As the owner of a private practice, it is really important to know who you serve and who you don't. You might have been trained to serve everyone and that doesn't work if you're trying to have a profitable business that give time and joy with what you want to do.
I share with you the case of meeting a non-ideal patient, how to spot it and what to do about it so you set yourself up for more of your ideal patients to come through.
Dr. T 0:00
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients and how they get paid. They have chosen this path with a love of medicine. This is the direct care way.
Dr. T 0:24
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.
Dr. T 0:52
I have something to celebrate. I am celebrating identifying who my non ideal client is. And you might be wondering, that is a really weird thing to celebrate. But it's actually really important. Because in your private practice, you have to be selective about the type of business that you do in a way that helps you create profit so that you can have freedom in your schedule and your time. So if you were trained in the US, our residency training for all specialties, revolved around the hospital setting, or an academic center, and maybe some private practices. So we had an abundance of resources to help all the people, right, anybody who came in with whatever insurance, we have the ability to help them in one way or another. But when you go into private practice, the resources are not abundant, you have to be more meticulous about who you can treat and who is better served elsewhere.
Dr. T 1:48
If you try to take care of every single person in your practice, just because they have a certain insurance, you're gonna find that you're gonna get burned out really fast. Because if you're not doing the thing that you love to do, serving the people who actually want and need your stuff, it can feel a little defeating. Sometimes I remember when I was trying to help some of these patients in the Wound Care Center. And some of them were not trying to help themselves. And I had gotten to a point where my conversations with some patients was, I cannot be the one who cares more about you than you care about yourself. Because I would give these recommendations, we would spend 1000s of dollars on these patients for various graphs, home health services, and so on. But at the end of the day, if they didn't want the help that we were trying to give them like if we didn't meet eye to eye, that this would be a mutually beneficial relationship, then it really wasn't worth all of the energy we were putting in.
Dr. T 2:43
And I carried the mentality of us having to take care of every single person from the academic center into my private practice. And that showed to be a very exhausting way to run a practice. And I'm going to share with you why it's really important to quickly identify who is not an ideal client for your practice, so that you can help them move on to the next person or referral that could help them. So our moral obligation as a physician in a private practice is really knowing our limits, and identifying who our ideal clients are, and who doesn't fit the model. And when I say knowing who doesn't fit the model, it doesn't mean what their pockets look like. It doesn't mean that we only serve rich people, it just means that we are serving in our private practice, the person who has a problem that we can solve and is willing to pay to have it solved those two things which go hand in hand in order for a private practice to be profitable. If it's one or the other, then maybe private practice might not be the model that you're looking for. If you want to be the doctor who serves every single person who comes in and however your paid is irrelevant.
Dr. T 3:52
As long as you get a check every two weeks, academia works really well, that makes sense. That type of model makes sense for that type of work that you want to do. If you only want to worry about the money, but not so much in the patient care, then I hate to tell you, but then healthcare is really not the place to do it. Because patients are incredibly vulnerable when they come to us as physicians. And if you don't care that much, or you care about money more than the patients who are coming to you for help. There's other industries that can serve you, but it wouldn't be in private practice. We are in private practice to help people and to make money those two things go hand in hand. So to have a profitable private practice, you have to be very clear on the purpose of the business is the business model intended to be for profit or not for profit, and even in a not for profit type of model. money needs to be funded somewhere either by donations or even an Insurance insurance reimbursement.
Dr. T 4:48
You have to be very clear. If you are here to have a profitable private practice. It's really important to know who you serve. And I want to share with you a recent incident where I identified somebody who was not my ideal clients. And what I did with that, ever since I went into direct care, I did get to see a lot of my favorite patients on the regular compared to when I was in the insurance based practice. And here's why, when I was in the insurance based practice, I saw everybody, there was really no screening protocol other than we take their insurance. So these people would show up, and my schedule would be 20 3040 people long per day. And I would just see patient after patient after patient, right, my schedule oftentimes also had patients who just decided to no show they felt no responsibility or any obligation to inform us that they would be absent. So you know, they didn't even bother notifying us to make room for other patients who wanted to be seen sooner. And I felt like there was just kind of a general disregard for people's time when you do that, when you don't give them notice, one way or another. And I just really hated that. Because I've never done that to other people. If I said I was going to be somewhere, I would be somewhere.
Dr. T 5:59
And if I couldn't, I would make a call, I would send an email or text, even to my doctors, I would find a way to ensure that the other people knew and made time for other people who might be waiting, it just goes to show how little people really are responsible with their own time when they're relying on somebody else to make payments to see the doctor, right. And some people for some reason think that no show fees, can be charged to the insurance companies. I don't, I don't understand that at all. So anyway, that was life in the insurance space practice, there was a high rate of no shows. And then there was also a really high rate of just people who I couldn't really help or I didn't know how to help, because they weren't looking to solve the problem, they were looking for a magic pill or a magic bullet for their thing, when you know, it's an accumulation of things, lifestyle habits, diets and stuff that brought them to where they were today. So in the insurance base model, I just saw a lot of folks that may or may not, we're a really good fit. And, you know, I was taught that we had to serve everybody who came in. And it wasn't until I started opting out and learning about direct care that I realized actually have the power to make a practice that is truly my own one that I really loved.
Dr. T 7:10
And in order to get that I had to be very clear about who I serve in the door and care model, you're not just serving people who are wealthy. And in fact, I have no clue what people's incomes are, when they come in, I just know that I have a service that they need, and what my price points are, and it's up to them to decide on how they want to spend their money. Now, let's be real, if you haven't direct your practice, you are self selecting for certain types of people, it's people who maybe they were failed by the system, and are looking for alternative options. Or maybe you have a really great reputation, and you are the go to person for this thing. And so it was by word of mouth, they found you. So having a direct care practice does self select for certain types of people. But that doesn't always mean that you will always get the right type of person, it does mean you get a higher percentage of ideal clients. Because these are people who are truly invested in solving a problem enough to pay in a pocket even if they have insurance even better if they don't have insurance, because then they're they've already shopped around and look for choices.
Dr. T 8:11
And then they chose you the opposite or the contrast is true as well. When you are in the insurance based practice, you are selecting for people who don't want to pay more than their copay, or they still complain about their copay. How often has that happened in either model, you're selecting for certain types of people in the insurance based practice you are selecting for people in the way of being in network. So these people don't expect to pay very much out of pocket and the direct your practice, same thing you are selecting for people who are choosing to pay out of pocket. So with that comes with a different type of mentality, the insurance base model, it's a high volume type of practice, I saw a bunch of no shows I saw people who were not really responsible for their own care. They wanted the magic bullet. It was very dissatisfying. They wanted me to do the thing that the insurance would cover, even though I knew it wasn't the best option. So how often are we seeing ourselves treating the patients because of what the patient's want, rather than what we know is right for them.
Dr. T 9:06
That was the problem I had with the insurance based practice. It was the underlying systemic issue that is really hard to pull away from when patients come to you wanting or self directing their own care, simply because they know well, my insurance will pay for it. So that's the thing that I want. They feel like the insurance sets the bar for what is right, when in reality the insurance is setting the bar for what is budgeted? Those are two very different things. Okay, so let me tell you about a patient recently who came in who I didn't really pre screen so the pre screening process of selecting for your ideal patient for me looks like this. Number one, they have to know how to use the computer in order to register themselves through my online portal. Because I am a micro practice I'm assault small solo practice, things need to be efficient, which means I had to select for people who knew how to use the internet, which is why I rely so much on social media as a source for patients. So number one, the self selection is they need to know how to use the internet. And then number two, I have a credit card on file so that I it shows me that they're committed to coming through. When people put credit cards on file, it's a different responsibility. They'll show up, sometimes they don't majority of the time they do.
Dr. T 10:18
And this has worked for me, by the time patients make it that far, I already know that they're a pretty good fit for the practice. They know that I'm efficient, I can see them quickly. And they know the cost of things. So there's no surprise bills, I like to start off my evaluation with what is the goal, because if their goal is to get something that I don't offer, then we don't need to waste each other's time, right? I've had patients asked me if I do laser for a certain thing with which I don't. So I'll just refer them back to Google. So instead of having that appointment slot wasted, or it's spent, and they want a refund, because they're like I came in here for the thing that you didn't give me, you know, we want to skip that part. This patient came through, it was a little bit hazy, I've never had this experience before. But they came in complaining of foot pain, and I was like, I can handle that. So they came in and did a full one hour evaluation, which included X rays, I showed them the X rays, I showed them the treatment plan, I scheduled their follow up and everything sounded like it went okay. And then later on, this person asked for their medical records, they wanted to get this medical record to essentially try to prove a 30 year old surgery that was evident on the X rays to try to correlate that with their current symptoms for today. So their goal was just to get documentation that will correlate an old surgery to their current problem so that they can get insurance coverage.
Dr. T 11:42
That was their goal. And I missed took that as they want it to get better, because we spent an hour talking about what's limiting why they have this pain, how that's holding them back, all the different things that they've tried. And I was a little bit blindsided when they asked for my chart note, I submitted that that's easy to share with patients through my online portal. But then they requested for me to make a edit in the chart note which they felt was not going to be relevant for them to submit for this insurance claim. And then I went through my chart, I tried to edit the note, but I couldn't. I've never actually had this request before. But when I looked into my chart, once I submit that note for the patients to see everything gets signed, it has a timestamp, it has the patient's signature that they received it so it becomes part of your legal document, but my legal documents, and so I told her unfortunately, I can't edit a legal document. But what you can do is print it out and just wipe out the part that you don't think it's relevant. I don't think it's a big deal. So then they replied, Well, I guess I came to the appointment, not achieving what I wanted to get out of it.
Dr. T 12:45
So I was like, Okay, well, I'm sorry, you feel that way, I will cancel your future appointments and carry on. So this entire interaction with this person, I should have known early on that they weren't going to be the type of person that I could serve. Even though they met some of the more superficial metrics, like they were able to use the online portal to self register, they had their credit card on file, they had a problem that I thought I could solve, which was I thought it was the foot pain I was trying to solve. But instead, their motive was just to get insurance coverage with my documentation, which is very weird. I've not encountered this before. But hey, now I know and I'm sharing this with you. Because you know, sometimes you might encounter certain types of people and not really know what they're after. Or they might say things in the way that feels in line with what your ideal client might be. And it could be just a mask, it could just be malingering just so that they can get what they want in return. Sometimes that might be a prescription pain medication prescription that they ultimately wanted, they didn't want to get better. So I share this case with you.
Dr. T 13:52
Because once in a while I get things that I've never encountered before. So I don't really know how to plan for that. And I'm sharing that with you. So that now you know, you have to be very clear on who you serve, and create a system that will pre select for your ideal clients. And the way to do that in this situation really was to be very clear about what is your goal for today. And sometimes you don't get that right away on intake, you get that through the conversation. And in the conversation, I did hear them say over and over again, we really just want to connect the surgery to the foot pain so that they give me insurance coverage. And all of the care that I will need in the future will be covered. Because they anticipated it's going to be very expensive. And maybe you're hearing me tell the story. And maybe you're much more intuitive and you're like, Well, that was obvious, but for me I was like that should have been obvious. I mean, I think it was but I kind of oftentimes give people benefit of doubt if they're willing to pay for my services. I'm gonna give them my time and having dealt with a lot of seemingly impossible situations and helping people in their small little ways. You know, those were rewarding times. And so I was like, I thought that I was trying to Be a hero. And instead, my ego got the best of me, and I could not help them after all that. So moral of the story is, I'm still learning. And I'm gonna share all of that with you. But I'm really glad I had this experience because it just reminds me it really humbles me, right, like, I don't know everything, and I won't encounter all of the situations that you might and vice versa, you know, like, every single individual that walks through, they're all very unique.
Dr. T 15:25
And I can only give you a roadmap of what you could do to increase the chances of you having your ideal clients all the time doing what you want to do. For me, I love second opinions, I love being able to connect the dots on complicated cases. But this was one particular case that I could not solve, because they didn't want it solved. Their agenda now is very clear. They just wanted to connect a really old problem to tap in over 30 years. And I was very transparent. I said, I understand the goal of you wanting my chart documentation, I will put down what I find objectively, and whatever you do with that information is beyond me, I'm just here to do my part. And I don't know if you're going to get what you want. Because a 30 year old problem can go any which way. This is a challenging case. But I don't know, if you can correlate a surgery to what symptoms you have now, especially if you've never had a follow through within those 30 years. So I was frank about it. But you know, at the end of the day, people want what they want, they only hear what they want to hear. And we were not a good fit, they were disappointed. I was disappointed. We went our separate ways. And that's all there was to it. So a friendly reminder, your ideal client avatar is the person who has a problem that you can solve that they want to solve and are willing to pay for it. So that's all I have for today.
Dr. T 16:46
I hope you took a little chuckle out of that I hope you took some light into recognizing that this is all a work in progress. It's really important to know what your business does. It serves people and it makes money. But also knowing when somebody doesn't fit the mold and being okay with letting them go. You never need to hold on to a patient because you need to make a little money. Never ever take on a patient because you need the money. That is not why your business exists, that will ruin your reputation, you're going to be miserable. It's not going to set you up for long term success. Do not do it for the money. The money is the consequence of you doing the thing that you love that you're really good at all the time helping the right people. I hope that makes sense. If you have any questions, shoot me an email. If you'd love to dive into a direct care practice and you just need a roadmap purchase my course it comes with a monthly coaching program, where I meet with you oftentimes one on one in a private group setting I do it over zoom. I give you all the things because I want you to be successful. I need you to be successful in order for us to move the needle in favor of physicians and for patients. That's all I've got for today. I'll see you next week. Take care.
Dr. T 17:57
Thank you so much for being here with me. If you enjoyed this episode, don't want to hear more. Please like share and subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect find my info in the show notes and send me your questions. That might be the topic for future episodes.
Dr. T 18:16
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time