In the 2010 documentary Joan Rivers: A Piece of Work, Rivers holds up a blank page in her appointment book and says, “You wanna see fear? Here’s fear!” Cosmetic practitioners can sympathize with the late comedian’s sentiment. Few things are more disheartening—or frightening—than opening your appointment book to a schedule riddled with gaps, open slots and canceled appointments. Conversely, overbooking on busy days can lead to disgruntled patients left sitting in waiting rooms and stressed practitioners who barely have time to breathe between appointments.
“Scheduling is probably one of the hardest things to do,” says Rebecca Kazin, MD, a dermatologist with the Washington Institute of Dermatologic Laser Surgery in Washington, D.C. “Either you’re too busy or too slow. It’s rare that you have that perfect day with the perfect number of patients.”
Achieving a seamlessly scheduled day may feel elusive, but it is not impossible. There are several steps practices can take to fill empty time slots and increase patient bookings during slow days and seasons.
Getting a Handle on Bookings
The first step in creating a robust but organized schedule is to make sure you and your staff are realistic about how much time each appointment will take. While double- or triple-booking appointments is not unusual among dermatologists, Dr. Kazin says patients don’t appreciate it. “People don’t like signing in and seeing that someone else is scheduled in the same time slot,” she says. To prevent overbooking, she recommends strategies, such as scheduling patients every 10 minutes, rather than booking two patients in the same 20-minute time slot.
Both Dr. Kazin and Edwin Williams, MD, of the Williams Center for Plastic Surgery in Albany, New York, cross-train all staff members by having them observe procedures and shadow employees in other positions—even if it’s a medical job for which they are not qualified. That way, when a patient calls, they will have an understanding of how much time is really needed for an appointment.
“Sometimes a patient calls and uses words that make it seem like what they need will only take a few seconds. They say, ‘Oh. The doctor just needs to zap a spot.’ But what the patient really needs is a 45-minute appointment,” says Dr. Kazin.
Practice owners and managers will benefit from reviewing their appointment books daily, looking for unfilled time spots or canceled appointments. In the short term, this gives them a chance to fill last-minute openings. Over the long term, it helps practices identify days or seasons that are traditionally slow, so they can adjust staffing and create new marketing efforts to fill those gaps.
Anna Guanche, MD, a dermatologist with the Bella Skin Institute in Calabasas, California, says the most effective tool she’s instituted for ensuring a full schedule is software that sends text messages or emails to patients to remind them of their appointments, which reduces the number of no-shows. The software can also be customized to alert patients when it’s time to schedule an annual, full-body checkup or come in for a dermal filler or botulinum toxin touch-up.
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Every practice has a slow season, typically in the late summer or fall. For Dr. Kazin, August is her slowest month for appointments, so that is when she and her staff schedule their vacation times. “We take time off when it’s not too busy,” she says.
She views slow days as an opportunity to spend more time with each patient and introduce them to procedures or products that may be of interest. “When it’s really slow, you should pay more attention to those patients who do come in,” says Dr. Kazin. “Sometimes you can augment your revenue that way.”
For filling last-minute cancellations, Wendy Lewis, founder of The Knife Coach, a consultancy for cosmetic surgery patients, recommends keeping a wait list of people who are interested in getting in earlier than their scheduled appointments. “There are always going to be cancellations. There are always going to be no-shows,” she says. “Keep a waiting list. People appreciate that. It shows patients that you are going the extra mile for them.”
Dr. Williams sends text messages to his nonsurgical patients, alerting them to open appointments. “We’ve filled many slots that way. That certainly has had a positive effect on our bottom line,” he says.
Dr. Williams also keeps a list of his top 50 patients and rewards their loyalty with special discounts or events. Similarly, Dr. Guanche keeps track of her highest-spending patients and bestows them with a “platinum card” that allows them discounts or special offers every quarter.
For instance, she may offer $100 off every $300 they spend for products, facials, laser treatments or Botox injections. When patients take advantage of one of those specials, it is not a loss for the practice. “It kind of gives them permission to spend, and they spend more than $300. I guarantee you that,” she says.
Cancellation fees are another tactic for ensuring that patients respect a physician’s time and schedule. Dr. Guanche charges $25 for patients who don’t provide 24 hours notice that they are going to miss an appointment.
“We were worried about it the first time we did it,” she says. “We didn’t want to offend anyone. But it’s also a sign of growing confidence. People are okay with it as long as you’re nice and not inflexible about it. It lets them know, ‘You can’t just walk all over me.’”
For a patient who has missed prior appointments, Dr. Kazin recommends asking for a deposit. “If someone is a repeat offender you can consider taking a deposit,” she says. “That’s better than having to argue with them over whether their excuse for missing or canceling an appointment is good enough.”
A surefire way to fill your schedule is to increase the number of patients coming to your practice. But while many practices focus on reaching out to new prospects, a better strategy may be to strengthen your relationship with existing patients. Catherine Maley, founder of Cosmetic Image Marketing, finds that physicians can be too focused on attracting new patients at the expense of a much easier win—their existing patients.
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“A lot of them say they want new patients and I say, ‘Is that what you really want? Or do you just want to be busy?’” she says. Maley surveyed the patients of hundreds of doctors throughout the U.S., and her results showed that 25% of patients came from the Internet, 30% were current patients and 45% found the practice through word of mouth. “If doctors put their entire budget into Internet marketing, they’re missing 75% of their patients,” she says.
To pinpoint your most effective marketing efforts, she recommends combing through your schedule and looking at the last 40 to 100 surgeries or big-ticket items. Identifying these patients and how they heard about your practice will provide valuable insight into your desired patient base and best marketing strategies.
Dr. Williams agrees that keeping existing patients happy is easier than trying to attract new ones. In the past, he focused his marketing efforts on the Internet, but he has changed his ways. “I’ve altered my strategies in the last five to ten years,” he says. “I’ve found that the best thing you can do is take care of your current staff and patients. For a long time we thought it was about optimizing SEO, but we’ve found it’s not about that.” Ten years ago 5% of his marketing budget was dedicated to the Internet, today that figure is 1.4%.
In an effort to fine-tune his marketing budget further, Dr. Williams—who has been in private practice for 22 years—recently analyzed 40 patients who completed surgical procedures that cost $5,000 or more to learn how they came to be in his practice. Five were new patients and 35 were previous patients, or a family member or friend who was referred by a current or former patient.
“I think many patients are right under our noses,” he says. “But you have to work for them. You have to work for every piece of your practice.”
Dr. Williams also works hard to promote a productive and happy culture among employees, because staff conveys unspoken feelings—both positive and negative—to patients. Staff members in his practice take part in annual goal-setting sessions, set mini-objectives during daily huddles and receive awards and recognition when they excel. It’s not unusual for Dr. Williams to recognize staff with a $50 gas card or to let them off an hour early when they achieve a goal. “When we hit a goal we celebrate,” he says.
Though consumers may follow rational steps investigating physicians for their cosmetic surgery procedures, Dr. Williams notes that the final decision is still based on emotion. That means every patient needs to feel cared for and appreciated.
To make sure his schedule is filled with patients who are serious about their desire for cosmetic surgery, he charges a $150 consultation fee that is applied to the surgery if the patient decides to go forward. While charging a consultation fee may be a good way to avoid cancellations and weed out those who are not serious about booking a procedure, Lewis cautions that it’s not possible in some communities. “In some markets you can’t charge a consultation fee because no one else in town does,” she says.
In addition, she discourages doctors from focusing only on big-ticket or specific procedures. “You have a better chance of turning a prospect into a patient by getting them in the door,” says Lewis. “Not everyone is a candidate for a $25,000 facelift, but they may be a candidate for an $8,000 eyelid surgery or a $500 peel.”
Annemarie Mannion is a freelance writer based in Chicago.
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