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3 Strategies to Help Physicians Maintain Their Revenue

dollar sugnby Vicki Rackner MD

Physicians’ concerns about the impending erosion of their revenue potential loom large. Falling fees, rising administrative costs and higher taxes all contribute to a worrisome financial future.

You are not doomed to be a victim of Obamacare.  You have many options that will allow you to create a practice that works for you.

Here are three general strategies to help you take control of your financial destiny:

1. Focus.  Get very, very good at helping a specific kind of patient achieve a specific kind of medical outcome.  Here are a few examples:

  • The Shouldice Hospital in Canada performs exactly one surgical procedure: the Shouldice inguinal herniorrhaphy.  And their published 99.5% lifetime success rate for primary hernia repairs attracts patients from all around the world.
  • An ob-gyn focuses her practice on helping her patients manage peri-menopausal symptoms.
  • A dentist takes delight in treating phobic patients who have not been in a dental chair for years.

Three thing happen when you narrow your scope of practice.  First, you get better medical results. Second, you can scrutinize every step of the process for ways to enhance efficiencies and reduce costs. Third, you increase your chances of delivering the patient experience that will generate more referrals.

Surgeons used to quip that “the whole world is pre-op.”  With the advent of social media, you could potentially attract patients from around the world.

2. Unplug. Look to your patients rather than the insurance companies for payment of your fees. If you’re a primary care provider, this may mean converting to a concierge practice; if you’re a specialist it could mean converting to al all-cash practice.

A local pediatrician carved out an all-cash consulting service helping kids with ADHD optimize their chance of life success.  She manages medication, offers life skills classes and coaches parents.  And she collects his initial $500 consultation fee before she schedules the first appointment.

If you go this route, expect push-back from both patients and colleagues. Here are some comments you may hear:

  • “It’s not fair.”  This model attracts patients who can afford your services.  If you feel called to treat patients regardless of their ability to pay, create a scholarship-like fund.
  • “Patients won’t pay.” Patients can and will pay for services they value.
  • “Patients can’t afford it.”  A group of bariatric surgeons charge about the same amount for their services as their patients would pay for a mid-range car.  Like auto dealers, the surgeons developed relationships with lenders who offer patients  financing.

Change is never easy.  I just flew on an airline that charges a fee for carry-on luggage.  I felt the same bolt off astonishment when airlines started charging for snacks, gas station attendants stopped pumping gas and librarians stopped punching due dates in library books.  Over time this became the new normal.

3. Explore non-clinical options. Your value transcends your ability to diagnose and treat individual patients.  You can put your knowledge, skills and judgment to work in other ways–and getting paid for it!

How do I know?  I’ve done it myself.

Please know that the rules of engagement are different in the world of business than in the world of medicine.  In the business community, the buyer exchanges money for value the seller offers. While clinicians deliver what patients need, successful businesses deliver what customers want.

Here are three key business questions to answer :

  • “What is my value?”   Like beauty, value is in the eyes of the beholder.  Women are more likely to dismiss, minimize and discount their worth than men.
  • “Can I assign a price for my value?”  Business people think of money as a bartering tool.  You may experience  discomfort translating your value into an asking price.
  • “Can I sell?”   We physicians feel about as uncomfortable asking for payment as patients feel about talking about some of the other “embarrassing P’s”: peeing, pooping and procreating.  Further, women physicians tend to have ambivalence how much money we really should make.

If you venture outside of clinical medicine, plan to invest in new sets of skills and adopt a new mindset.  Further, look into an errors and omissions policy to protect your assets.

These three strategies can be implemented in countless tactical plans.  Further, they can be combined. A more business-minded approach to clinical practice –one in which physicians focus on what patients want–results in higher compliance, better medical outcomes and higher satisfaction. This leads to greater clinical success.

Some think the golden days of medicine are over; I think they are just beginning. You have many options that will allow you to create a practice that works for you.

ⓒ 2014. Vicki Rackner MD.  All rights reserved.

You may reproduce this blog post with this by-line:

Vicki Rackner MD, President of, is a nationally-noted expert in the doctor-patient relationship.  This author, speaker and consultant helps physicians create practice that work for them. Her upcoming book The New Medical Mindset: How Physicians Can Reinvent Themselves and Thrive in the Era of Obamacare will be released in the Fall of 2014. Reach Dr. Rackner at (425) 451-3777 or at




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