How to Build a Successful Medical Practice

You’ve spent a decade through medical school, residency, and maybe a fellowship. You hang up your shingle for your new practice. The custom figs and embroidered white coats have arrived. What’s next? Who in their right mind is going to come see a brand new doctor?

First, not trying to brag but just to explain why I think I’m qualified to write this post. As of writing, I’m several years out of fellowship as a subspecialty surgeon, performing elective surgeries only, meaning patients have a choice in who they want to do their surgery. I’m in a highly competitive market. I’m in private practice. Over these first several years, my practice has grown from zero to now collecting about $2.8 million annually. My surgical volume and payor mix have improved every year as well. My clinic and OR schedules are full and I’m about as busy as I want to be.

Before starting

This is more for private practice, but either before your practice opens or in the initial weeks when you aren’t that busy, you need to build an online presence. Ultimately your practice will grow most reliably through word of mouth, but even if my friend or family member gave me the name of a doctor they liked, the first thing I’d do is Google that doctor. If I see a nice website and reasonably good reviews, that’s enough for me to give them a call. I think most patients are the same.

So I think that’s all you need, a nice website and some good reviews. I don’t think social media is necessary, and in fact I do not use social media for my practice. I think it takes a lot of time to do a good job with social media. And while it can be accretive, there are some significant downsides that maybe we’ll discuss in a separate post later.

You can either build a website yourself, or outsource it to a number of services that do this for doctors. The website needs to look good and up to date. This is a manner of personal taste. If you think you have taste, then I would encourage you to try building the website yourself through a service such as Wix or Squarespace. It takes more time initially, but once it’s up and running, it’s great to be able to make edits or add content on your own.

In addition, you should create a Google Business profile. This is how you’re going to solicit reviews. Google is the dominant search engine, and having good reviews on Google is absolutely critical.

The first few months

Let’s face it, nobody wants to be treated by a brand new doctor knowingly. There is nothing that teaches better than experience, and new doctors are doomed to make some mistakes that doctors with more experience wouldn’t. That’s just the way it is.

So in the first few months, it’s going to be slow. Really slow. That’s okay! As someone once said to me while being on trauma call as a resident, “They can hurt you but they can’t stop the clock”. Even if it is painfully slow because nobody wants to see a brand new doctor, the clock is still ticking, which means you won’t be a new doctor forever.

The patients that come to see you in those first few months are there because they either didn’t do the research to figure out that you’re brand new, or they have no choice but to see you based on insurance or availability. That’s okay too, don’t take it personally. Everyone has to start somewhere.

All you need to do at this point is to be an amazing doctor. Go above and beyond. Imagine if it was you or a loved one who is the patient. This means spend lots of time talking to them in the office, do the best surgery or intervention that you can, and just take really good care of them. If you’re a surgeon, this means calling them the night before, speaking with their family member after surgery, calling them after surgery, and be very hands on through the entire postoperative process. Maybe even give them your personal email or number if they have questions.

If they’re happy with their care, you can ask them to leave you a review. There are many ways to ask for this - asking in person directly, email, links, QR codes, the key is to make it as easy as possible. Your Google business profile allows you to generate a one-click link to leave a review. From personal experience, however, only about 10% of my very happy postoperative patients will leave a review on Google. Part of it is because it is not anonymous and it may be linked to their Google profile. That’s okay, just keep at it!

Referral sources

Depending on your specialty and market, it is also important to cultivate referral sources. This might be other doctors such as pediatricians and primary care doctors, or other providers such as physical therapists. If someone referred a patient to you, send them a nice note to thank them for the referral.

You can also do direct outreach, such as offering to give talks at other physician offices or physical therapy locations. This can be a great way to get your name out there starting out, especially when you have some free time. If you’re going to do this, try to make it as efficient for you as possible. A webinar that you can do from home for a physical therapy group with 100 therapists on the call is great. Speaking to 10 seniors at the local YMCA in the evening is probably not.

Word of mouth

Once you start treating a few patients, the snowball will start to gain momentum. During Covid, the news kept talking about a R0 number, which was the number of people that each Covid-positive person infected. The same is true for your reputation for taking good care of patients. Every happy patient of yours will spread your name to X number of other people, and assuming you did a good job with creating a positive online presence through a website and some reviews, your practice will begin to grow.

Providing quality care efficiently

At this point, you’ll start getting busier, and you won’t be able to spend an hour with every patient. You’ll need to learn how to provide great care more efficiently. This is a process optimization problem. For me, this is when I hired a physician assistant (PA), which unlocked tremendous productivity gains.

In the office, my PA prepared all of my notes for the day, because I want to maximize my time actually talking to patients. Anything that doesn’t require you to do well, you should outsource. My PA would call patients if necessary before surgery and after surgery. Postoperative wound checks could be done without me. Your office staff will grow as well. The most important thing is to maintain quality and service. Make sure anyone you’re hiring has that customer service gene in them. A great book to read about this is Setting the Table by Danny Meyer.

Self-sustaining practice

As your practice grows, your capacity for treating patients will grow gradually, but there is a limit. There are only so many days and hours that you can see patients. If you’re a surgeon, you’ll be capped by your OR time as well. You might become more efficient over time, but there’s a limit to that as well.

Conversely, with time and volume, your word of mouth continues to grow linearly with the number of patients you have treated that are happy. At some point, a crossover happens where your word of mouth alone will generate more patients than you have the capacity to treat.

At this point, your practice has become self-sustaining. As long as you take good care of patients and you don’t move geographically, this will inevitably happen after X number of patients or surgeries. You no longer even need referrals, just your own previous patients can sustain your practice. I think this takes about 5 years or so for most practices. Congratulations, you’ve built a successful medical practice and an engine that can provide steady financial rewards as long as you keep wanting to go to work!