Building a Profitable Private Practice Part 1 - The Power of the NIche

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[Music] hey guys this Dr Mike woing welcome to another edition of bootstrap MD the podcast for physician in healthcare entrepreneurs we've been a little bit on a hius but we're back to on schedule and we're so excited to bring a series of interviews with my good friend Dr an trong we've had her on the call before as you know she is a medical practice owner in Virginia she's a very successful Sexual Health practice and we are excited because we are bringing together a what we call call a challenge you're going to know more about that in just in just a a few minutes or just later in the program about how it works if you are thinking about starting a practice or maybe you already have an existing practice already and or maybe you want to incorporate cash-based Services into your practice or perhaps you're doing a cash Based Services maybe you have a med spa maybe you have a clinic right now but you want to maybe you want to turbocharge that a bit more get more profits get bit more security as you know we can't always count on insurance to help help us pay the bills and keep us growing and you know we have discussed about cash based practices and I wanted to focus today on especially if you're a practice right now and you're seeing you know we want to get into Cash Bas services but I don't know which direction to go to you want to sit down take notes we're going to be covering that today but before we we get into it I want to introduce my my friend Dr an trong man how are you doing thank you I am doing very well I'm really excited for us to be working together on the uh Medical Practice profit challenge I don't think anyone had done a challenge like this before and with me and you doing this and and really to really help doctor uh um make a profit because you cannot continue a business right now with uh taking uh insurance and so I I'm I'm happy to be here and to contribute and to spread the message uh to help doctors make more money so they can really enjoy being a doctor again it's important for me because my daughter right now is taking her first Board of us mle board to become a doctor she just finished her second year and I really want to set up the landscape for her in the future to enjoy what she loved doing and really enjoy being a doctor because right now as you know uh all the doc most of the doctors we see and some of the doctors I'm talking with have been just out like really one to three years already thinking about transitioning uh because they're already uh burnt out so I'm happy to be here and to talk about you know uh our challenge that is coming up okay yep so but we're going to teach you just just a little bit more exactly what is the challenge what's that encompasses but I want to kind of get into the topic uh first that we have on hand and that is deciding on a niche for uh your medical practice specifically with a focus on cash Based Services just for people who may not know you maybe just a little bit of of kind of your background a little bit about your practice uh and uh perhaps how you decided on your Edge as well right so um I uh I'm I'm a a Pinar uh physician and uh I've been doing Interventional pain management since I've been out of practice since 1997 and um what taking Insurance where um and was uh growing the practice to about six providers and uh 35 Staff was uh working long hours when making less and less money every year I was getting burnt out before even burnt out was even a word uh used because I was not a good person to be around and I decided and I actually started having um um uh PVC I started having PVC and I keep getting sick all the time uh I was always having the sniffle and I just thought because there was allergies uh then one day uh a good friend of mine who's my primary care uh uh is my primary care his office is right next to me and I walked over I said you know I'm having trouble uh breathing and he put the he listened to me and he put on EKG uh and I had like PVC continuous PVC God knows how long that was but that's why I was so tired and he said you got do something and I'm going to put you on beta blocker I said no way I am not going to be on beta blocker at that time I was actually uh like um you know almost 50 at that time and so I decided I need to do something so that's when I decided to go to cash because I knew that with the current model at that time of taking insurances and worker comp it wasn't working out and expenses were Rising so I downsized the practice from uh six providers to myself and to five staff I got everyone uh their job and uh decided just to go cash I let my patient know um uh within like I think 90 days we actually uh did that at that time we had 35,000 uh patient database and uh of course I knew that I was going to take less patient uh because I was going to go to cash and I was prepared for that uh Hest ly so my my journey was that burnt out or being bought over or being an employee and I decided I wanted to stay in private practice and uh uh to continue doing what I'm doing but part of what I also do is I also do regenerative medicine so I used I do PRP uh for pain but then I thought in 2014 I got into uh using PRP for aesthetic and for uh sexual uh dysfunction um um so so I I I said you know we went over to cash but part of the thing was we were doing some cash Bas practices as well but at that time in 2018 I was doing um uh pain I was doing aesthetic I was doing weight loss I was doing IV therapy and then I was also doing Sexual Health it was a lot you know it was a lot a kind of a menu we we there was a lot of things that we had to focus our our our energy on so when I went to cash I knew that I I needed to hone in on one service but I have to say at that time I also had a coach I hire a coach in 2018 with my first code I pay him $50,000 at that time uh uh for how do I transition to uh cash based practice and uh be profitable I knew I knew that I didn't know what I didn't know H so it that word when I first heard it I said what I didn't really understand it but when you let us sink it you really don't know what you don't know so you have to hire uh somebody a mentor or coach to guide you there who's been there and who already knows the pitfalls and who knows the best path going forward and that's why I hire a coach and that was the best thing I did and since 2018 I've always had a a a coach so the coach uh at that time you know uh advised me that I need to Niche down because I'm going to go to cash I need to Niche down to what the heck does niching down mean and but let before I say that uh let's just say that okay so I I went into cash in 2018 and since then we have not looked back when we went to cash and we started niching down we made more money every year the only year we didn't make money was 2020 uh and you know during Co I also got sick as well uh and I was on near death but the reason why I mentioned that was because I knew I had a second chance in life and I knew that I I wanted to make something meaningful of my life at that time I probably have another 30 years on this Earth and I I wanted to make a uh do something that I wanted to do and so I I went all in on online digital marketing and so I became a digital marketer I learned marketing I learned to be a copywriter and we uh we hone in on sexual uh Health using uh th cell therapy hormones and shock wve and we grew up practice now to not only in office uh uh treatment but we also have an online coaching program we also uh have um a newsletter a membership and we're now uh you know cross our 8 figure uh and making um a figure for a year and uh so and I want to share what our my experiences with other doctors um so getting back to that's my story to getting back to um niching down in uh 2018 uh what is niching down when I first heard that word I didn't know what the heck it is and the those of you are listening it's really meaning um narrowing down going deep you know ask doctors we can really do anything even if you're a specialist um you can probably do a lot of stuff I'm P Minar but I did two years of internal medicine before I uh did another three years uh of um panar uh so I can probably do I work in Urgent Care I can probably do a lot of stuff as well too so Niche down is like Starbucks like what is Starbucks known for Starbucks known for coffee all right uh Starbucks known for great tast and coffee you don't go to Starbucks to get get a salad or a hamburger right you go to Starbucks for coffee and that's what the brand is known for but when you go to Starbucks you can have uh they also sell salads and sandwiches and muffins and everything else right so niching down mean be known for one thing and a market for one thing like be like a Starbucks right so um that that's why I narrow down on sexual health for men I focus on sexual health for men mainly erectile uh dysfunction using uh uh using PRP PL rich plasma hormones uh and uh chock wve therapy so I create a package I create an irresistible uh package to deliver uh the service and I didn't I didn't uh uh I didn't advertise and I didn't um um I I I even put away the You Know The Pain Management part I I still do pain today but I attract the patient for uh erectile dysfunction and if they have pain then I'll take care of their joints once they come in for uh the techical heal so the the reason you Niche down all your energy all your marketing efforts it's geared toward one thing so it's like it's it's like I correlate that as like going to med school when you go to med school the goal is to take one test after the other to study and to graduate right it what you had no other goal except that goal to go through med school the best you can same thing with niching down in your medical practice um I've attended um three conferences within the last like literally like month and I've been talking to medical doctors who is spinning their wheel they're on the hamster wheel these are talented medical doctor who's been practicing for over 20 years who taught all over the world and uh who are the innovators but yet they're struggling to even make seven digit a year to even make a million dollar a year H and they're in their own practice but yet they're doing um multiple service they do pain they do weight loss they do aesthetic they do Sexual Health they do hair restoration so they think that the more service they do the more money they're going to make that's actually the opposite uh it's actually the opposite you know because the more service you do you have to figure out what to Market what to spend your energy on right so who who do you Market when if you do if you do all that who do you Market you Market everyone when you Market to everyone you Market to no one so you have to hone in on one particular customer and I will and that customer is the one that buy your one service and that is easier to focus on for marketing effort for messaging messaging meaning what you say to attract that particular uh customer and also uh what you what what uh advertisement material that you put out uh as well too so when I learned that thought uh for me it makes so much sense and that in 2018 we just um went all in on male sexual Heth uh and we uh have not and I've been trying to uh tell the doctors that I met in the last three conferences is that you know you don't have to give up all the stuff you do but just focus on one service that give you the most leverage with the least expense so what I'm trying to say is that what is that service that service shouldn't be uh doing spine injection that require you to pay uh um you know a same day surgery cost uh uh floral equipment attack uh die and all this stuff and then your profit margin probably 30% you want to focus on a service that you want to Niche down to that give you at least 70% profit uh and not 30% so that that's this is a tip you're listening to this it's like you're thinking okay if I want to Niche down which one should I Niche down on Niche down the one that give you about 70% profit with the the least amount of time right you don't want to do that and take you three hours to do with the least amount of time that's the reason why I do uh Sexual Health uh for Ed because it will take me about 15 minutes to do the procedure and all I have to do is just uh uh use a PL rich plasma which is a kit um uh and uh and you know the the shock wve machine there's no disposable so I could just reuse it again so my margin is uh my margin is about 80 uh uh percent at this point so that's what I mean by leverage the profit margin uh is the leverage so uh think about that because the more you Niche down the your laser target on your message and uh on your marketing uh effort and it just makes so so much easier for you for you and for your staff right because your staff can when they talk to um uh patient calling in or Prospect calling in they they know what to say they know what the menus are all right and it's also uh you can also decrease a lot of costs in your business as well too because when you Niche down I always think in my head is this so if I think about buying a new machine or uh or buying something new I always ask is this going to move the lover and give me more profit in what I'm doing now and that would that that would say yes or no because I I you know I what Al I also see doctor do is buy uh a new shiny machine you know because when we go to conference we go to the exhibit hall and we see all the nice new technology and so forth and we go oh yeah you know I want to buy that but I I have tell you I've talked to many doctors who will buy a laser machine or a shock W machine for $100,000 or more and then it sit there in their office and they're not getting the patient in to cover the cost of that machine you know they're struggling to bring patient in so that way they can charge for the machine they already you know they either lease the machine or pay for the machine and they're now like scrambling trying to get somebody uh for that so you don't want to do that you always want to say okay is whatever machine you want is this going to be uh um consistent with the services that you're doing your Niche that you're doing is this going to make you money and pre-sell it first pre-sell the services first before you you even buy the machine right most doctor buy the machine and then we try to uh get patient for the service but uh uh now you should think about how is that going to fit into your Niche uh and try to pre-sell that so anyway I kind of want to plug that in because I just been to three uh conferences and that's what I see at the commonality is that doctors think that they can make more money if they do more Services that's not true at all and that is a myth and that you know buying a new machine will make you more money sometimes that could be truetime that could not be true because you buy the machine but it's your responsibility to get the patient in to cover your cost of that machine sometime it will take you years uh to even cover that cost especially that machine is uh over 100,000 as well but the wck will tell you anything you want to hear right they'll go oh yeah you buy this machine you're going to get like 20 30 patient in the office and so forth but how you going to get patient into the office that's more of a challenge right so that is we're going to talk about that our next part but right now we're just talking about niching what Niche should you do so like uh I spoke to uh um I spoke to a friend of mine who is a premier uh physician in regenerative field and he does you know everything he does hair face he does ozone Prolotherapy bone marrow fat and PRP and does spine and everywhere and we talked about it we narrow it down to focus on one service we narrow it down to doing the knee just the knee just platelet rich plasma to the knee why is that because the knee you don't need a fosc toy you don't need a metal jacket all you need is an ultrasound machine and a PRP uh kit and he can do the knee in about 20 20 minutes right so you can knock out probably two or three patient in an hour and then package it with uh a knee braid package it with some supplement um and also there this is another Advanced strategy is to um uh talk to a personal trainer or in town or a dietitian in town who can offer a free uh introductory uh visit to your patient after to the treatment so that way they offer a free visit and then the patient goes there and the patient wants to continue with them they make the profit from that so but your patient get one free visit with the personal trainer or a dietician so for you it's a complete package and then when you have that package you can charge more because it is it is a package it's not just uh uh a one Service uh um you know that you deliver um the reason why I mentioned packages that way it allows you to stand out from the crowd and allow you to charge more uh for the service that you're uh niching down to because evidently and with what I see too a lot of doctors think that they need to charge less to be competitive well there is no advantage to be the lowest price or the second price uh leader in your charge some doctors are charging like uh $400 for PL rich plasma treatment and they profit maybe $100 I like it's not worth it right it it that's not the uh that's not something that you want to do because that's probably that's what 25% of uh of profit so the the point is uh Niche down uh because it's easier for you to focus on and you you get less distracted with um um with uh other like buying equipment or other expenses it's good for uh your staff and it actually will decrease your expense it it's easier for customer as a doctor I wasn't used to asking for help especially when it came to subjects outside of medicine but then I found physician coaches.com in an instant I found hundreds of experts to help me in all aspects of Life on areas I was afraid to ask dealing with burnout starting a side gig money management even help with my marriage and the best part nearly all experts are Physicians themselves after reading their profile and a quick chat I knew I found the right Mentor for me at physician coaches.com help from professional away want to stay up to-date with preneurs join the lounge to stay stories the latest pH investor and entrepreneur info emailed directly to you join the lounge at bootstrap mb.com the lounge and I also think too an important aspect is actually wanting to do you know this this service whatever Niche you are you got to like the patients that that you're working with you know so for example in my case you know we we had a number of different services but we found that you know we focus on weight loss one it had great margins but we were also liking the patients they were being proactive pay they were they're paying you know to to get better and that may not be the case in all the different ises that you do for example in my case you know mental health sure it might have some great margins but perhaps you might be struggling with with dealing with your patients with your staff um but again every physician is different you have to find out what works best for you uh and I think you know getting that great combo great profit margin making a difference in your patients and liking your patients you know can really make a difference especially perhaps you're struggling with with some burnout and it it's just not working for you what what do you say yeah oh definitely um you you have and the bottom line is you know what as Doctor you know we went into medicine because we want to help patients and or else we wouldn't have gone to four years of grueling uh med school and working as slave during residency when you and I went to residency we were slaves uh yeah we we work like 120 hours um a week and being on call every third day right and there was no cap in the hours that you work at and uh uh and you you uh anyway you learn you you you got gone through all that because you love what you're doing right and now when you're in practice reality hits so the bottom line that you have to love what you do and the patient that you work with and the service all right and so that's one thing and another thing is that um about niching down is that when you're when you're niching down it's actually less stress on you as well too because you have less to worry about uh as as well you just uh uh concentrate your effort on one service like you said you do weight loss you attract the patient in for the weight loss but then once they're in they're in the office they can get BOTOX fillers and other um aesthetic stuff as well too in the spa right uh and uh so uh you could do that as well as for me that that's what I do I attract patient in for um erectile dysfunction and then uh once they're in I can I can I do hair restoration I also do weight loss uh as well and I also do the um pain management but that's not what uh brings them uh to the door for because know this once a patient buy from you whether it's $7 or $1,000 there they are 22 more time to buy from you again 22 more times so get them in the door even just $7 $27 all right and once they get to know like and trust you they will buy more from you and I can't stress that enough can't stress that enough to doctors that it's it's the relationship building in getting a patient to spend uh more with you right a lot of us you know we're used to the insurance company feeding us patient because um of insurance right uh so insure uh what patient if you take insurance patient come to you because you're a part of their uh network but uh when uh when you take uh uh cash it's a little different mindset but the thing is even if they come in with just uh if you let's say you do uh you give them something that's like $27 or just a small uh uh a small charge they they'll more likely to buy from you um again and again and that's all part of the expertise of you and I I know best about uh digital uh marketing how to how to bring a customer online on YouTube or on Facebook Tik Tok or Instagram to uh call uh to call your office or to get something from you online either free or for a small amount and then become a customer in your office or become a customer in another service that you offer online um so you know having said that as physician we can we have a wide reach more so and than we uh than we think because as physician you are naturally an uh um uh an influencer online you just don't you just uh because I will tell you what defines as an influencer an influencer is somebody who has credibility you have the credibility you're a doctor all right and you're G to med school number two is expertise knowledge you have that yeah you're a doctor that you're only missing the third component of influencer which is reach meaning audience Reach In online audience reach and that's something that that uh Mike and I can teach you on on how to reach the masses online and that way they uh that way you get eyeball and they get to know like and trust you and to become uh a customer with you it doesn't have to be in your office as long as they know like can trust you and follow you and that's what we've done in the last like four years where we take a customer uh from YouTube just just an uh an online uh uh um subscriber from YouTube to buy uh uh to get a free ebook from us to subscribe to our newsletter and then eventually come to our office for our in office uh treatment at 12,000 uh dollars so that is a journey that you eventually want to take them on and after that they're still in our world because they we have uh the uh coaching uh program so I love working with doctors on building that model of passive income integrating with their uh in office uh service so that way when we're sitting there like this when you're with your family you're making money and I love helping doctor do that because this morning I woke up I saw on my phone and my stripe account that I made money while I was sleeping not not I'm not woring Buffet where I have all these stocks or something but I made money because I have h a membership and I also have a store that uh Paton buys from so I'm I'm excited uh about you know um uh helping doctors and my yeah and working together with Mike on helping you all really hone down and what what is it that you need to do to attract your ideal customer that uh is ready uh to buy from you and as physician you are two3 two out of three there as an influencer and when you're an influencer and the more audience you have the more impact you have not only in money but the impact in changing people's lives I can't tell you and I right now have 65,000 uh subscribers on YouTube that's not a large audience but it but it's a very engaged audience and I can't tell you how many times I read comment and say thank you doctor I've never heard this before I I made the change and now I'm starting to see Improvement and I don't know who that person is that person we've had followers all the way from New Zealand and Nigeria and all over the world and I'm now impacting them because of the information that I'm teaching them online that they watch uh on social media and doctor if you're listening to this think about getting on YouTube YouTube is the perfect medium for us to be on to attract uh uh to be an influencer as well as attracting customers because YouTube is also owned by Google right Google is is um is the um the biggest search engine so if you produce your material in YouTube it can be searchable on Google if you write uh if you use the appropriate keyw but if you if you put your content out on Tik Tok or Instagram Facebook it's not searchable by uh uh Google so something to remember I have a video that I put out three years ago that is still uh getting views it's making me uh money uh on YouTube uh and I have a thousand videos now so it's like having a thousand products right now that's out there um on YouTube for uh people to consume yeah and uh let let's uh uh kind of wrap this up here I mean this has been amazing uh you guys I know you're gonna want to re rewatch it but the great thing is we're going to have an next week coming on talking about how to attract patients online uh so you won't want to miss it but before we end the call we talked about this challenge that we're having if you thought you've got you know a lot of great information just over the last you know half hour what if we give give you three days of this content ppra information talk about how to transform your practice we're calling it The Medical Practice profit Challenge and you do you want to do you want to talk about what this is just give them a little tease about this yes so it's a medical um Medical Practice profit challenges that's exactly what it is where we're going to do three days days where you're going to uh we're going to uh do a little uh Web Master class and then we're going to give you some homework and uh actionable homework that you can do that literally you can insert that into your practice and you're going to see a difference because we want to overd deliver to you so Mike and I are going to do one day uh three days of training the first day we'll we'll we we'll be talking about uh niching down and we'll give you actionable worksheet to do and the next day we'll talk about how to attract uh uh customer online and creating content we'll give you another worksheet to do and then the third day we'll talk about um how to create an offer and uh and how to create a a membership uh and then uh we'll we'll also uh let you know about our uh a coaching program that we're going to help you implement and uh insert this into your practice so that way you can start uh learn uh learning how to attract uh uh uh customers into patient online and create a a passive uh income because you know a medical practice like any business you're no different than a McDonald you're no different than uh than a Walmart because all businesses need three things leads or you know customers and our business need to have uh to char to charge right so you you you you need to know what your offer is and number three is to have the same customer come buy from you over and over again so for those three days we're going to focus on those three Lev of of business how to get new customer how to create an offer or service so good that they want to buy from you and and that you can charge more for and number three how to make that same customer buy more and more from you because if you have those three levers in your practice or your business uh you will never have to worry about uh burnt out or uh be going out of business but as at the medical practial you're so busy and your head you know looking down trying to chart trying to trying to build and deal with all the operational uh um headaches of the of the practice and that's where Mike has the the expertise on uh um um on a cash Bas practice and I have the expertise on uh on marketing and creating um um passive uh income uh stream so we that is our JM pack three-day challenge but every day you're going to get some actionable item to do and um a worksheet and uh that will uh occur on uh April 30th at 8:30 um Eastern Standard Time or 5:30 uh Pacific time uh and then the next day will be uh May 1st same time at 8:30 uh Eastern Standard Time and then on uh Thursday May 2nd uh as well and you get a chance to ask uh questions on uh the third day and U we may uh do some hot seat uh as well uh too so we want to make sure that we overd deliver for you and you get some actionable item uh from this and and no one no one will ever do this for you and I think this is the first what we're going to do uh it's a three-day challenge that uh for me uh and Mike and just be there you you never know you may listen to one thing that may move uh the the needle uh for your practice as well and you can ask us questions on uh the third day so we look forward to um having you there and you can go to uh practice profits wouldn't ask challenge.com to sign up oh all right guys uh this has been amazing and uh practice profits challenge.com as mentioned uh happening here at the uh end of April uh April 30th over the span of a three days training everything you wanted to get started uh in your practice in involving cash Based Services we're going to be covering it uh we'll also leave the link here in the show notes register I know we're going to be limiting it uh um and uh the amount of students we want to accomp we want to help as many as we can and I think you'll be pleasantly surprised uh uh about how affordable this uh this uh challenge is going to be so again practice profit challenge.com hope to see you there and this has been amazing uh but we're this is just the beginning of a series uh that we're doing here in the podcast we're going to be covering uh next week about attracting patients online using social media that's something an does tremendously well and thanks again for joining us thank you guys for listening to the program and as always whether you you're gonna have ups and downs in your business do something every do something every single day to keep you close to [Music]