Latest / Voices of Otolaryngology / Building Your ENT Practice Without Breaking the Bank

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Building Your ENT Practice Without Breaking the Bank · Voices of Otolaryngology

• 0:01
  Welcome to the Voices of Otolaryngology podcast series, where we spotlight
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  diverse perspectives and insights within the field of otolaryngology.
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  I'm your host, Rahul Shah.
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  Let's jump into it.
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  Well, welcome to Voices of Otolaryngology.
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  I'm at the Oto Forum April 2025.
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  Alexandria, Virginia.
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  For those of you that have listened, you know my theme for
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  this meeting is what, Chris?
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  Sometimes you just get lucky.
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  And so I met a new friend, Srinivas Kaza.
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  Nice to meet you.
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  Okay. Your nickname? Sinew. Yes.
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  Yeah.
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  Rolls right off the tongue, but Srinivas rolls off my tongue.
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  Welcome. And where's your practice?
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  So I'm in Rochester, New York.
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  Okay, but a northwestern guy, right?
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  Northwestern, undergrad medical school
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  and then residency in Pennsylvania at, Geisinger. Yeah.
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  And then ended up in Rochester.
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  Yes. How's that?
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  It's great. I've been there 20 years, so. Wow.
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  How did you end up from Geisinger to Rochester?
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  You know, it's kind of,
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  always one of those stories where there's a spouse and, I got it.
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  Decision making.
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  So my story is that my wife, who I met when I was an intern
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  in Toronto and, when we finished, when I finished my training
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  and when she finished her training, she's in, obgyn.
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  Oh, sure what is your family medicine?
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  Okay.
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  She wanted to go back to Canada,
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  and we kind of went back and forth and kind of at that time.
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  Yeah, socialized medicine.
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  And there was a lot of anti Canada.
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  So we were like, well, let's kind of get close to the border without going across.
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  You did it.
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  So as we looked at the map, one of my co-residents
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  who was a few years ahead and we happened to be looking for adding
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  a third physician and, that was in the Rochester.
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  And that's where we ended up, and that's where we've been.
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  Wow. Well, thank you for running the Oto panel today about OPPS.
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  It was marketing and reputational strategies.
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  Is that right?
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  Yes. Okay.
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  And you just finished it.
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  We just. Fresh, fresh off the press.
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  No, not at all.
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  I'm pumped.
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  You're pumped. All right. Well, how did the panel go?
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  I thought it was nice.
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  I think it was hard to follow a conversation about value based care.
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  It's always hard to follow Will Harrill! And Doctor Harrill.
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  So that was engaging.
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  And I think people's heads were scrambled and swimming.
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  So I think this topic was, you know, a little more of a bite sized nugget.
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  Yeah. What are some of those nuggets?
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  Well, you know, I think.
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  Probably the biggest take home theme is that it's a it's a spectrum.
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  When you look at marketing and reputation management,
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  there is no one size fits all.
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  Everything is going to be local to where you are.
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  So you have to understand your region.
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  You have to understand your market.
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  You have to really look in the mirror and understand
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  who you are as a practice and what you represent.
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  What is your why for existing.
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  So I feel that we kind of had these three levels.
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  The original idea was low, medium and high budget.
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  And then we kind of changed the title to Marketing Reputation Management
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  for Different Budgets.
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  So we were clearly the low budget example.
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  And I think it was very insightful
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  to see that the way that we do things works for us.
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  But yet the South Carolina group, they had a different strategy
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  to work for their market.
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  And of course, ENT and Allergy, who was the third part of the
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  kind of panel had a much bigger campaign for their, for their market.
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  I know the Charleston group very well.
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  I know stuffy the mascot.
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  So you don't have a mascot?
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  We do not.
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  You don’t have a branded mascot named Stuffy on commercials?
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  I think that's the only ENT mascot I've ever known in existence.
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  Yeah.
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  And that's a that's a medium resource because you said low, medium and high.
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  And we'll talk about that in a second. Right?
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  You talked about strategies.
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  Yes. Go back a second.
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  You talked about all marketing is local.
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  Kind of like real estate. Right.
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  So how do you learn your local market?
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  You know, I think it's it takes time.
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  I think you have to look in the mirror.
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  I had, put up a slide that just really had a simple set of dots,
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  and you just have to kind of see what those dots are.
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  The data points that tell you where, where's
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  your geography, what's your population base, what are your demographics?
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  And you connect the dots. We bootstrapped it.
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  I use two terms constantly throughout, the panel.
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  Who did you use?
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  So two terms that I use constantly - Two terms?
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  Yeah. Two terms.
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  And I use this in every conversation that I have
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  anytime we meet people: scrappy and bootstrapping.
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  So our practice is scrappy and we've bootstrapped
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  almost everything that we've done.
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  So all internal in terms of figuring out what our market is.
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  So give me some strategies.
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  How do groups, any group really start understanding their market.?
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  What are some resources?
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  Yeah, I mean, I think, you know,
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  probably the quickest resource
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  would be Google search or now with an AI search and ChatGPT.
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  What do you ask it? Yeah, what do you query?
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  Very sophisticated content.
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  I mean, you could ask it just about anything.
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  The more detail you put in.
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  “Tell me about ENT marketing in the greater Rochester region.”
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  What are strategies that work to compete against system A and system B?
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  And you will get probably a reasonably sophisticated businessman.
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  We did not actually do that because we've been around
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  long before this fad Did you see what I was doing?
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  I was reaching for my Claude AI.
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  And I was going to say, let's do it.
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  Well, Chris, we were going to do that.
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  Chris and Miguel I resisted the urge.
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  But you could dictate it in.
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  You could just dictate it right in.
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  But you haven't done it because you kind of know the market.
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  Yeah, we've already kind of progressed to the point where that piece,
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  we've not had to do.
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  However, as we go to the next step where we bring on new physicians
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  and new hires and new PAs, we're expanding in our main location
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  to a brand new medical office building, and all the services that come with it.
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  We will absolutely rely on those resources,
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  even if it's for the purposes of pointing to what are some good third
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  party vendors to help engage. Yeah.
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  So let's go back to learning your local market.
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  So you use search engines, other strategies for people.
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  Yeah.
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  I mean, I think, you know, maybe that came up in your panel or questions or slides.
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  Know your - know your patients.
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  Listen to your patients.
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  Huh! Interesting go with that one.
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  Patients are always right even for marketing.
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  What do you mean by that?
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  They will tell you what they like about you, what they like about your practice.
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  If they had a good interaction with your front staff,
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  we get constant feedback, oh my gosh, the people at the reception
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  and all the people are so invested they care.
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  And so that is great marketing.
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  How's that with marketing? How do you turn it in a marketing?
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  That's it.
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  You have patients that are giving you good reviews, good word of mouth.
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  They're writing those Google reviews, the posting on the Facebook, then.
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  You amplify them on your website.
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  Yeah, exactly.
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  Other resources, referring doctors, it was mentioned on the panel
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  that any time a new physician sends you a patient that you're not familiar with,
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  call them back, give them your cell phone, engage them.
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  So we do that?
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  Yeah.
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  It's just understanding where you are.
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  So Chris and Miguel, I think we have a title for this one:
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  Marketing and Reputational Management.
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  Know your patients. It's really interesting.
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  That's actually really, really great.
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  So we start with understanding our local market.
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  And it seems like there's
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  a lot of opportunities, including my good old buddy Claude AI.
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  Then you talked about low, medium and high resources that you put into it.
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  Can you build that out?
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  And you don't have to, but dollar values or percent of revenue
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  that you invest or operations might help some of our members, but by all means.
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  Yeah. No. Absolutely.
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  So and presentation our low budget scrappy version,
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  it's less than 0.5%
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  of our total gross revenue that we dedicate to any type of marketing.
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  Hold on. Love your specificity.
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  We don't even know each other, but we're.
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  I'm starting to love the way you think.
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  0.5% of total gross revenue invested in marketing.
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  All right, so million dollar practice you're spending hold on 10%.
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  It's 100,000.
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  Hold on 1% 10th 5000.
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  So low practice would be less than 5000.
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  Exact per million okay.
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  So go with that. And then a medium, then high.
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  So it was described in the panel that kind of industry
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  standards for marketing are anywhere from 4 to 5%.
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  That's not a total gross revenue. Total gross revenues.
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  Wow. That's a lot. It does sound like a lot.
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  I was a bit surprised to hear that.
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  So that’s 40 to 50,000 for $1 million.
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  Yes. Right. Yeah.
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  For doing our math. Right. Wow.
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  And if it's let's say a facial plastics practice that just goes
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  hand in glove with what it takes to kind of get your name out there.
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  I saw some people nodding in the audience when I mentioned that marketing
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  for a cosmetics center practice or facial plastics practice are totally different.
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  I think my two co-panelists kind of surprised me in the sense
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  that they are relatively low budget for their markets as well.
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  So, why did they surprise you, though?
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  Well, they're they're bigger footprint practices.
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  So, Doctor Burkhalter's practice.
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  And where is that practice?
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  That's in the Midlands of South Carolina.
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  So an affiliate of Charleston ENT, so it's Palmetto ENT.
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  But they call themselves a low.
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  Medium media medium budget.
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  So they have about a 2 to 3% got
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  percent of their topline revenue on, on the marketing
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  and then ENT and Allergy, so it's very, very big group in kind of the greater,
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  New York City metro area, as we all know.
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  They were kind of in the 1.5 to 2%.
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  So, so probably some of them, you know, was do exactly right.
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  If you're so big.
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  Both of those South Carolina
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  and New York/New Jersey if you're that big people know you.
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  Right.
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  And then yes, what percent of the market do you have in Rochester?
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  You have three offices in Rochester, three physicians, five APPs?
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  3 in 3 and six, hopefully soon to be four and six.
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  So four and six.
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  So ten providers.
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  And what percent of the market share?
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  You know we’ve never really done a deep dive on that.
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  But if I had to kind of tell you what our patient flow is relative to the other.
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  Otolaryngologists Otolaryngologists
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  in the community we're probably about 10 to 15%.
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  Oh, wow. Wow. So it's not dominant by any stretch.
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  And it seems to be fragmented.
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  Yeah.
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  So marketing is important in your area.
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  And how about the high resources.
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  You said 4 to 5% for mid or what would high be what is?
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  So these
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  so both of the groups really developed their marketing departments in-house.
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  So reputation management,
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  social media, website, all of those things, they do in-house,
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  but for a sort of high resource practice that doesn't maybe have the
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  operational ability to do those in-house, you're outsourcing it and whatever.
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  Yeah, it's asset to a third party reputation management
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  company website design company, social media,
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  you know,
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  marketing and any type of spend on any kind of campaigns,
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  whether it's multimedia, digital streaming, you are going to pay.
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  There's some value captured that those other entities will take.
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  So I suspect that that's where you get to that.
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  You know, 4 to 5%.
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  To 4 or 5% is the high end of industry standard.
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  The low resource you call 0.5% or less.
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  And then the other is a middle guy example.
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  So what are some strategies that we can try when one great word
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  in the quality improvement world is what are you going to do by next Tuesday?
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  So today is Sun - Saturday.
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  What can somebody do by Tuesday?
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  Yeah, I mean, if you really want to bootstrap
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  something like that, it could just be creating
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  a simple feedback card to give to patients.
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  Feedback card. You can put stars on it.
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  You know, having circled
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  the number of stars have a blank line for them to give feedback.
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  And it's just dump it in a box on the way out or mail it back.
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  What I just build from there is simple, easy.
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  What would you build from there?
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  So they send it back to you and then what do you do with the information?
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  You know, I run it, but we don't actually do that.
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  We have them do Google reviews.
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  So we review the Google reviews online.
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  But why would they do a Google review?
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  Do you, do you give them a gift card or a donut?
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  There's there's no inducement.
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  Of course there's no incentivization.
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  We just have a plan where
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  there are.
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  And this came out in the presentation.
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  We give patients many, many different ways to reach us directly
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  or to have engagement through QR codes, text messages, emails.
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  There are content loops that we play in the exam rooms and in our waiting rooms.
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  They have QR codes, so they have plenty of opportunities in this.
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  Let's face it, is the time in the world where people like to review
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  just about everything.
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  My experience at the takeout fast food restaurant, my experience
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  at the gas station - whatever it is.
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  Experience with my in office traditional first.
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  Yeah, yeah. Similar to the takeout. Yeah. Yes.
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  So you you capture that information,
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  then how do you turn it into marketing or reputational management?
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  Yeah.
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  I mean, I think it will again, vary based on your practice in your market
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  for us to give the kind of the low
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  resource kind of small practice format,
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  the less is more for us.
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  So less is more in the sense that the less that we really try to buff and shine.
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  The diamond, we try to keep it a diamond in the rough.
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  We're not looking to have market dominance,
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  because I think
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  there's the potential to overextend and to look like you're trying too hard.
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  Yeah. So a little bit of.
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  Yeah. Why does this doctor's office keep reaching out to me?
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  They're not busy enough. And. Right. Is there something wrong?
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  Why are they spending money on billboards and advertising?
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  And when you.
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  Look at, Google reviews and let's, let's segment
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  into generations and let's define a generation is 20 years.
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  Okay.
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  Tell me when you lose me 0 to 20, 20 to 40, 40 to 60 and 16 above.
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  So four generations of people,
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  do you see a certain generation that fills out the Google reviews?
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  Is it?
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  And you don't have to use the word millennial -
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  I'm just asking you kind of age demographics.
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  Yeah. I mean, if you.
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  My eighty two year old mother is not going to finish - to do that.
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  Yeah. If you chunk it up that way makes it quite easy.
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  So it's going to be the 20 to 40 and the 40 to 60.
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  That have more of an inclination. There.
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  They're right in the middle of that, bell curve for sure.
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  Yeah.
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  Any other strategies that you think about
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  and you use the word reputational management.
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  So what do you do?
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  How do you manage a bad Google review?
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  Can I call Google and take it down?
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  You can't take it down.
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  You can only reply in a very, you know, HIPAA compliant way.
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  What do you do if someone trashes you on that?
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  Well, like I mention during the talk, it's just a, it's a direct reach.
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  I mean, I think there are some
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  that are just sort of a little crazy, a little ridiculous.
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  And what do you do there?
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  You're not even worth it. We just let those stay.
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  But the ones where there's a.
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  Falsity or lie. Yeah.
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  I mean, if there's something that's just, you know,
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  someone has an
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  unusual Google review name or something that is defensive
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  and the language is offensive, then we just leave that alone.
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  But if somebody has a genuine problem, we will immediately
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  call them within 24, 48 hours to say, hey, you know, please tell us more about it.
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  But can you tell Google to take it down if they say something bad
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  about Doctor Kaza or inflammatory or just not appropriate, will they take it down?
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  Do they look through it?
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  You can't take it down.
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  You cannot easily have them take you down the road.
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  The person who posted that can take it down.
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  Yeah, sure. But Google won't.
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  If they say stuff like Doctor Kaza is mean.
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  No unless you probably have a third party company, scrub them.
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  that is going to scrub and reduce active maintenance, which we which we.
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  Don't. But that's tough.
• 15:18
  So that's why you do feedback and reputational management, right?
• 15:21
  You've got to be ahead of the curve. Yes.
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  What are some marketing strategies that you use.
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  We've talked about reputational management where some marketing strategies and
• 15:29
  and not just you.
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  Sorry that you learned the Oto forum that some of our other colleagues
• 15:33
  or audience members are using.
• 15:35
  So there's a lot of analytics and, click through search engine optimization.
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  May I think the digital platforms are really
• 15:42
  where probably that mid-range budget is.
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  It gets expensive SEO search engine optimization is not cheap.
• 15:49
  Exactly.
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  So they're really putting time and effort into those,
• 15:54
  trackable leads where, you know, where
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  kind of where are people online and where are they spending time?
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  There are social media campaigns, whether it's TikTok or Instagram
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  or Facebook, where they're producing, you know, a little snippet, but.
• 16:08
  You've got to outsource that.
• 16:10
  I mean, you can't do that.
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  We have chosen not to do that.
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  I think practice is that do do that.
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  They have to have a dedicated team because as was mentioned in the panel,
• 16:18
  there's nothing worse than starting that and then having a go stale.
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  Yeah.
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  And I think the higher resource ones, they will just hire it out.
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  And then you have somebody who's just cranking out content.
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  20, 40, 50, 60,000? That's no joke.
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  It's a lot of - it’s a lot of money.
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  I gave in one of the earlier slides, kind of the analogy of a nuclear arms race.
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  So if you kind of ante up your spend and know that more nuclear weapons
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  and the other team or the other country is going to do the same, and.
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  And then it's. Going back and forth.
• 16:46
  Yeah. We're not competing on quality at that point. Right.
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  You're competing on the number of nuclear weapons you have. Right.
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  How do you compete on quality?
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  You get the word out to referring doctors that your high quality practice,
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  and you want to grow the pie.
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  You don't want to cannibalize other practitioners in town.
• 17:00
  Correct?
• 17:01
  I think we're fortunate in one sense that there is more demand
• 17:05
  for otolaryngology
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  care than ever in our market is, you know, as you've kind of canvased.
• 17:10
  Yeah.
• 17:10
  The membership, it's just they're right on.
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  It's just the perfect storm of forces that have led to that.
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  So I don't think we ever feel like we are eating
• 17:18
  each other's pieces of the pie, which which is nice.
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  I think it just grows.
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  And, you know, to your point, if you, provide good care,
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  good service, patient centric, all sort of the basic
• 17:34
  building blocks I had mentioned in my panel.
• 17:37
  The Four A’s: affability, availability, accountability and ability.
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  Over time, there is a flywheel effect where that will ultimately drive home
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  the point and, internal referrals, word of mouth
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  referrals, doctors bring their patients to there,
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  and strong advocates and testimonial shows and so on and so forth.
• 17:57
  It just kind of builds from there.
• 17:58
  Some of my favorite words.
• 18:00
  Miguel and Chris know that, right?
• 18:01
  The Four A’s, and then the, flywheel.
• 18:05
  We have an Academy flywheel as well, but right.
• 18:07
  How you use the Academy to power member value, which drives
• 18:10
  member growth, which decreases the member unit cost, which causes more members.
• 18:14
  But same for you.
• 18:14
  Yeah. Like you get out there. You get out there.
• 18:17
  What were some of the, bad strategies you heard?
• 18:20
  From the audience, from the panels, things gone wrong.
• 18:24
  Maybe. Social strategy that's not committed.
• 18:26
  You turn it on and off. What else did you hear?
• 18:28
  Yeah. You know, it's funny.
• 18:29
  I don't think, there was, nothing negative
• 18:33
  from the panelists in terms of things that they had tried and that didn't work.
• 18:36
  I think the one comment that Doctor Burkholder did make
• 18:41
  is that you don't want to overload patients during the holidays.
• 18:45
  Holiday time is a bad time to.
• 18:47
  To go out there with the marketing blitz.
• 18:49
  Too much saturation.
• 18:50
  It's brain overload. What what does he mean by.
• 18:52
  Oh, go with that.
• 18:53
  There's there's a holiday blitz from everything.
• 18:55
  Right. All the commercial.
• 18:57
  So your spend during that time is not going to really get right.
• 19:01
  Gets diluted by the holiday and merchandizing and
• 19:05
  shopping sprees.
• 19:05
  Do you keep a patient list by emails or sales and do you go after them?
• 19:10
  Some of our members talk about the lifetime
• 19:13
  economic value of a patient, that they'll keep coming back,
• 19:16
  they'll send their grandkids, their other family members.
• 19:18
  Do you do you target your existing patients? Yeah.
• 19:20
  So it's interesting.
• 19:21
  Albany ENT maybe where you saw that lifetime value of a patient.
• 19:25
  They have really tracked that.
• 19:27
  So we have kind of known that we don't track that
• 19:30
  at the analytical level, but certainly there is a lifetime
• 19:34
  value to any patient that comes in in terms of the database.
• 19:37
  We have an EMR.
• 19:38
  I mean, I think there are probably a few practices out there.
• 19:41
  They're still on paper, probably very few, which we probably will be dinosaurs
• 19:45
  at this point in time.
• 19:46
  But all of that is in there.
• 19:48
  The emails, the cell phones. Yeah.
• 19:49
  So do you use them?
• 19:50
  As they become patients, they're signing disclaimers.
• 19:53
  Hey, it's okay to text me. Yeah or email me.
• 19:55
  And so we we do use that.
• 19:56
  But again we're careful.
• 19:58
  We have used the diamond in the rough approach.
• 20:00
  We don't want to oversaturate.
• 20:03
  It has to be if they get a contact from us, it has to be meaningful contact.
• 20:06
  But I think you can absolutely
• 20:08
  leverage that in the medium and high resource examples.
• 20:12
  Is there an ROI?
• 20:15
  Yeah, I mean, I think for us again we've bootstrapped it.
• 20:17
  So we're not able to because our spend is so little - Exactly.
• 20:22
  It's you you'll get a return! You put that numerator.
• 20:24
  You get 10 patients in a year, yeah. In a year it'll be good.
• 20:27
  So we so it's definitely there I think for the others
• 20:30
  there was some discussion about what things work and what things don't.
• 20:34
  Which campaigns online generated the clicks that kind of
• 20:38
  came back through to the website or what have you.
• 20:40
  So, yeah, I imagine that's there.
• 20:42
  I don't know how to track that.
• 20:43
  I think if we had to, we would probably have to get a third party involved.
• 20:48
  Doctor Kazaa thank you very much.
• 20:50
  I thought it was awesome.
• 20:51
  I know your panel was well received about market
• 20:53
  marketing and reputational management. Know your patients.
• 20:56
  Any final word?
• 20:58
  No. I think just a shout out to the fact that the OPPS
• 21:01
  has come into existence and the fact that you're actively involved.
• 21:04
  Thanks, man.
• 21:05
  So, you're still a Bills fan?
• 21:09
  I'm not a Bills fan.
• 21:10
  You might want to cut that. I know you can keep that a man.
• 21:13
  All right, so hold on - you’re Eagles, because you're a Delaware boy.
• 21:17
  So I’m a Commander's fan.
• 21:18
  We had a great game. You all deserve to win. It was fine.
• 21:21
  It was fine, right? I mean, it was a great game.
• 21:23
  Yeah, I think the score justified.
• 21:25
  I'm talking about the championship justified.
• 21:27
  I mean, the better team won.
• 21:29
  I agree. Yeah.
• 21:29
  So when I win I want you to agree.
• 21:31
  All right I'll be right there. Right on. Good to meet a new friend.
• 21:34
  Thank you very much for what you do for the Academy.
• 21:36
  Thanks for being here, spending time and educating our members.
• 21:39
  Thank you. All right.
• 21:39
  I'll say fly eagles, but let's clip those wings.
• 21:42
  Thank you.
• 21:43
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• 21:44
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• 21:47
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• 21:50
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• 21:52
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• 21:54
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• 21:55
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• 21:56
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• 22:01
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