Expert Advise: How To Chose The Right Location For Your Practice

We’ve all heard the saying, location, location, location. The 3-rules of real-estate. But how can we be certain if the location we are choosing for a new medical practice is the best one?

Susanne Madden, practice management consultant, provides practical commentary on what docs looking to find the best location for their practice should consider.

When it comes to opening your own pediatric practice, you don’t have to be a seasoned business person to know that location matters.

But knowing location matters is one thing. Deciding  which location is the best choice for a practice is  another matter.

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Common sense tells us to not open a practice in an area that is saturated with pediatricians, but how do you define saturated? Is 1 or 5 or 20 competing offices too much? What if there is only one practice in the area but the practice has 25 pediatricians?

Is proximity to a hospital better than proximity to a school? Should one consider number of daycares and schools in the area over the number of OBs?

If you are opening your second office, perhaps these questions aren’t difficult to answer because you’ve already navigated these waters.

But if you are flying solo, in other words, deciding to open your own practice, these can be daunting questions to answer.

Susanne Madden is the President and CEO of The Verden Group. The Verden group advises physicians on a variety of practice management issues. Among the services is coaching doctors to set up their own practices.

I recently caught up with Susanne. I asked her if she had any words of wisdom or practical advise for doctors opening up their first office and are weighing location options. As usual she had great insights.


Susanne cautioned that there is so much to cover to adequately address office location because office location isn’t just a location question. Branching out involves setting up a whole new practice!


Susanne advises physicians looking for ideal office space to first consider convenience  before proximity to a school or OB group, for example. Being close to a school is helpful, but it’s important to make sure the office is along regularly traveled route.

You don’t want to be 1-mile from the largest school but in the opposite direction of where folks are headed to/ from home and work.


When it comes to competition – the number of pediatric practices already in the area – Susanne thinks it is best to find a location far from other practices.

And I agree. Ideally you want to be the only game in town. But realistically this can be a big challenge for someone opening a practice in an urban area like Chicago, New York or San Francisco.


Other considerations must be evaluated in addition to the location challenge when one doesn’t have the option to open far from other practices. The considerations, however, depend on the circumstances.


If there is one big group nearby and not much else, that could work really well. The new practice potentially can draw patients that don’t enjoy a big group experience (provided the new practice markets itself as the alternative to that).

On the other hand, if there are a lot of solo / small practices around, then the new practice needs to figure out what they have that the competition doesn’t and make that distinction their central marketing strategy.


Susanne reminds physicians the importance of market research. Knowing the area factually, will help physicians answer many questions, she says.

If the area is growing and the market demographics suggest that there is ample demand and not enough supply, then opening a practice where other pediatricians practice could work just fine.


Most property manager or landlords require lessee to sign a 5-year contract. When we were opening our practice, I remember the 5-year lease stipulation terrified us. I wondered, what if our new office doesn’t survive five years?

Fortunately, we were able to negotiate a 3-year lease (instead of a 5-year lease) and a few other accommodations to help us get up on our feet. Consider negotiating with your landlord lease terms. More often than not, they will be willing and able to work with you.


Share space with another physician is a great way to start. Susanne points out that staying lean initially will mean the practice can branch out later without being saddled with having to build volume quickly in order to pay debt.

New practices that are sharing office space with another physician, Susanne recommends to not sign more than a year-to-year sublease. The idea is that once the practice reaches capacity, it will be easier to move the practice and their patients to their own location.

Susanne was kind enough to send over a few resources she had so that physicians could glean more information on this topic.

Setting up a practice support pages:

AAP resources:

Medical Economics Resource:

To learn more about Susanne Madden and the work she does at The Verden Group, click on the links. If you prefer Facebook, you can also check them out there:

Consider signing up to receive blog updates for free. You will revive in your inbox post like this one. 

Customer Service Axioms For Your Pediatric Practice

Have you noticed that everybody knows how to deliver exceptional customer service, except those that actually do? We’re all customer service connoisseurs. We all can recognize excellent service. And we are even better at pointing out bad service. But when it comes time to execute, most fail.

I think that the reason customer service is hard to execute, is not because we don’t know how to, but because we easily forget. We often get wrapped up in our task, that we lose the service-centric service that we started out with.

Samuel Johnson said, “Men more frequently require to be reminded than informed.”

With this in mind, I’ve put together a slide deck that highlights a few axioms I use to remind team members (as well as myself) how to get back on a customer service-centric track.

In the comments, share with us what are your favorite customer service axioms?

Extra, Extra – Now Offering Coaching Services

Screen Shot 2015-02-03 at 7.56.46 PMPeople always ask me if I do practice management consulting.There was a time when I did. But for the past two or so years, I’ve responded by saying no. I enjoy consulting and love to do it, but I had to stop because of the time commitment.

Recently, I was talking with a loyal reader of PediatricInc about this very topic and she suggested I do remote coaching.

My friend, who owns her practice, explained that she doesn’t necessarily need a comprehensive on-site consult. “I just want to ask a question about my practice or run things by someone familiar with practice management,” she said.

She went on to say, “…you know doctors don’t get training on business, management, marketing, collections…. having somebody to reach out to that has the business and practice management training would be valuable.”

“Like a practice management coach?” I asked. And she said, “ yeah, that is a good way to put it.”

We talked a little while longer. By the time we finished up, my loyal reader and friend had convinced me.

Today I’m announcing a new service on PediatricInc called PMB Coaching for those pediatricians and/or managers that want my perspective on practice management, discuss in detail a blog post, run something by me or provide another set of eyes.

Interested in learning about the PMB Coaching?

Click on this link.


Do Pediatricians Have A Marketing Problem? [Pediatric Practice Management AwesomeCast]

WorkingTogetherToday, Chip and install about pediatricians’ marketing problem. We dive in and discuss how pediatricians have not done a good job of distinguishing themselves from the competition. And when we say competition, we don’t mean other pediatricians, but rather retail based clinics and large hospital networks.

The result of our poor efforts in differentiating ourselves? Parents don’t really understand the value that comes from visiting the pediatrician’s office rather than a retail based clinic. So in many parents’ mind, going to retail based clinic is the same intern of quality of care as visiting the doctors office, but faster and cheaper.

We also talk about what each of us thinks peds could do to begin fixing this problem.

We hope you enjoy the Awesome cast, and if you do, make sure to tell your friends about it.

For the audio version, click below:

iTunes link

Big is Not Necessary Better – How a Solo Doctor is Changing Pediatric Healthcare in Her Own Way [Pediatric Practice Management AwesomeCast]

Today on the AwesomeCast, we had the pleasure to talk to Dr. Robin Warner.

Dr Warner is a solo doc outside of Cleveland. Chip and I were interested in talking to Dr. Warner for several reasons. For starters, we wanted to learn about her experience as a solo doc. We also uncovered some interesting patterns that I think are great lessons for those of us that have smaller practices.

Dr. Warner also shared a project she has been working on that I think is absolutely brilliant. Here is a hint… she is embracing the smartphone craze, leveraging people’s attraction to on-line games and using it to provide deliver awesome pediatric medicine.

Stick to the end of the PodCast. There are a lot of nuggets that if you aren’t paying attention, you’ll miss.


To listen to the audio, click below.



Deceptively Easy Way to Improve Your Practice, Guaranteed

On a piece of paper, write down this question:


It doesn’t have to be written exactly like I wrote it. Any variation will do. Then, make copies. Several of them. For the next few days or even weeks, hand each parent that comes to visit your office the sheet of paper with the question on it. While they wait, they will have plenty to think about out. You can ask them to use the remaining space – as well as the other side – if they require more than just a few lines.

I just saved you $5000 in consulting fees. Not to mention provided a way for you to have specific and practical ways  to make your pediatric office 10x more awesome than it already is.

You’re welcome…

Learn How to Get a Handle on Your Collection Efforts

Screen Shot 2014-02-04 at 10.23.03 AMOne of the questions I get asked the most about, is our credit card on file program. We started this policy back in 2009. And let me say it has been one of the best decisions we’ve ever made.

For starters, having credit cards on file enables us to focus more on health care than health care collections. It goes without saying that our A/R has improved tremendously. We don’t have to send out multiple letters or make too many phone calls in order to get paid. If the account is delinquent, we process the card.

There are many more advantages. But fundamentally, a credit card on file puts the practice in a better position to collect 100% of what they are owed. It also transfers the credit risk to the credit card company. Which are far better at lending and collecting than we will ever be.

When we first started doing this, we didn’t know what we were doing. We just put together a policy that we thought worked best. There wasn’t anybody, that we knew of, that had done this so we had to basically create the wheel.

Fortunately, that is not the case anymore. Why? Because my friend Mary Pat Whaley from has an awesome seminar that teaches you exactly what you need to do in order to set up a credit card of file program in your office.

Below is Mary Pat’s pitch:

Were January’s revenues even more disappointing than in previous years? It’s probably not going to get better as the year goes on – 2014 has THREE BIG REASONS why practices are struggling to get paid:

  • High Deductible Health Plans (HDHPs) are creating lots of confusion and practices may not know fow to explain financial responsibility to the patient. Sending patients endless statements or turning them over to collections is NOT the way to establish financial viability for your practice.
  • Exchange Plans have a loophole in which patients can receive services for up to 90 days without actually having paid more than the first month’s premium. If patients do not pay their premiums after 90 days but you’ve furnished them services, how will you collect?
  • ICD-10 will be the disaster we are all anticipating in October of this year. Even if you’ve had ICD-10 training and know what you’re doing, it’s a good bet that insurance plans will use the excuse of ICD-10 to withhold payments for as long as possible. Can your practice continue to pay expenses when insurance plans AND patients aren’t paying you?

If your practice is like most, you may not be sure what to collect from the patient and so you collect nothing.

Having the patient’s credit card on file allows you to responsibly charge any remaining balance to the patient’s credit card once the insurance plan pays. It also allows you to establish electronic (“set it and forget it”) payment plans.

What is really unique to the Manage My Practice CCOF program is its flexibility! Based on each practice’s specialty, demographic and philosophy, the program can be tailored to fit your practice and the way you want to collect from patients.

Credit Card on File is a safe and secure way for your patients to pay their balances.

This program is compliant with the Payment Card Industry (PCI) standards, and patients actually like the convenience once they understand the program! Credit Card on File is safer and more convenient than sending statements!

Join us for this week’s live webinar:

“Starting a Credit Card on File Program in Your Medical or Dental Practice”

Thursday, February 6th, 3:00 – 4:30 p.m. EST

90 MINUTES – Twelve (12) worksheets, patient handouts, forms and policies ($99.95 )


Please contact me if you have questions about how Credit Card on File could work in your practice.

Best wishes,

Mary Pat

I’m telling you, this is one of the best $100 you’ll spend this year. Don’t delay and sign up for this seminar. You’ll get a step-by-step, resource rich guide on how to implement something that you know you desperately need.

Editorial Note: In the interest of “transparency” please note that I have absolutely NO financial arrangement with Mary Pat or her organization. This is truly something that I believe in. Furthermore, I esteem Mary Pat and I think she is doing great work. I wish this seminar would have been around when we started doing the credit card on file. Thus, wanted to bring awareness to this webinar so that you don’t make the mistakes we made. Lastly, the more people start implementing it, the more common it will become. And the more common it becomes, patients will freak out less; and hopefully we can get to the level of awareness hotels and car rental companies have with their patrons. 

The Reason Your Collection Letters Are Not Effective

Screen Shot 2013-11-14 at 10.53.56 AMMost patient collection letters I’ve seen come off very threatening and standoffish. They are written to intimidate. For example, they’ll say, “Final Notice” or “…your account will be sent to collections if you don’t respond...” The notion one is trying to convey is, you better pay now or else.

At our practice, we sent out letters with these aggressive words. And most of them got ignored. So what did we do? We sent another letter but this time, with stronger words like  2nd Notice or Final Notice… you know, to get them to shake in their boots.

Again, most of them were ignored. My guess is that at best, 1% of parents would respond to them. I think we offended more parents than those that sent payment.

Clearly, this was the wrong approach. Not to mention highly counterproductive. I wondered if there was a better way.

I thought about the reasons someone would disregard  2 or 3 statements (plus another 2 or 3 collection letters) from the doctor’s office? These 5 reasons came to mind:

  1. Genuine Oversight – This is the crowd that forgets, or procrastinates  or miss places our correspondence.
  2. Overwhelming Feeling – This is the group of people that have so many bills, thus so overwhelmed, that they take the out of sight, out of mind approach.
  3. Confusion – These are the parents that don’t understand their bills. So they set the statement aside with the hopes to call one day to find out what the deal is, but never calls. Out of site, out out mind creeps in until next billing cycle where the process starts again.
  4. Can’t pay the balance outright – Since this group can’t pay all their bills, they ignore the ones that aren’t on the priority list, like for example, cable TV.
  5. Disingenuous Oversight – These are the professional debtors. These are the people that never had intentions to pay. These are the people that intentionally disregard anything that they don’t want to pay.

If we slice up your A/R into 5 equal parts, and we trust that these are indeed the reasons parents haven’t paid, we’ll find that 80% of our patients aren’t deadbeats. Consequently, one is doing more harm than good when you consider that only the people that are in group 5 (or 20% of the people that owe you) are the deadbeats.

The 80% or more of your parents just need help.

The problem is, the stern letters are written under the premise that everybody that owes you is a deadbeat. Not to mention, people have a harder time paying people they don’t like. Sending them a nasty letter simply stirs the pot. At the very least it adds a bit of friction to the relationships between the practice and the parent.

And for those that the stern letter is truly intended for, they don’t really care. Nothing is going to motivate them.

How do we solve this problem?

With this in mind, I took a different approach in writing our patient collections. My focus is still wanting patients to pay their bills, but instead of threatening them with legal action, or telling them we are going to send them to collections, I wrote the letter with the intent of offering help.

Here is an excerpts that we use in our letters:

If you have a question regarding your bill or need help reading your insurance’s EOB, we’d be happy to help. We understand medical billing is not always simple to understand, but we can help. 

By lowering our guards a bit and reaching out rather than growing aggressive with every letter is simply  a better and more human approach. In other words, kindness is the approach.

The letter continues with this:

We understand that many of our patients experience financial difficulties. If this is the case, please let us know so we can assist you in making budget payment arrangements. 

The most stern part of the letter is written like this:

We want to help you fulfill your commitment without causing undue hardship, so please do not hesitate to contact our offices.

Lastly, we personalized each letter with the patient’s PCP. Most people really like their pediatrician. And the thought of sticking them with the bill may be enough to persuade the “good” debtors to give us a call.

Here is an example of the wording we use:

Your prompt attention is appreciated. Dr. « Insert_Patient_ProviderName» would appreciate it very much.

We found that our response went from 1% (at best) to around 25 to 30% by merely changing the tone of the letter.

It is worth noting, that the sooner one starts sending the letters, the better results you will have. If you wait 90 or 120 days before sending out the “friendly” collection letter, your chances of getting paid are less. The friendly letter, however, is very effective in the beginning stages of the collection process.

Before the day is over, take a look at your collection letters and see how you can come across as caring, compassionate and empathetic (which all pediatricians are) instead of the opposite. I’d be willing to bet someone else’s money that you will see better results.  

What Disney Can Teach Medical Practices About Keeping Employees Motivated

Screen Shot 2013-12-08 at 9.58.02 AMWhile touring Magic Kingdom as part of the Disney Institute customer service program, I learned that Disney doesn’t pay better salaries than other companies. I also learned that promotions are hard to come by.

With 60,000 employees working at the parks alone, it is difficult to be chosen for a promotion when thousands of people are also applying for the job.

Disney Park employees work long hours, mostly standing, in 100% humidity for a good portion of the year, work weekends and holidays, all while maintaining exceptional, customer centric, above and beyond, unsurpassed customer service, always.

As it turns out, our pediatric medical practices have a lot in common with Disney. We hardly can afford to pay support staff above average salaries, they are required to work long hours, mostly standing, and chances a medical assistant or receptionist will get promoted to a high management position is very, very slim; especially if they work at a smaller office.

And if you think about it, Disney employees have it easier than many of our employees. Parents and children want to be at Disney, whereas nobody wants to visit the pediatrician. Instead of dealing with happy mom, dads and children, our staff has to deal with grumpy, moody, sleep deprived, overworked, anxious parents and their sick, uncomfortable children.

So I asked the tour guide how or what do they do to keep their staff otherwise known as cast members, up-beat, motivated and willingly to always go the extra mile for every guest. Not everybody gets to be Cinderella on top of a parade float waving to excited children.

He said it was difficult to encapsulate in a sentence or two, but the easiest and fastest way to explain it, is that each person has to find their own applause.

You see, Disney embraces the notion that they are an entertainment business. So, they view everything through a stage or movie production prism. That is why they call their employee cast members. When on the job, they refer to it as “on-stage.”

But the remarkable thing about their company culture is that the notion of being in the entertainment business is not limited to the stage. It permeates all the way throughout every single person in the organization, including the custodial staff that clean and sweep the park.

Thus the “everybody needs to find their own applause” is a profound metaphor to explain how they keep staff motivated despite the not so always great working conditions.

It means that the Disney employee has to find an intrinsic motivation to deliver on Disney’s promise. Going the extra mile to make a family or a child’s experience at Disney that much better is the actual motivation. Not the money, or the potential for career advancement.

I found this nugget of information worth the entire trip. Because it crystalizes for me the importance of hiring staff members that find joy in delivering on our core values rather than finding people that can simply do the job. It was clear to me that as a leader of our little practice, it isn’t always my job to keep staff engaged and motivated with incentives, raises and perks, but rather work with each of them find their own reward, applause, or motivation.

For me it was also a reminder to lead employees rather than to instruct them to find that intrinsic sense of purpose. Because at the end of the day, you can always train someone a process, but you can’t teach someone to be nice.

Are you helping staff members, employees, or your cast members find their own applause? Do you hire based on an employee’s ability to deliver on your promise to patients and parents? What motivates your employees? Money? Promotions? Time off? Smiles from parents and their children?

How to Deal with Unreasonable Patients in Your Medical Practice

Angry patients, customer service, medical practiceA while back, I was working the front desk when a dad of one of our patients came up to me and said he didn’t want to sign the credit card on file authorization. I politely insisted he needed to fill out the auth form. He cut me off with loud: “WHY? Who came up with this stupid idea?”

Awkwardly I uttered, “Ummm, me.”

Now, both of us felt awkward. Silence…

So the parent broke the silence and in a less aggressive manner he asked why we were doing this. He asked, “…don’t you get paid by my insurance company?”

I started explaining how insurance worked. I happened to have a collection report on my desk. I showed him the bottom sum. It displayed the number that we had written off due to bad debt for the previous months before the CC policy went into place.

His draw dropped. He said “I had no idea..” he then said, “…how can you run a business when you don’t get paid right away?

“Now you know why this policy is so important to our office,” I said.

He gladly gave me his card.

In my experience, very few people will have a problem with your practice policies, whether it is collecting a charge for forms or instituting a credit card on file program. The ones that have an issue, will have less or no issue once you explain to them why you are doing it.

Let’s call these two group the reasonable parents. 

There will still be a group – a very, very small percentage of those that will continue to have a problem despite your best effort to explain your reasons.

How about if we call that group unreasonable parents? 

For the reasonable ones, continue doing what you do best. In fact, bend over backwards for this group.

For the others, the unreasonable ones, let those skeptics go free. Let them pout, yell, scream,  and complain. But don’t be afraid of them. And what ever you do, don’t let them dictate what you know is the right thing to do. Also, and equally important, don’t let those bad apples influence how you will continue treating the reasonable ones. You don’t need the unreasonable ones . Let them go.