Marketing is not part of the curriculum taught in nurse practitioner programs. And patients don't show up just because you've opened a new practice.
When Lakewood, Wash., nurse practitioner Lea Poso got her degree, she didn't want to work full time. With her military pension and plans to use business profits to fund medical missions, she had hopes of seeing about 20 patients in her home office each month, primarily for natural family planning. It's been a slow start.
Poso's marketing has been low-cost and conservative. She's placed an ad - a copy of her business card - in her church bulletin and in a local monthly newspaper, and she's donated two free initial office visits at a charity auction. The response has been disappointing.
"I expected to have a couple of hits off of the bulletin, but I've had more hits off of NP Central's directory," she says, referring to the Web site (www.npcentral.net) that offers resources for NPs and consumers who want to find them. Her revised marketing strategy includes promoting her house call services among other health care providers.
Poso used common-sense marketing practices. She identified the type of practice she wanted to have and the type of patients who would make up her clientele. She knows how much she's willing to spend on advertising, and she made an attempt to get her name out to potential patients. The initial low response to her attempts motivated her to expand her services and audience. What else should she do?
Every business plan should include a marketing plan and budget. For help with a marketing plan, you can contact a professional marketing service, join a business owner organization, or take a course at a local college. Many communities have small business associations that offer resources that include retired entrepreneurs. As you work on your marketing plan, you'll need to articulate the overall goal of your practice, objectives you'd like to achieve in the next year or so, resources available for achieving your objectives, and the tactics you will employ. These tactics are often expressed in a rule of thumb known as the Four Ps:
Product: What do you do? What makes your services unique?
Place: Where can consumers find your services? What are your office hours? Are you available after hours? Do you have a Web site?
Price: What are your rates? Do you accept insurance? Do you offer discounts?
Promotion: How will you advertise? Do you need to educate the public? Do you expect referrals?
Marketing expert Bob Wetmore stresses that you need to do some research to answer these questions. When his nurse practitioner wife, Liz, launched her new clinic, the Community Wellness Center, in rural Cimarron, Kan., Wetmore involved some business students in developing the marketing plan. Their first step was to assess the current health care environment.
Student Jos Sanchez and his classmates held a brainstorming session and decided to conduct a consumer survey. They drew on their own experiences as patients to devise three or four carefully worded questions about health care service, office atmosphere, and suggested alternatives. The students then polled about 100 randomly selected Cimarron households and tallied the results.
The research proved invaluable in defining the clinic's product. "The nitty-gritty details told us exactly what we should have as messages in our advertising," Wetmore explains. "They told us what patients hate about their current experience - 'we wait too long.' So Liz would say, 'you don't have to wait.' All the typical nurse practitioner-type things that are a uniqueness of NP care - we put those things right in our ads."
And they followed up on their claims. "We found out patients wanted comfort and current magazines, so we signed up for a whole bunch and put up a huge rack. Now even Business Week is current," Wetmore laughs.
The students also learned that people like easy access to their providers, so Liz doesn't limit her services to the clinic setting. Patients who have gone off to college or the military can e-mail her with questions or for appointments. She also gives out her cell phone number and is available 24 hours a day. So far no one has called her at night for anything less than an emergency.
The research also helped the Wetmores design a strategy for promotions. They concentrated on print advertising, particularly in local newspapers. But the promotion wasn't all advertising. Liz Wetmore appeared on television and radio programs, contributed to news articles, published health newsletters, and passed out informational brochures at local events.
The Wetmores also handed out 3,000 refrigerator magnets with the clinic phone number, address and office hours. "We gave them to everybody, everywhere, everybody. Because when you're starting a clinic from scratch, nobody has the phone number - it's not in the phone book," the marketer explains. "That was a very inexpensive, quick way to get the word out."
Market to Established Patients, Colleagues
Bob Wetmore advises NP practice owners to view marketing as an investment rather than a cost. "If you invest in your patients, it pays off," he says.
Marketing is not merely self-conscious promotion. Don't overlook the marketing you do every day by simply providing good care. Before starting her own practice, Lori Holter worked in a hospital as an acute-care nurse practitioner. She had to educate some of the hospital physicians about what NPs can do, but it paid off when she opened Paragon Health Alliance, a nurse practitioner group in Lexington, Ky.
"I ran into a lot of physicians who knew me, knew the quality of care that nurse practitioners could give, and what our scope of practice was. So by educating the physicians in the hospital, that increased the contacts out in the community," Holter says.
She has seen her business grow without fliers or advertisements, but it helped having a business partner with a degree in marketing. Early on, a physician she worked with gave Holter the idea to expand her group and pursue providing care to residents in nursing homes. "I think the nursing home workers saw that we really did care and wanted to make a difference, and so from then on patients started coming," she says. Many of Paragon's patients are family members of nursing home patients or employees.
Susanne Phillips, owner of Pacific Family Wellness Center in Irvine, Calif., agrees. "Your patients are going to be your best referral base, better than any list you get on. Our biggest source of patients has been patient referrals," she says, adding that this type of marketing is also the least expensive. Colleagues are also a useful resource. When Phillips and her partner opened their office, they held an open house and invited nurse practitioners in the area. "We get a fair amount of referrals from the other NPs," she says.
Find Your Niche
Phillips specializes in bioidentical hormone replacement therapy, and this probably accounts for some of the referrals she gets from other nurse practitioners. "There are a lot of people looking for alternatives. Find your niche and capitalize on it. Don't try to be everything to everybody because then you're not," she says.
Eric Doerfler, NP, owner of Nightingale Health Centers in Harrisburg, Pa., has found the phone book to be his most successful marketing venue. "That's because I'm a specialist," he says. Promoting your practice can be easier when you offer a service that others don't. The Yellow Pages and other directories are full of listings for "Physicians/Surgeons" and "Nurses/Practitioners." Doerfler is listed with his group under "Holistic Practitioners" and individually under "Homeopaths." He says, "They come to see me because I'm the only name."
Think Outside the Box
But specialization can also present a big marketing challenge. People might not know to look for natural family planning, bioidentical hormone replacement therapy or homeopathy, for example. "Because I do somewhat specialized service, people don't quite know what it's about," Doerfler says. "They don't know what to expect."
The NP has used some unusual techniques to get his name out to people who don't know they're looking for him. He recorded an 18-minute lecture on homeopathic medicine and had a sound engineer friend make a few hundred compact discs and cassette tapes. He places them in health food stores along with brochures about his practice. "I've gotten a lot of business from those [free CDs and tapes]," he says. He adds that reproducing disks and tapes can be time consuming and that if you try this technique, it's important to keep costs down to under a dollar or so per recording. "A lot of people are going to pick them up and not come in," he notes.
Doerfler has also had mixed results from informational dinners he has hosted in local restaurants. For these dinners, he negotiates a fixed-price dinner, around $10 per person, and then buys meals for people who signed up to listen to a short lecture on homeopathy. "Some of the dinners were really well attended, and some were poorly attended. I didn't really feel that the cost-to-benefit ratio was working out very well. I think it's important to only access this technique if you have to," he says.
Don't Forget the Basics
Be creative in promoting your practice, but don't neglect traditional techniques. Most people think of print and broadcast ads and billboards as traditional advertising, but many other techniques have become standard. Here are a few suggestions:
- Send news releases to your local newspaper. Provide straightforward information about health studies, current medical technology and the services you provide. Avoid making self-serving claims that seem like an advertisement.
- Write a health column for a local newspaper or offer to be interviewed for a health report on a television or radio program.
- Get involved in a community service project or health fair or offer a free lecture on a health care topic through a local service club. Many of these clubs schedule lectures months in advance, so don't worry if they don't jump at the chance to have you speak next week.
- Sponsor a local sports team or offer a door prize for a local event.
- Get listed in the Yellow Pages. Since it can be expensive to place your ad in the larger directories, consider smaller, audience-specific directories that can point select populations your way.
Jill Rollet is the associate editor and online editor. Contact her at firstname.lastname@example.org
For Further Reading:
Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients. By Susan Keane Baker. Jossey-Bass, 1998.
Guerilla Marketing: Secrets for Making Big Profits from Your Small Business. 3rd edition. By Jay Conrad Levinson. Mariner Books, 1998.
Off-the-Wall Marketing Ideas: Jumpstart Your Sales without Busting Your Budget. By Nancy Michaels and Debbi J. Karpowicz. Adams Media, 2000.
Rose Marketing on a Daisy Budget. By Heidi Richards. WUN Publications, 1998.
The Anatomy of Buzz: How to Create Word-of-Mouth Marketing. By Emanual Rosen. Doubleday, 2002.
How to Start an Independent Practice: The Nurse Practitioner's Guide to Success. By Carolyn Zaumeyer. F.A. Davis, 2003.