Whether you are in an academic setting, a group practice, or a solo practitioner, setting goals and developing realistic strategies will help your practice grow

Marketing is the ability to promote your skills as an orthopaedic surgeon to a target group, aimed at improving the financial health of your practice. Although some orthopaedic surgeons claim to be adverse to “marketing,” if you want to increase your profits, you must be able to reach patients and react to the changing healthcare environment.

In reality, we “market” ourselves daily as we care for our patients, who become our greatest ambassadors to potential new patients. The fact is, even in a competitive marketplace, we can influence how our practice evolves by developing a marketing strategy to reach out to future patients who will benefit from our services.

Making marketing decisions
Four primary aspects of an orthopaedic practice are amenable to marketing: Ability, Availability, Affability, and Price. The hardest aspect to market is price. Others can charge less than you do, particularly clinics that employ care extenders such as nurse practitioners or orthopaedic physician assistants. But you have more control over the other three aspects.

Ability refers not only to your skill but also to a special focus for your practice—such as hip arthroscopy or pediatric sports medicine—that appeals to a specific niche of patients. Affability should not be ignored, because your demeanor—as well as the behavior of your front office staff—can either nurture new patients or drive them away. The easiest aspect to market is your “Availability,” which may include offering after hours orthopaedic urgent care or Saturday hours.

Orthopaedic marketing should be designed to improve your practice by focusing on areas of practice development and reaching patient populations that may need further care. In making your marketing decisions, you must determine what area(s) of the practice that you want to grow or expand. This goal-oriented approach will enable you to develop a marketing plan to improve the number of procedures you perform, the number of patients you see, and your W-2 income

According to the 2006 AAOS member census, more than 80 percent of orthopaedists are in private practice, in one of the following four practice types:

• academic practice—8 percent of members
• integrated group model practice—9 percent of members
• orthopaedic group practice (large or small)—58 percent of members
• solo practice—25 percent of members

Marketing for academic practices
Salary and/or salary plus production provide the primary revenue sources for orthopaedists who practice in academic settings. Additional or alternative revenues may come from teaching stipends, a university professor’s salary, and consulting fees.

The marketing approach for an academic practice should focus on reaching a broad spectrum of patients, because most academic practices contract with all payors—government as well as most managed care organizations. An academic marketing approach should use print, radio, television, and other general population media to increase the number of patients referred to the practice.

Integrated group marketing
The second type of practice is the integrated group model, which is usually a large multi-specialty group. The revenue stream in this type of practice is usually from a combination of salary and incentive bonus, plus possible partnership revenue. Physicians looking to augment that revenue usually have to renegotiate their bonus calculations, because they may be prohibited from taking on outside work.

Marketing for a large multi-specialty group is usually done at the corporate level, directly with employers and other medical specialists within the group. Physicians frequently tend to market only to their area of subspecialty interest. Outside marketing is rarely necessary because the groups tend to “capture” patients by contract arrangements.

Group practice marketing
The most common group practice type is the single specialty orthopaedic group practice. These practices can be further subdivided into large group (12 or more surgeons) or small group (fewer than 12 surgeons) practices. These groups usually have both a partnership track and a non-partnership cohort. Revenue is frequently divided in a tiered fashion, usually based on production minus expenses, with partners sharing a bonus derived from a “tax” on non-partner orthopaedic surgeons. In this model, alternative revenue sources such as surgery centers, imaging centers, and physical therapy can be quite attractive.

Large group practices may want to direct their marketing efforts toward establishing a “brand” identification and marketing to referral physicians and other non-specialists, using print, radio, and television. Large group practices tend to contract with most payors and insurers, as well as government payors. If the group handles workers compensation claims, targeting large employers or networks of employers may generate a workers compensation contract.

Small group practices may benefit from using similar approaches, especially to referral physicians. When approaching a referral physician, the group must be sure that the contracts accepted by the group match the referral physician’s contracts. Group practices may also consider adding locations near referral physicians’ offices and obtaining staff privileges at multiple hospitals to service the referral physicians.

Marketing a solo practice
The solo practitioner may be in the best position to market directly to patients by identifying the needs of his or her patient population. For the solo practitioner, the key to successful marketing is patient-to-patient marketing rather than referral physician marketing. Although the solo practice may do some referral physician marketing, the ability of the solo orthopaedic surgeon to develop enough patient-to-patient referrals can enable the practice to operate autonomously of surrounding referral physicians.

Once the patient-to-patient marketing and referral patterns have been established, the solo practitioner can begin to drop off contracts that are onerous or less profitable, up to and including government contracts.

The marketing of orthopaedic surgery practices, although complex, is really dictated by the practice type. Each type of orthopaedic practice has certain target patient populations with various marketing options. An effective marketing plan can be constructed and carried out based on the type of practice and the specific skills of the surgeon(s) involved.

These are challenging times for orthopaedic surgeons. Ensuring the growth of a successful and rewarding practice in the current climate of fee reductions, escalating overhead costs, and liability concerns seems difficult. But the goal of an effective marketing plan is to improve the practice over time. By defining specific practice goals—such as increasing profitability, developing a niche expertise, or even spending more time away from the practice for family and friends—an orthopaedic surgeon can develop an effective marketing plan that can help turn these dreams into reality.

Thomas J. Grogan, MD, is a pediatric orthopaedist practicing in Santa Monica, Calif., and a member of the AAOS Practice Management Committee. He can be reached at tjgrogan@aol.com