The "good old days" were when: Physicians of almost all types of specialties were in great demand; physicians could "go anywhere" in the country that they wanted to practice medicine; patients "followed" physicians to their place of business and an open door was virtually the only thing physicians needed to have to attract them.


Those good old days, though not long ago, are dying fast.

They're dying fast because the rapidly changing and competitive nature of the health care industry are making this so.

Today, the U.S. has 553,000 licensed physicians, a third more than just a decade ago, according to a report in the Jan. 26, 1987 issue of Newsweek magazine. There are 22 physicians per 10,000 people compared with 17 in 1976 and 14 after World War II. If this trend continues, the end of the century will bring 26 physicians for over 10,000 people. Most of the surplus, the report reveals, is concentrated in big cities and the specialties, both places where the majority of physicians want to be.

Bill payer

And in the old "follow the leader" relationship between physicians and patients, the tables have turned. Today, the leader is in most cases, not the physician but the party footing the bill.

"Whoever controls the limited resources, controls the health care economy," says Thomas Erickson, director of marketing and consulting services of the Minnesota Medical Assn. "Today that limited resource is money and the purchasers of health care are the ones in control.

"When the physical resources to deliver medical care were in short supply, the physician pretty much controlled health care - they were the resource allocators. As care has become more expensive and access problems have diminished, insurers and HMOs have taken a more visible role in resource allocation. Today the purchasers - employers and government - are taking control. They no longer accept health care as a pass-through benefit; they want to take an active role in managing the delivery of care and allocating resources."

Obviously, it's a scene which is having a great affect on physicians (particularly younger ones and those just starting out), and the way some of them are handling their profession. Like health care purchasers, physicians, too, are becoming proactive - proactive in terms of marketing and marketing research.

Medical marketing

Although marketing is a term traditionally found in business and entrepreneurial circles, it's not uncommon to the medical profession and has held more weight in recent years.

"Four or five years ago as physicians started to get involved in marketing, they took a 'soft approach.' They tended to make their marketing decisions based on personal experience and relied on their gut feel," says Erickson. Today, because health care is becoming more competitive and the risks are greater, physicians are taking a more deliberative approach. The competition requires them to be more business-like in their approach."

That competition - in the number of physicians, the number of hospital beds, improved consumer knowledge about health care and the expenses of advanced medical technology - is forcing physicians to compete among themselves and to better understand the marketplace, says Alan Dakay, vice president of marketing at Park Nicollet Medical Center in Minneapolis.

Know the marketplace

The need to better understand the marketplace was exactly what the physicians at Park Nicollet wanted to know about three years ago. They noticed that the community, especially hospitals and HMOs, were moving toward marketing and advertising and they, too, wanted to become more aggressive in marketing.

First, the clinic needed to know something about its market and its consumers, says Dakay, who came to the clinic last fall after serving seven years in marketing research at General Mills. Unfortunately, the clinic began its investigation on little substantial information about its patient base.

"The only information we had was off of our medical records data but nothing on who we were, what we were and how we were perceived," says Dakay.

That's when it was decided to conduct focus groups using the clinic's patients and non-patients to find out what issues were facing the clinic and the type of vocabulary the respondents were using for the clinic, says Dakay.

The next phase involved two telephone surveys conducted last fall among patients and non?patients in the western metropolitan area of Minneapolis. The first was an awareness study involving 400 respondents and the second was a patient satisfaction study involving 330 respondents.

Incorrect impressions

The research discovered that potential patients were confused about what exactly the clinic was. Some thought Park Nicollet was a health maintenance organization and others thought it was a hospital. Both impressions were incorrect.

"Park Nicollet is the second largest clinic in the Minnesota, the fifth largest in the country. It also has over 270 physicians in 36 specialties and subspecialties," says Dakay.

The research findings formed the groundwork for the ad campaign. A series of TV and print ads began running in March, 1987. In one of the TV commercials, clinic physicians introduce themselves and their specialties, emphasizing the fact that the clinic is a collection of specialties. Yet another spot shows some of the clinic's physicians stating the highly respected medical schools they attended, adding further credence to Park Nicollet.

The next step, says Dakay, will be to measure the effectiveness of the clinic's advertising by doing another wave of research to see if knowledge of the clinic and its image have improved.

Already many people have called saying they have seen the advertising and request a particular physician.

In the interim, says Dakay, the clinic will be conducting a short, in-clinic survey asking people about the clinic's advertising.

Dakay says the clinic is also using the results of the fall survey and the inpatient survey to develop an in?patient service training program called "Patients First."

"Patients First"

The survey involves asking the patients about a particular unit of the clinic where they had been treated to find out how the clinic performed, if they were satisfied with the level of service, if they were treated well and had all their questions answered. The staffers of those units rate themselves, too, on how well they think they're performing.

The survey results are fed back to the 1,700 employees at the clinic's 18 Minneapolis metro locations to let the staff know what its 400,000 patients think and where it can improve.

Because of Park Nicollet's size and budget, it is able to undertake such extensive research and media projects. Other clinics and hospitals, depending on their budgets, are following suit but on the whole, the health care industry has not seen a lot of this before, says Dakay.

It's a way of doing business which is bound to increase, however, in light of the competition and other changes which face physicians practicing medicine.

"Anyone in business needs market research," says Sheila Jacobs, president of Healthcare Images in Baton Rouge, La. "Physicians are in the business of practicing medicine and must learn about business to practice it and develop it entrepreneurially if they want to compete in the marketplace."

ARTICLE SIDEBAR

Pediatrician lauds surveys, with some reservations

Physicians are used extensively as respondents in health care market research, especially in research for pharmaceutical companies. Direct mail surveys and telephone interviews are probably the research methods most often used by these companies. Focus groups and one-on-one interviews are also used, but because of their cost and the limitations inherent with the sample size, these techniques are less appealing.

Dr. Sanford Anderson, a pediatrician at Park Nicollet Medical Center in Minneapolis for the past seven years, has been a participant in numerous focus groups, one-on-one interviews, telephone surveys and direct mail surveys. The following article offers Dr. Anderson's insights and comments about being a research participant in the health care industry.

Dual purpose

Dr. Anderson, who has been interviewed by companies that manufacture infant formulas, vaccines and other drugs, has the impression that market research is conducted for two reasons:

"I think the supplier's intention is first, to get us to think about the product in question. Second, and indirectly, they're reinforcing our notions about how we're 'selling' their product and what patients are saying about that product so that they can find out how to market it better."

Knowing how patients feel about these products is something pharmaceutical companies need to find out on a regular basis, believes Dr. Anderson.

"The pharmaceutical manufacturer and the supplier have to be keenly aware of society's changing attitude about their product. It can vary from one year to the next. They have to keep up with the social changes that are occurring that affect the product and what the media is saying about it because it may require them to shift marketing gears."

Dr. Anderson cites the vaccine, "pertussis” as a good example.

Traditionally, this vaccine has been taken in combination with the tetanus and diphtheria vaccines. These vaccines are recommended for all children under six years of age. Dr. Anderson says the medical community and the vaccine companies advertising in the 1970s stressed that parents should have their children get the vaccines.

Within the last five years, however, the pertussis vaccine has been covered in the media as having adverse side affects. This media coverage has created concern by the public, says Anderson.

Researchers for a vaccine like DPT are understandably interested in knowing the concerns patients express to their physicians. Those concerns can then be addressed in print advertising. It's also an opportunity for researchers to point out to physicians the improvements and positive actions they've been taking with the vaccine so that the physicians can then pass this information on to their patients.

Research methodologies

Of all the research techniques, Dr. Anderson prefers the one-on-one interviews most.

"You're interacting with a human being, not an anonymous person over the phone or in an impersonal mail survey. I feel as though they're genuinely interested in my knowledge. An honorarium or gratuity is usually given as a sign of recognition of the worth of my time and knowledge."

Having a good presentation, such as a slide show or similar type of visual aid, makes a one-on-one interview especially appealing and worthwhile, says Dr. Anderson.

"It shows me that they took the time to prepare their presentation. Besides, if the product is good, marketing it should be good, too."

Professionalism is equally important in the interviewer as well. If the individual is experienced and well qualified in conducting interviews, whether it's a one-on-one situation or a focus group, it often determines whether or not Dr. Anderson agrees to participate in future survey research with that company.

For several reasons, Dr. Anderson dislikes telephone surveys. "They're impersonal, they take up my time and my information. The interviewers are getting paid for their work and justifiably so but the interviewee also deserves consideration for his time.

"If I participate in a telephone survey, I answer the questions in a casual way so it's probably a waste of their money to contact me. I don't have the time for them. I'm on a time schedule and I have patients to see. The interviews are also conducted at off-hours which interrupts my time with my family."

Dr. Anderson, who receives direct mail surveys about every three weeks, is more positive about this research technique.

"I don't mind mail questionnaires generally because I can fill them out when it's convenient for me. I won't fill out a four-page questionnaire without an incentive, however. It's just too time-consuming and demanding.

Physicians, on the whole, seem to be willing and even enjoy participating in market research efforts. But, like all survey participants, they appreciate being respected for what they have to offer.