Competition is ingrained in the entire process of medicine, from bench to bedside, from the time someone decides to go to medical school, on through the interview trail, fi nding a position or starting a practice, and so it goes.
According to Kathryn Horwitz, PhD, of the University of Colorado School of Medicine, if you want to be a good scientist, “you have to have a fi re in your belly,” as she said in an interview as part of the Endocrine Society’s Oral History collection in the Clark Sawin Library, in which she discussed the “competitive side of science.” She added that “you really have to want it badly. You want to do some good… . But what you really want is to beat out all of those other bastards who are working in the same area that you’re in and do it better than they are!”
Practicing medicine indeed has noble pursuits, but ultimately, it’s a business, and like any other business, one of the main goals is to not only stay afl oat and earn a living, but to “beat out” everyone else.
Fear, Greed, and Jealousy
Elliot Levy, MD, a clinical professor of medicine in the Division of Endocrinology at the University of Miami (Florida) School of Medicine led a workshop called “Setting Up and Negotiating Your Clinical Practice” at last year’s ENDO Early Careers Forum. He points out that knowing just how “different things are now” — from offi ce overhead costs to the impact of the Affordable Care Act — is the fi rst step in dealing with competition. For instance, determining exactly how much it costs to treat
each patient “will allow you to make an intelligent, level-headed choice about participating in an insurance plan,” and will keep you from making a business decision out of “fear, greed, or jealousy.”
Other things to consider: Knowing where your patients are coming from, what percentage of your patient population has Medicare insurance, and whether patients have PPO or HMO plans; where your referrals are coming from, whether they’re from other doctors, advertisements in local media, or other patients; and the concepts of only seeing patients for cash, accepting no insurance, and concierge medicine.
Armed with that knowledge, it’s easier to handle whatever competition may arise. Patients will still leave one doctor for another, but myriad factors contribute to that, whether it’s an insurance issue, about which little can be done, or the patient simply didn’t like the way he or she was treated during the visit, about which plenty can be done.
A Tangled World Wide Web
A research letter published online in February in the Journal of the American Medical Association acknowledged the trend of rating doctors online, stating, “Patients are increasingly turning to online physician ratings, just as they have sought ratings for other products and services.” Lead author David A. Hanauer, MD, of the University of Michigan, and his team found that 59% of U.S. adults viewed physician rating sites as “somewhat important” or “very important” when choosing a doctor, based on the results of a nationwide survey in 2012.
The authors wrote that while there were limitations to their Internet-based survey — a 60% response rate and the possibility that most of the respondents were web-savvy and younger than most healthcare consumers — rating sites “may be useful to the public but the implications should be considered because the stakes are higher.”
Take a look at any website that rates doctors and you’ll see what criteria patients look for, such as how long the doctor spends with each patient, whether the doctor listens to his or her patients, timeliness, cleanliness, professionalism, and so on.
Using online reviews as a barometer of just how well your patients like you isn’t an exact science, and usually the people who take the time to leave responses are only the ones who feel passionate enough either way to do so. Still, it’s a good start. “All of these factors mean a tremendous amount to a patient,” Levy says, “but often are never addressed or even considered by a doctor.”
But handling competition isn’t just about keeping the patients happy; referring physicians need to be able to feel like they can count on you when they send a patient your way. Be flexible and accepting of patient’s own schedules, even making time to see them over lunch or toward closing time. “Putting off a referral for six to eight weeks is a sure way of never receiving another referral from that doctor again,” Levy says.
The best thing you can do to deal with competition is be the best doctor you can be, which means treating your patients and fellow doctors with the utmost care and dignity. “Once a patient sees you, that person should walk away very satisfied with your care, and will tell all their family and friends, and then tell their referring doctor what a good experience they had in your office,” Levy says.
At the end of the day, don’t worry about your competition, he adds, echoing Horwitz’s comments from her oral history, “just be better and smarter than they are.”
— Bagley is the associate editor of Endocrine News. He wrote about health disparities and patient cultures in the March issue.