We're starting then on with our next talk. This is on building your medical practice and the foundations really for a successful medical practice, whether you're in private practice, group practices, university practices. These are some things and there's some good considerations here. I will go over what I think is the very basics of building a good practice and then maybe some futuristic considerations and utilizing social media to advance those agendas. The first thing that I think is very important when you come into a practice is looking at its governance structure because it has a lot of meaning. How are you going to incorporate? I've been through each and every one of those incorporations at one time or another based on tax benefits primarily. You can have an Inc., an LLC, an LTD, a C-Corp. All of those are structures that you should at least be able to define what those are. They all have bylaws. Those bylaws are written by attorneys. The person back there who asked, when do you first meet your attorney, it might be when you look at your governance structure. Next is a shareholder's agreement, employee agreements, determining who the directors are and what the officers are doing, and that's usually an unpaid position, and how that maintenance of governance is done. The bylaws are generated by attorneys and they provide an overview of how you run your practice. If you are going to ever survive an IRS audit, the first thing they're going to do is come into your office and say, or into your practice, and say, let me see your governance. Because one of the things that a lot of physicians do, they get lazy about it, they forget about what the governance is and how it coordinates, and I've even seen that in my own practice where we had neurosurgeons claiming they were vice president or secretary and not realizing that we changed officers last year. It gets confusing, but if you keep records, you maintain those records, and you meet on a yearly requirement, or follow the requirements of your governance structure, that's important. These meetings include the board of directors, how it's set up, your executive committee, officer stock, indemnity, shared redemptions, records, and audits. There's several structures to your bylaws that you need to be aware of. Then there's the maintenance of the governance, and as I mentioned to you, typically in most states, it's the president, the vice president, the secretary that really runs that aspect of your practice, and those are elected officers within your physician group. Please maintain those minutes, and please manage yourself in accordance with your bylaws, and don't deviate. I feel that the basis of running a practice is based on four R's, respect, responsibility, recognition, and referrals, and I'm going to go through that with you, starting with responsibility to your patients and to your referring physicians. Nowadays, we have to respond to patients in terms of the quality and the value of the neurosurgical procedure or care that we're going to administer, and we are behooved to prove that we have a culture of customer service, because that is what our government is now demanding of us, and what patients are being educated to discuss with their neurosurgeons about. So, do you provide a timely access to your patient's questions and or concerns? Because it's really bad if someone's leaking spinal fluid, or they call in that they have a clear leakage coming from their eardrum from their recent acoustic neuroma surgery, and it wasn't addressed for several days. That's not going to look good. But good communications with the patient's family, referring physician, the power of thank you, and patient satisfaction now should be coming to the top of your list. So, going into that a little bit more detail, your responsibilities in communicating with patients and families have to be taken seriously. When you examine a patient, look at them, listen to them carefully, and don't get wrapped up in checking boxes. The second thing is go over the films, and what I do with my patients, because I think durable material is important for them to walk away with, every patient who I even look at a simple x-ray, they sit down with me, and they see that x-ray with me, and I encourage them to take a picture of it. Because they can take a picture, I just may not be able to take a picture. Outline the problem for them, and you have to make sure that you clearly articulate the plan of care you have for them, and that they voice that they have an understanding. Give them accessibility to answer questions. You have to, you may be really, really busy, but if you can't answer their questions, then reschedule them, and make sure that you do answer their questions. And provide them with educational materials. Usually that will be on a website that you can refer them to, and documents that they can refer to. I think the nicest thing you can do is at the conclusion of seeing a patient, if they walk off with a picture in their phone about what, you know, let's say a post-op ACF, they saw the picture, they knew you looked at it, they even have a picture showing that they've had the surgery, and they walk off with a piece of paper with definitive instructions of what they should be doing. I think that you will definitively improve patient compliance. What about the responsibilities in getting back to your referring physicians? In my particular practice, there's a number of nuances. Now some of you might be in hospital employment, where you work for a single entity, and all of your referring physicians come from that entity, and then the communication is usually pretty good, because you might have an electronic medical record system that's completely tied. But there's some doctors that also want you to let them know immediately that you've seen the patient. So it might require an email, a text message, all of this, of course, being HIPAA compliant, or a phone call as a heads up. Say I just saw your patient, check your electronic medical records, I have some interesting things that you need to read. And what I have done is I've taken my smartphone and my contact information and put it in the notes what the particular referring physician really likes to know. Because as Deb had mentioned, many of the cases that we see, I get referring physicians I hadn't even heard of, and they live in other towns or other cities. But once I know who they are, I find out how they like to communicate by cell phone, by email, and I send HIPAA compliant messages of where to find the information about their patients. Or I just ask them to give me a call, or I just call them directly. So it's an important response and accessibility to these referring physicians, because they're the ones that are going to send you many of your patients. So just one other comment about that, and I oftentimes ask my patients, how did you get to come to see me? Because many of them don't say I did an internet search. They rarely say I did an internet search. Now they might do that perhaps in bigger cities, but I find that a lot of patients don't trust health grades. They don't trust what they read on the website, but they do trust their family, their friends, and their church members. And if you've taken care of somebody and they know you, they oftentimes say, well, you took care of my shirt tail relative. The other thing that sometimes can happen is your referring physician has to believe in you too. Once you've done a great job with patients, they see that you provide not only just quality, but value to their patients, they will keep sending you patients. There's also recognition through service, what I call trusted leadership. So if your health care team trusts you, and your hospital trusts you that you're a good steward, then your patients and families will trust you as well. So you have to protect the system resources. You have to partner with hospitals or the entity that you work with to show that you are providing not only cost effective care, but high quality care as well. And then you have the role as the educator, sharing knowledge with your colleagues about changes in care, health care team, and sharing that also with your patients and families. Then there comes the next R, which is respect and collegiality. We didn't quite hit, I hit mentorship a little bit earlier in my previous talk, but I'm going to emphasize that you need mentors. And you have to look both inside and outside neurosurgery for those physician mentors, and sometimes even administrative mentors at the hospital level. Be inquisitive, be inclusive. If it's your first year or two out in practice, and you have a neurosurgeon mentor that's going to come in and watch you do cases or help you with cases, that's a good thing. But if you don't have such a neurosurgeon, let's say you go to hospital employment and you're the first neurosurgeon now that they've hired in three years, then you ought to at least get to know some of the general surgeons, cardiac surgeons, maybe ENT surgeons, and say to them, hey, I'm doing a great parafalsina meningioma today. Please stop by if you have any questions. I just love this type of case to do. So that they know you're very confident at what you do, and you're confident about what you're doing, and you're willing to share that with them. The other is professionalism. It always helps if you do some community service. So let's say that you were very interested in kyphoplasties, but you were concerned because you saw that a lot of men and women were coming into your clinic, more so than what you expected, that were suffering from untreated osteoporosis or osteopenia. There is an example where you could get out to the community, find out where you might be able to give a public talk, and do something to really help others. And osteoporosis is just one of many, many, many myriads of community services that you can do. And then also think about your social activities. You know, if people see you in church, that might help. People do not want to see you sitting at the country club on your third martini. I'm sorry, but we're neurosurgeons, and people have a certain level of expectation. I do know that sometimes doctors would rather go to really huge communities where they can kind of hide out, break free, and have a good time. But if you're in a situation where your patients are going to see you, you really have to be mindful of that behavior. So it's not just those Facebook pictures that you were shown. But if you want to build a practice, you've got to show the world that you're a safe neurosurgeon and you're available, and you will be competent at the time that you're being called into the hospital. So building your practice has a lot to do also with fun things like data, outcomes, collaboration, and the power of social media. So I'm going to talk about some upbeat things you can do to build your practice. There are benefits to having a web presence, and usually when you do that, you have to advertise with a goal. You want frequent visitors, you want something that's attractive, preferably something that's interactive and educational, user-friendly, make sure it runs efficiently and provides patient education both in pre-op education and post-op expectations. The patient is looking for a physician. Your web has the opportunity to talk about what kind of neurosurgeon are you? What are your credentials and clinical interests? What really are they? I see a lot of people really putting a bunch of things down behind their name, but you can back that up. Can you operate? What distinguishes you from your other colleagues around you? What are your outcomes, your collaborations? And do your clinical interests expand into a serious clinical outcome and data collection? So it's all about if you're better, you should be trying to be able to improve it. And one way you could do that is through personal data empowerment, outcomes that are very unique to your practice and your office. So we talk about patient satisfaction forms, electronic surveys, functional outcome. If you're studying functional outcome, your patients should be aware of it, that you are interested, how they measure up to others and within your practice yourself. So this is an example of one of my colleagues who's no longer practicing with me because he took a job elsewhere, but his personal data empowerment came out through health grades. And I don't think he did that great. He was only fair at scheduling appointments. The office that he was in was only good. And the office friendliness, well, nothing was very good or excellent about this doctor. But interestingly enough, when he did his own survey, which included a larger number of patients than health grades did, all of a sudden he was doing very good. He was in the 90s and everything, if not in the 100s, with regards to patient satisfaction. Don't forget, health grades is for when people are upset with you because they had to wait and didn't understand why you were on call. They had to see you because patients themselves are very selfish sometimes about their health. I mean, they're sick and they don't feel good, so they're going to be centered about themselves and maybe not understanding if you're late. And they may go to health grades to complain about it. So my suggestion is that you run your own numbers so that you honestly understand how your patients really think about you. So if you do have some criticisms, you'll know what to do to improve yourselves. So also, you should be aware of what the public concerns are. The public's hearing a lot about stroke certification. I mean, they can't drive down Veterans Parkway without seeing billboards that are flashing that this and that hospital's stroke certified. They hear about best hospitals. Which hospital might be associated with the top medical center. They're very concerned about hospital infection rates. In fact, that enters my discussion each and every time I talk to patients about what the risk of infections are at our local hospitals. So they understand my infection rate and the hospital's infection rate. They want to know that your hospital and you have the right equipment, the nursing skills, the collaborative clinical trials, and the research to get the work done that you need to get done. And also, are your patients adequately satisfied? So take advantage of social media. You can empower your website, your Facebook page, and your audience. Here's an example of one of our local hospitals that had received several five-star quality awards, like the American Stroke Association Award, the Blue Cross Blue Shield Spine Surgery Distinction Award. When those awards are given to your hospital and you're a part of that, you can help celebrate that. Why not do it with a tweet? That's just one example. So I tweet out, congratulations to the hospital for their A grade for hospital safety. Well, what happens then? All of a sudden, it gets retweeted. And it gets retweeted locally among the hospital, and you realize, gosh, a lot of my patients are my scrub nurses, the patients that work on the, I mean, the staff that works on the floor down in radiology, and suddenly they're seeing something nice. And so quality then gets celebrated. So the public is trained to view quality based on measures that are promoted by government agencies and the media. So identify the strengths you have and share them with your hospitals and use social media to do it. Remember, patient satisfaction scores, the initial measures are how well you communicate with your nurses and your doctors, the responsiveness of your hospital staff, how well you manage pain, your communication about medicines, and surprisingly, the cleanliness and quietness of the hospital environment, the discharge information you're given at the time you leave, and the overall rating of that hospital. So it builds that practice is really, in summary, strong communication skills, patient satisfaction, collegial relationships, outcomes and quality, which I think Dr. Benzel will cover with you here shortly, sound business practices, and a staff that's service-oriented, and the stewardship that you provide not only to your patients, your physicians, but to your community.

medical practice

governance structure

communication skills

patient satisfaction

social media