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November 6, 2006

From the Ground Up
By Beth W. Orenstein
Radiology Today
Vol. 7 No. 22 P. 54

Building an interventional practice starts with a foundation of traditional marketing. Doctors share what works for them.

Patients often tell Neil M. Khilnani, MD, FACPh, of Weill Cornell Vascular in New York City, that they sought him out for treatment of their varicose veins or uterine fibroids because they heard his advertisement on the radio. “We’re a niche practice involved mostly in treating varicose veins and uterine fibroids,” he says. “We’ve found that radio advertising provides a tremendous return on investment.”

Not too long ago, radiologists would have been loathe to advertise for patients. Part of the reason is they did not need to do it. “For a very long period of time, patients were served up to the interventional radiologist on a platter. They didn’t have to go out and beat the bushes looking for patients,” says Atul Gupta, MD, director of the interventional radiology lab at Paoli Hospital near Philadelphia. “Every other clinical physician has to go out and establish these relationships, but interventional radiologists have never had to do that. It’s foreign to them.”

However, things have changed during the past 10 years. Interventional radiologists now often have stand-alone practices where they offer minimally invasive treatments as an alternative to surgery for numerous conditions, including uterine fibroids, brain aneurysms, peripheral artery disease, carotid artery disease, and vertebral compression fractures. Some also offer nonsurgical treatments for liver cancer and infertility. So they often find themselves competing for patients with gynecologists, cardiologists, and vascular surgeons. Because of the overlap, says Arash Padidar, MD, an interventional radiologist at Minimally Invasive Surgical Solutions Inc. (MISS) in San Jose, Calif., “interventional radiologists of today have to generate business themselves.”

It Doesn’t Just Happen
“You can no longer be a passive observer, hoping business is just going to fall your way,” agrees Carl M. Black, MD, an interventional radiologist with Utah Valley Interventional Associates in Provo.

So how do you market an interventional radiology practice?

“All politics is local and there is no one solution that works for everyone,” Gupta says. However, interventional radiologists who have marketed their practices to much success agree: A good plan will include marketing directly to patients as well as to medical colleagues.

A good place to start is with a full-time marketing person, Padidar says. Having a marketing person is even more important to a smaller practice—two or three physicians—than a larger group. “Everyone knows about the 20-plus groups,” he says. It’s the smaller groups that really need someone who will, like a pharmaceutical representative, go door-to-door to physician offices and educate them about your practice and the procedures you can perform.

Black, chairman of a 21-person interventional and diagnostic group, says using a professional marketing consultant is a good idea because physicians are often too busy with their day-to-day duties to market their practice effectively. “It’s worth the expense of professional help.”

If you don’t have your own marketing person, you may be able to find one at your hospital. “I have a person in the hospital’s marketing department who is my point person and who does my marketing for me. I rely on her and she’s wonderful,” says Gupta, whose hospital is part of the Main Line Health System.

Your hospital will be happy to help because it has a vested interest in your practice being busy, Gupta says. It has invested a good deal of money in its interventional radiology suites and equipment. “Each interventional room is a $1 million or more investment and they may have two or three,” he says. “They’re paying for all this equipment.” When the room is used, it generates income for the hospital. “The radiologist gets a professional fee from the insurance company and the hospital gets a technical fee,” he says.

On the Web
Having a Web presence is important, too. Today’s patients do a lot of research on the Internet, Khilnani says, so you need a Web site that advertises what you do. “Whether patients come to you based on their Internet search is hard to know,” he says, “but having a Web site lends credibility.”

MISS Inc.’s Web site (www.endovascularsurgery.com) has information on every procedure it offers. Its physicians have found that many patients visit the site before their appointments. The Web helps bring patients, Padidar says, because informed patients are more likely to choose the less invasive alternative if they are aware there is one and they are assured they are good candidates.

Other good ways to market directly to patients include screenings and advertising on the radio, TV, and billboards and in newspapers and magazines.

“We do a large number of screening programs in conjunction with the hospital,” Gupta says. “We’ve done many on chronic venous insufficiency or varicose vein disease. We screen hundreds of women. These are women who will come to a well-set-up screening program at the end of the day and be educated on their condition and the procedures we can do to take care of it. Then we’ll do a screening where we’ll evaluate them and see if they are candidates for further imaging. It’s really a good way to educate the public and get patients into your system.”

Black’s practice regularly uses radio, magazine, and newspapers to market directly to the public. Their advertising tends to focus on treatment of superficial venous reflux disease. “However, building the vein practice has resulted in significant positive spin-off for our interventional practice as a whole,” he says. “Our diagnostic colleagues wholeheartedly support our efforts.”

Khilnani’s group runs its radio ads mostly on news/talk stations in the New York area at different times of the day for maximum exposure. That way it’s not only the patient who hears the ad about the minimally invasive treatment they offer for uterine fibroids or varicose veins. Her spouse or friend who hears it may tell her about it.

Repetition Matters
The repetitive exposure is what works, says Khilnani, who is also an associate professor of radiology at Weill Medical College of Cornell University. “If you have uterine fibroids and, one day, you hear there is an alternative to hysterectomy, and you hear it again the next day, and then your husband hears it and mentions it to you, it gets your attention,” he says.

Radio works well in his market, Khilnani says, but others may find print or magazine works just as well or better where they are. In New York City, even subway advertising can work, but not everyone lives or works in an area served by subways, he says.

Padidar says the most effective ads on radio or in newspapers are those that are a call to action: “Do you have back pain? Uterine fibroids? Varicose veins? Come and see us and what we can do for you.” You want patients to ask their referring physician for a referral or to come directly to you if they are able, he says.

Interventional radiology practices also have to market directly to referring physicians. Some of the best ways to do that are participating in grand rounds and continuing medical education (CME) lectures and—the tried-and-true—taking colleagues to lunch or dinner, the radiologists suggest.

Reaching Colleagues
Gupta says physicians are likely to attend grand rounds, which almost every hospital offers either daily or weekly. Attendance at grand rounds will increase, he says, if you offer food or CME credits or both. Doctors are very busy, so “you need to give them some value for their time,” he says.

Sponsoring or participating in CME lectures gets your name out there in association with procedures that you do routinely, Gupta says. “Educating physicians is great because it teaches them things they may not know about interventional radiology. From that point on, the referring doc who sat in on your conference or lecture will think of you when they hear the term venous insufficiency or uterine fibroid disease. It gives you brand identity.”

You should also consider sponsoring CMEs that are available on CD, Padidar says. That is yet another way to get a colleague’s attention and inform him or her of the services you can provide.

Padidar says taking key players in a particular field to lunch or dinner works, too. “It works better if you’re known in the community vs. cold calling,” he notes. “Now that we’ve been here three years, when I call Dr. Smith and say, ‘I want to go to lunch and tell you what I can add to your patient care,’ 90 times out of a 100, he’ll make time for you. So you have your secretary call his and set up a lunch.”

Some may be surprised at how little their colleagues know about what they do, Padidar says. “Even though the physicians know you, they don’t know how many different types of procedures you do. You could be doing lung biopsies for him for the last three years and he doesn’t know you also do angioplasties. Even though he knows you’re an interventional radiologist, he doesn’t put it together.”

The Big One
Padidar believes developing and maintaining relationships with referring physicians is the single most important external marketing an interventional radiology practice can do. The marketing should be not only to primary care providers but also emergency department physicians, surgeons, and neurologists because of the role interventional radiology can play in areas such as stroke therapy, among others.

One obvious source of referrals interventional radiologists tend to overlook is their diagnostic colleagues, Gupta says. “Every single patient that had a compression fracture of their spine had an x-ray or an MRI. The radiologist who has seen that could be a great referral source if he or she knew that I did a minimally invasive procedure—vertebroplasty or kyphoplasty—that could take care of it,” Gupta says.

Podiatrists, too, are often a good source of referrals that physicians tend to overlook. “Podiatrists are not MDs, and traditionally, they have not been treated all well by the physician community,” Gupta says. “I think that’s a big mistake because they see a lot of patients with peripheral vascular disease, diabetes, and venous insufficiency.… We have procedures that we can do to help. I think it’s a mistake if an interventional radiologist does not go after podiatry groups and lecture to them and market to them because they’re a very big source of referrals and both of us can help these patients.”

Vendors are yet another source of marketing for your practice, Gupta says. Like hospitals, vendors have a vested interest in the radiologists performing more procedures. “Vendors that supply me with stents and filters and catheters and wires are in a long line of people who are making money off me being busy,” Gupta says. “They have a vested interest in you being a busy practice and they are by the virtue of their job a salesman, so I have them go to referring physicians and set up lunch-and-learns in the middle of the day. They will do it because the busier you are, the more you purchase from them.”

Interventionalists also need to participate in the decision-making bodies that establish protocols for their medical community. “Every hospital has task forces focused on particular clinical entities such as management of deep vein thrombosis, acute stroke, carotid artery disease, or peripheral vascular disease. These task forces look for evidence-based solutions,” says Black. Interventional radiologists need to be involved in those committees to have a say in defining local standard of care and healthcare policy. That involvement not only improves patient care but will pay off politically and help interventional radiologists establish themselves as trusted consultants, Black says.

Pick the Right Fight
Gupta says that while interventional radiologists compete with other specialties, there’s no need to fight over patients who are already diagnosed. “Our role should be to go out there and educate the patients and referring docs because if you want to look at it from a business point of view, there is more than enough disease to go around. The goal of our marketing should be finding those patients who are not diagnosed and helping them.”

Padidar says interventional radiologists are helping themselves by getting the word out, but they are also helping patients. “Interventional radiology is an increasingly important specialty,” he says, “and we have to get the information to the right people.”

— Beth W. Orenstein is a freelance medical writer and a regular contributor to Radiology Today. She writes from her home in Northampton, Pa.