Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
Mountain View
Medical &
Surgical Associates,
Madras, Oregon
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The last few weeks have been slower than normal. My one year old practice, slow at the outset, had been picking up the pace. Until the last couple of weeks, July and August, that is. As the typical doctor who doesn't like to be bored, I went to my practice administrator to ask him about it. "Don't worry," he responded. "This is the slow season for us." Slow season? Does that exist in medicine? As a newer physician, I haven't had many years to experience the seasonal trends, and to make matters worse, I've changed practices. So here's my question: is podiatry seasonal?
On the surface, this question sounds strange. What am I, a clothing
boutique, a tourist venue? How can medicine be seasonal? My guess is it would have to do with many factors. First, patient base. If your practice centers on the geriatric population and you do primarily palliative care, you could expect to see a consistent patient flow pattern. If the practice has a heavy trauma component, you might see some seasonality with heavier volumes during times of the year when patients are more physically active. Of course, anyone attached to a level one trauma hospital is likely to dispute this point. Similarly, some practice types are more consistent. Podiatrists employed by large healthcare systems may not see this seasonality, while private practice podiatrists might experience seasonality to a great extent.
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Second, population statistics. If your patients travel during certain times of the year, you're likely to see the associated elevations and declines in the patient census. My first two years of practice in Michigan provide a good example of this. Lansing, Michigan contains two transient patient groups: Michigan State University students and the snowbirds. MSU students leave for the typical college breaks during the summer and winter. During the school year, we would see a flood of students into the area, increasing the Lansing population by thousands. The other population, the snowbirds, consists of the elderly retired folks, who leave the cold Michigan winters and temporarily relocate to warmer climates (usually Florida or Arizona in my experience).
Third, insurance. I think we've all been approached by the patient who wants to schedule his surgery at the last minute, as the year ends. These patients have paid their deductibles and can now have their surgery for "free." Of course, we all know it's not free, nothing is. The patient simply has no deductible to pay. Clearly, this is more important for the surgical side of the practice. Was this significant in my practice? I'd have to say no. I would have a few patients who'd schedule their elective surgery based on their deductible, but by no means was this the majority.
Fourth, the season (literally what season of the year it is). More than insurance, I've had quite a large number of patients schedule their elective procedures during certain months/seasons. For instance, the other week, I saw a patient regarding her painful bunion. She wanted surgery but asked if she could wait until the winter. She didn't want to be cooped up in her house during the sunny Oregon summer. Who could blame her? Everyone's outside enjoying the warm weather while she's stuck recovering from her surgery. Of course, if your patient is in enough pain, they won't care what time of year it is.
If it's in fact true that podiatry is seasonal, how best is the physician to survive these ups and downs?
- Have a diverse practice. Punctuate your surgical practice with some palliative care, diabetic wound care, trauma (where available), and sports medicine. Consider some of these your "bread and butter" patients. Just as diversity in the stock market is protective, so is diversity in medical practice.
- Budget increases in marketing/advertising during the projected slow times of the year. Use this time to reacquaint yourself with your referring providers. Are there new physicians to meet and add to your referring base? Perform in-services and community education during these times, if possible.
- Use the slower periods as times to re-evaluate your practice. Could you be doing anything better? Are there protocols you can improve to increase practice productivity? Are you billing appropriately? Is your staff adequately trained? This a good time to cross-train staff. Browse through past issues of Practice Perfect and New Docs on the Block for tons of practice building ideas.
- Analyze practice trends. Be aware of the slow times before they happen. Be ready.
- Consider vacationing during the slow times. Do you really want to be unavailable to your patients during the busy times of the year? Take this time to renew yourself mentally and emotionally. Similarly, schedule CME courses during the slow season, if possible.
- Speak to other doctors in yours and other professions. Do they see trends like you? If not, why not? Are they doing something to succeed that you could be doing?
- Continue expanding ancillary services. Diabetic shoes, DME supplies, orthotics, arterial and venous vascular testing, nerve testing and others provide value-added services that increase reimbursement on a per patient basis.
- Consider holding some investing money aside as an insurance policy.
- Provide top quality patient care every day. Make your practice the best in town, one that everyone will want to go to. A busy practice will suffer a slow period better than a slow practice.
The simple answer to my question, is podiatry seasonal, is yes (in many cases). But just as in everything in medicine, it's not that straight forward. Some of us may see this seasonality as a significant factor in our practices, while others may not. But just as in anything with practice management, a little planning and forethought always help.
Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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