Medical language can be slow to change, even as the field itself sees rapid innovation. In fact, over the last 20 years, the vocabulary we use in health and medicine has changed very little.
While this may seem unimportant at first blush, a deeper look reveals a different view.
The Deceptively Simple Matter of Words
Words are containers for ideas. Ideas, in turn, comprise innumerable emotional and intellectual ingredients coming together in the brain, which the brain then seeks to name. Once the brain manages that, we exchange ideas through language.
The trouble is that every person’s brain works a little differently. Our thought processes, backgrounds, and emotions all vary. So the ideas behind our words don’t always match up.
Take the word tree, for example. When I say tree, depending on where you grew up, you may imagine a tall pine, a full oak, or a scrubby mesquite — your life experiences and preconceptions color which idea the word evokes. If I want you to imagine a specific type of tree, I need to use a particular term.
Language use has a broader sphere of influence than we may realize. In the healthcare context, I believe our word choices even influence the prevailing thoughts around the practice of medicine. And if we want to change the conversation, we must change the language.
As concierge and DPC physicians, we’ve already departed from the unsatisfactory manner conventional healthcare operates. We don’t have to bring its deficient vocabulary with us.
Four Terms to Reconsider (And Possible Alternatives)
We do a disservice to ourselves when we use language without pausing to consider the messaging or status quo it reinforces. Much in medicine requires nuance, and I suggest we use language to communicate those nuances accurately.
Below are four pervasive medical terms I suggest we eradicate and replace with these more reasonable alternatives.
1. Provider —> Physician
I’d love to see the word “provider” immediately stricken from the healthcare lexicon.
A “provider” is anyone who provides a service. This generic blanket term conveys nothing besides that fact. An Uber driver provides me with a ride from point A to point B. A restaurant provides me with a meal. And, yes, a physician provides medical care.
But no one orders a car from a ride provider or orders from a meal provider. It’s weirdly generic and, frankly, demeaning.
My medical degree didn’t confer upon me the title of medical provider. I became a medical doctor. This distinction is important because a doctor has a specific job.
A doctor holds a position of respectful influence in people’s lives. On a personal, one-on-one basis, we’re trying to help people daily. This is significant work that should be recognized and appropriately named.
The words doctor and physician communicate the reality of the role we play. But the word provider devalues our profession. When we, as physicians, use the term, it’s a form of self-harm.
What about other medical practitioners covered under the “provider” umbrella? If they work in a clinical setting, then I suggest clinician. The physical therapist, for example, is clinically oriented and provides a clinical service. Or, we can simply call them by their job title.
When someone says “provider,” what they actually mean is clinician, physician, or doctor. Let’s say what we mean.
2. Consumer —> Patient
Healthcare aims to get the best health outcome as early and quickly as possible, with the least amount of friction. We want people to get better faster.
The people we’re serving in healthcare are patients, not consumers. Like the term provider replacing physician, the term consumer degrades the perception of the healthcare experience. And consumers differ radically from patients.
I’ve never seen a consumer in the intensive care unit. That’s a patient. What’s the difference? Mainly, choice.
Consumers have many options and the freedom to choose or reject those options. As a consumer, I might visit a café and decide not to buy a drink. I might buy a sandwich instead or nothing at all. I can leave, and it’s no harm, no foul.
Patients have a very different experience, fettered by various limitations. While a consumer has free will, a patient has tethered will.
A patient isn’t in the ICU for a bit of window shopping, considering whether or not to make a purchase. Patients have a problem they must solve and make a decision, usually from minimal options.
There are other differences, too:
- Consumers have the money they earn and can decide how much of their resources they want to spend on a given item.
- Patients pay through insurance, and the system’s convoluted way means they don’t typically know their care costs.
- Consumers typically receive an immediate benefit from their purchase — a drink, an iPhone, or a trip next month.
- Patients don’t know if or when their medical care will be effective.
- Consumers are excited to go shopping.
- Patients are anxious and afraid.
- Consumers are adding something new to their lives that they didn’t have before.
- Patients are getting rid of something or recovering something they lost.
Clearly, a consumer has little in common with a patient, and the terms are not interchangeable. Healthcare isn’t a festival of products and services for free-wheeling consumers to choose from.
Bonus Word: Patient-Centric
On a related note, by thinking of patients as customers, we’ve allowed a strange adjective to creep in: patient-centric.
Perhaps the intent is to indicate high care and attention toward patients, but that should be present anyway.
Patient-centric sounds like a business-savvy term, but what does it mean? What are patients the center of? No complex system revolves entirely around the end user, and healthcare is no different. Instead, it’s a composite of the clinical, patient, and data/technology universes, with communication at the center.
Let’s leave patient-centric, a derivation of customer-centric, out of our lexicon.
3. Reimbursement —> Payment
When you go to the supermarket for milk, you’re a consumer buying an item. You pay the money; you get the milk. You’re not reimbursing the grocery store for the milk. You’re paying them.
The same is true for any product or service you buy. And yet, in medicine, we’ve allowed reimbursement to become the standard terminology concerning insurance companies.
Reimburse and pay are synonyms of a sort, but their connotations diverge. Where pay is straightforward, reimbursement implies repaying someone who spent money on your behalf. You reimburse your buddy for picking up your movie ticket; you don’t reimburse Walmart for your shampoo.
Using the word reimbursement for insurance payments to doctors makes the relationship sound like a deal between friends. If one friend forgets to send over the money (or decides not to), oh well. It was just a friendly agreement anyway, and it looks like the doctor made a bad deal.
The lay public doesn’t understand what it means for a doctor not to receive reimbursement. It’s confusing, and that’s not an accident. But if we change the language from reimbursement to payment, people will understand that it’s unfair when doctors don’t get paid for their work.
4. Explanation of Benefits (EOB) —> Terms of Limitation
Lastly, this insurance-oriented term really gets my goat because it’s so incredibly wrong.
If you’ve ever used medical insurance to see a doctor, you know about the little sheet of paper your insurance company sends after the fact titled “Explanation of Benefits” (EOB). The problem? It mainly highlights the benefits you’re not getting.
Rather than explaining anything, an EOB lists several inscrutable codes and descriptors alongside a chart of what the company paid, what they didn’t, and what you now owe. No detail, no explanation.
Furthermore, as Americans know all too well, the notation of what the insurance company paid is surprisingly low, surprisingly often. And the patient foots the rest of the bill.
There’s no explanation, and there are few benefits. A better name for the EOB might be “Smoke and Mirrors Statement” or “We Decided Not to Pay for That.”
Of course, those will never pass muster, but something like “Terms of Limitation” would undoubtedly be more realistic.
Final Thoughts
As concierge and DPC doctors, we intentionally design our medical niche to create an optimal healthcare environment for physicians and patients alike.
We can support this change with the way we talk about our world. Let’s let our terminology accurately reflect and convey our value to patients.
- ROAMD
- May 16, 2023
Though membership-based medicine is relatively young in the grand scheme of medical practice, the fact is we’re an aging population.
Right now, the vast majority of concierge physicians fit firmly within the Baby Boomer and Gen X demographics. A few fall on the border between Gen X and Millennials, but it’s rare in 2022 to spot true Millennials practicing in or running a concierge office.
Millennials are the next generation on deck in medical care, and we can’t put off the need to engage with and attract them to membership-based medicine. Not if we want to see this patient-focused model of care — not to mention our own practices — continue into the future.
Every generation is unique, and that presents certain challenges in recruiting from a generation not your own. We have to understand a new catalogue of wants and needs, and take stock of our current offerings and operations to ensure we’re positioned to attract great talent.
The great news is that some of the old challenges in recruiting have fallen away. Millennials are less entrenched in the conventional medical system than older generations, and more likely to embrace an alternative approach. They’re more flexible, easier to train, and want to be part of something that makes a difference in the world.
In turn, younger doctors attract younger members to practices. When patients join a practice and begin developing a relationship with their physician, they want to know this doctor will be with them for a long time.
Millennials also present important opportunities for succession planning. If your next hire is your age (or older), the odds that they’ll become your successor are low. But if your new doc is in their early- or mid-30s, they’ll have plenty of working years remaining when you’re ready to retire.
So, how can concierge practice owners attract younger physicians — and staff, and patients — to their businesses? What things turn them off? What draws them in?
Below, we’ll explore both opportunities and challenges involved with recruiting Millennials as America’s largest living generation moves into its prime years.
Technology Expectations
Millennials came of age with the internet and the explosion of personalized, mobile technology. Outdated, clunky, or inefficient technology can be a major area of frustration for them.
The healthcare industry isn’t known for being technology-forward, and in general lags behind other industries in user-friendly advancements. So while it’s not necessarily your practice’s fault, you’re probably starting out a bit behind the curve.
However, you can still evaluate the technology you have in your office — because if you fall a little behind in this area according to healthcare standards, you’re really behind according to the overall standard Millennials are used to working with.
Simply acknowledging and understanding this frustration upfront can be helpful. In fact, I’d encourage you to embrace young physicians and staff as technology experts. They may not know how to code, but they can offer more extensive insight from a user experience perspective than many of us older folks.
Given the opportunity to innovate, they may find and incorporate new options that improve the tech-friendliness of both the patient experience and your operations.
Schedule Flexibility vs. Rigidity
Millennials aren’t necessarily fans of rigid, traditional nine to five workdays, perhaps thanks in part to the rise of remote work, freelancing, and the gig economy.
Whatever the origin, we know Millennials greatly value work-life balance and place a high premium on schedule flexibility to take care of family and other responsibilities.
We recently heard a story about a married couple working as physicians at a local hospital. They had a young child whose daycare was putting on a morning program they wanted to attend, but it would make them a half hour late for work. In order to attend, they would have to use a half day of PTO per the hospital’s requirements.
They didn’t have a lot of PTO and didn’t need a half day off. They just needed a bit of grace from their employer to come in slightly late for a particular reason.
Now, I’m not suggesting concierge practices typically operate this way. Most would certainly give a physician the extra time. But what about your front office employee, or your MA? Though I think many offices already practice this principle, it’s helpful to remember how important a priority flexibility is to potential Millennial physicians and staff.
Creative Opportunities
New physicians or staff just starting out might want more money than you can pay them based on their minimal experience. But that doesn’t mean you can’t get creative and help facilitate other ways to earn more.
You might offer them the space to run a side hustle within or adjacent to the business (as long as it doesn’t interfere with their ability to perform their work). Maybe their side hustle is a task-based opportunity that generates revenue and/or awareness for your practice.
Just providing that kind of outlet shows you understand and care about their struggles.
Or, maybe they’re more interested in community outreach and charitable activities. If that’s your front office person, you might give them a sidebar title of Chief Community Officer and throw some extra money their way for hosting occasional community engagement events — which could contribute to new patient leads.
Opportunities for Upward Mobility
Investing in the growth and development of younger employees is key, not only for their benefit but also for the long-term benefit of your practice. Similar to the point above, many of them are too young to be making the sort of money they want, but that doesn’t mean you can’t help them get there.
But upward mobility doesn’t always equate to a flashy new title and a big raise, especially with Millennials. Many of them care about building social capital through the development of their own personal brand. They like to do good in the community and enjoy showcasing their accomplishments.
You have so many options to bolster their personal brand as a function of your practice. Maybe one of your new physicians goes to a black-tie charity gala. You could have them take pictures of themselves at the event, and then post one on your social media channels about your new doc helping raise money for ALS research.
Or, maybe they love volunteering with Habitat for Humanity. Maybe the whole office can spend a Saturday morning volunteering alongside them. You can use pictures from it on your social media channels or newsletter. Or maybe you feature it on your holiday card cover and give a shout-out to your employee for spearheading the whole thing.
A bit of support and public recognition helps build an employee’s personal brand, makes them happy, and illustrates your values and community involvement to potential members.
Change vs. Stagnation
Some of the older generations really preferred consistency. They liked things staying the same. They like their old office chair, thank you very much, and please don’t move their couch.
But Millennials tend to crave change, and they can’t deal with stagnation.
It goes far beyond physical space. It could be outdated technology or lack of room for growth, as discussed above, or perhaps stagnant thinking or tedium. Right now, the average tenure for Millennials at any job is less than three years.
It helps to understand that Millennials have a burning desire for new things. So, we can either anticipate that they’re going to leave and not invest in them, or we can embrace the challenge and find ways to create that newness within the practice to retain them.
Multi-Channel Recruiting
To reach great Millennial candidates, you need to know where they live and get in front of them. And this audience lives online.
But where online? They’re on social media, for sure, but different social media platforms are popular among different groups. Facebook still ranks high with Millennials, but they also spend lots of time on YouTube and Instagram. And the vast majority of this usage takes place on their phones.
These platforms — and your website or rating sites — are the places younger populations research you long before they ever call or complete an application. It’s how they become familiar with your branding, your values, and the character of your business.
It’s worth taking stock of your online presence and asking whether it represents your practice accurately, thoroughly, and authentically, and reaches your intended audience where they are.
Concierge Medicine Is a Creative Pursuit
This list isn’t exactly a how-to, but a collection of observations about a generation of people critical to the growth of concierge practices.
But they aren’t the only ones who can embrace change. As concierge practice owners, you looked at the conventional system and decided to forge another path. That same determination and creative problem-solving will allow you to imagine new solutions for attracting and retaining Millennial talent.
Have you tried some ideas for recruiting Millennials to your practice? Do you have thoughts about what might work? We’d love to hear them.
- ROAMD
- December 20, 2022
Physicians aren’t salespeople.
I know that’s not a revelation, but it does help highlight the difference between highly empathetic doctors accustomed to sharing their expertise for the betterment of others and persuasive sales representatives accustomed to hearing the word no constantly… and keeping right on selling.
Telling patients about price increases can be intimidating, and much of the difficulty stems from this fundamental difference.
When you have to communicate a price increase, it makes you feel more like a salesperson than a physician. It can cause a shift in the balance of authority, and it can grate against your empathy. You know people don’t like to pay more for things in general, and you don’t want to disappoint people you care about.
But if you raise your prices, communicating the change doesn’t have to be an ordeal.
If you communicate your prices well, the majority of patients will understand and stick around, but it requires some consideration and forethought. If you communicate the increase haphazardly or without strategy, negative consequences can ensue.
Why It’s Crucial to Communicate With Care
Really considering the best way to tell patients about a price increase and carrying out that communication well makes an enormous difference in your patients’ response to the news — and in how you feel delivering it.
Successful communication preserves your relationship with the patient, upholds your value, and reinforces your authority and reputation. Ultimately, it leads to membership retention — at the new rate — and perhaps even creates lifelong memberships.
On the flip side, poorly thought out or ineffective communication invites questions from patients that force you to justify the increase by outlining specific reasons, such as new services or equipment. This creates negotiating points for patients, inviting pushback like, “Well, what if I don’t use the new [equipment]?”
If you get into the position of negotiating with patients, empathetic physician that you are, you might end up meeting them halfway. Or 40% of the way. Or 30%. The point is, if you do that with too many patients, your carefully planned tier structure falls apart because every patient now has their own negotiated “tier.” Besides being incredibly uncomfortable, negotiations like this land you with an overcomplicated system that confuses patients and staff alike.
If you’re unable to communicate a price increase clearly and with conviction, you diminish your value in patients’ eyes. It can tarnish your carefully cultivated physician-patient relationship, and ultimately leads to them walking away. So let’s get this right!
Be Clear and Confident in Your Communication
You can raise your prices for all the right reasons and raise them the exact right amount, but communication is still key. If the communication is flubbed, even the perfect price increase can feel negative to patients.
Successful communication starts with your own conviction about a price increase. What you do is valuable, but if you don’t recognize your own value — as so many physicians don’t — you won’t feel confident about an increase.
It’s important to review why you’re raising your prices in the first place. It isn’t about greed. You’re not raising rates because you want to jump from a Mercedes to a Maserati. It’s about running a business sustainably for the long haul.
Rent, interest rates, taxes, and the cost of labor have all gone up. Overhead and supply chain issues are off the charts. Inflation, too. And then you have investments in the practice’s growth and expansion. Perhaps your local market (e.g. real estate, competitors, population size, etc.) has changed in a way that sparks the increase. All of this more than justifies price increases, and reviewing it will provide the conviction you need to communicate with confidence.
It’s true that you can’t go into any type of price increase and expect to retain everyone. Part of being confident is being prepared for patients to say no and walk away. Don’t be caught off guard. Mentally prepare yourself. 100% retention isn’t the goal; your practice’s sustainability is.
Tips for Communicating Simply and Effectively
I encourage you to read this paragraph twice: Your entire business is about being bespoke. You don’t practice one-size-fits-all medicine, and I’d encourage you to avoid one-size-fits-all communication for a subject as sensitive as price increases.
Consider how each patient would want to hear about a rate increase. What avenue takes their personality and preferences into account? Think also about who they would want to hear it from. Maybe it should come from the physician, or maybe it should come from someone else in the office in order to protect the physician-patient relationship.
It’s best to avoid blanket communication about an increase, at least when first introducing the change. Perhaps you’ll want to make a practice-wide announcement at some point, but we recommend waiting until after one-on-one conversations take place.
Even virtual communications can be personalized. Recording a video message to patients about an increase feels more personal than a generic email.
There isn’t one right way. The guiding principle is to provide individualized communication for patients in this matter just as you already do in health matters.
When you decide on an approach, make sure everyone in the practice is aligned with how the communication will work. You don’t want the receptionist or an MA casually floating out a rate change at check-in or while they’re taking a patient’s blood pressure.
An important side note: Inflation-related increases are absolutely crucial to practice sustainability. Regardless of how you handle other rate increases, it’s incredibly helpful to hard-wire regular (i.e. annual) inflationary increases into patient contracts right from the start of their memberships. Patients will know what to expect from the beginning, and you’ll be saved one conversation about rate increases, at least.
Should You Offer Discounts or Scholarships for Existing Members?
Some physicians offer partial or full scholarships, or discounts, to existing patients when there’s a price increase.
Whether you offer scholarships is entirely up to you. It depends on your comfort with that added layer of complexity as well as on the needs of your patients.
Some ROAMD members absolutely offer scholarships, and others absolutely do not. Some have particular patient populations they want to preserve and use scholarships to do so. Others want to avoid bringing in complicated negotiations and confusing concessions.
One of our members told us at last year’s Annual Meeting that when someone requests a discount, he asks, “Do you want a discount, or do you need a discount?” If they really need a discount, they can share their circumstances, and accommodations can be made accordingly until they’re able to get over a financial hump.
If you’re planning to discount, it makes sense to wait for patients to ask rather than to offer scholarships preemptively for patients you think will need them. And when they ask, finding out why they’re asking — need vs. want and temporary vs. permanent — will help you determine how much and for how long to discount.
Prepare for Difficult Conversations
Telling patients about a price increase takes some emotional preparation, especially for empathetic physicians. It’s difficult, but you have to be prepared for a few patients to walk away, and know how to handle if they do.
Will you offer discounts or short-term scholarships, or grandfather in your longest-running members? Will you be happy with 95% retention, or 90%? Whatever you do, don’t let yourself be caught off guard. Have a game plan, and prepare in advance for those conversations.
The goal is sustainability: serving more patients, and serving them for a long period of time.
How have you communicated price increases to patients in your practice? What has worked for you? What hasn’t? Take a moment to share your insights with the ROAMD community.
Scott earned his PharmD from Ohio Northern University, where he participated in Habitat for Humanity, Phi Mu Delta, Order of Omega, and NCAA basketball. After graduating from ONU, Scott completed a pharmacy residency at Cone Health, followed by a specialty residency in infectious diseases, internal medicine, and academics at Campbell University and Duke University Medical Center.
- ROAMD
- October 18, 2022
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