient we care about their care and outcome. We hope to treat all patients as their parents were treated — with dignity, respect and attention to detail. With this mission in mind, the quality of care delivered and personal experience will continue to maintain our presence in the community.

Cole: Yes, we do. Objective data includes zip code tracking for patient origin, referral source tracking and capturing Internet-based search data that leads to new patient visits.

Bert: What do you consider unethical marketing techniques employed by orthopedic surgeons or other specialty physicians?

McIntyre: I heard a radio advertisement the other day for one of the medical doctors who are running an “executive” practice in the city. What they do is see you, examine you and then run all sorts of scans as a screening measure — all out-of-network and paid for in cash, by the way. The ad was, “Dr. X, he gives cures, not Band-Aids.” Clearly, this is misleading, and I think unethical. As long as your advertising is honest, I think it is okay. My great uncle, who was a pediatrician, always told me, “Don’t hide your light under a basket!”

Powell: Certainly, claiming to have training or skills in a field that is not the primary segment of a practice is misleading to the public and overreaching claims of success rates of surgery is not ethical.

Plancher: While increased volume has been the mantra for many orthopedists across the United States, we strongly believe it is the quality and the personal experience that markets our practice. The use of data outcomes registry and tracking is an essential component of our marketing plan. We believe a successful and ethical marketing plan should focus on the excellence of care and successful outcomes, using these data to support claims of excellence.

Cole: We emphasize research-based technologies and treatments with supporting levels of evidence and avoid the promotion of technologies that lack proper support for widespread implementation. In addition, we remain sensitive to our high-profile patients and avoid leveraging their treatments and ailments for marketing opportunities unless driven by the patient or organization with proper HIPPA considerations taken into account.