Money mind-set and private practice.

Many clinicians I work with struggle with talking to patients about money, and this has a lot to do with mind-set. From time to time in the past, I’ve certainly struggled with this, and it’s a critical issue as it can be an inhibitor to practice growth.

What is it about earning money in a private practice that makes us feel uncomfortable?

Do you find it, well, a bit tricky, when having conversations with patients about their dosh and your treatment?
Let’s unpack this a bit. I find there are several familiar trends that underpin this.

 Private practice Ninja helper  The first issue is our mind-set.

I’m willing to bet, that one of the original reasons you went into your profession, was a desire to help people. Sometimes earning money from treating patients who are in need can seem discordant with the altruistic act of ‘helping’. It doesn’t matter whether you are an Endocrinologist or a Physio or an Osteopath – I bet you’ve experienced this a least once, or maybe a family member has ‘expressed an opinion’ or tried to guilt trip you about working in private practice.

The NHS doesn’t prepare us well for monetary chats. Unless we were very high up in a management role, it’s unlikely we were expected to be responsible for a budget. In other words, we were conveniently shielded from having financial conversations with patients.

Even if a patient wanted something from the NHS service that we couldn’t give them, we could hide subconsciously behind the idea that the Government, NICE, or a nasty out-of-touch-suit just wouldn’t allow it. Maybe you have even said to a patient “I really want to be able to give you this treatment, but the NHS just can’t afford it.”

Because it’s human to want to feel helpful, we often have an internal desire to help everybody in need who reaches out to us. The fact is, in both the NHS and in private practice, that’s just not possible. Whilst finance can be a barrier for patients, it’s definitely not the most important barrier and yet frequently our mind-set that tells us that it is

Here’s the truth you have to get comfortable with..

You are not going to be able to help everyone.

It’s ok to make a good living doing something you love doing and doing it very well.

Private practice Ninja helper  Remember the plus sides to treating patients privately.

Firstly, patients get to choose whom they come to see. Even in the NHS, you might be able to select your surgeon, but the chances are, you won’t see them often for a post-op follow up; you’ll be seen by the SHO, the SpR or the third year med student.

Patients also get the choice of timing. This could be hugely important if they don’t want to take time out of the office or spent money on child care costs. Private practice care can be a godsend if sciatica prevents you working as a self-employed plumber.

Even from a medical point of view, think of the number of patients who could be rescued from a protracted recovery, chronic pain, or even secondary complications as a result of not having their diabetes fully or promptly treated.

Private practice Ninja helper  Remember this is the opportunity for you to give your patients fantastic quality care – your way.

Patients get all your attention, they get your unrushed clinic time, your expertise and you may be able to give them things that the NHS can’t. In return, they will take delight in telling you that you’ve restored something which is priceless to them – returning to running, sitting comfortably at their desk or playing with their children.

We have to get used to mapping out recovery pathways with our patients.

So many people get this wrong. Don’t be one of them.

At the next initial consultation you have with a patient, I challenge you to map out how things should progress as they come to see you.

Picture the scene:

A patient ships up with an ankle inversion injury. You give them a thorough assessment, put your magic hands on them, prescribe some rehab and the conversation ends with:

“we’ll see how things are going when I next see you”.

Instead, I’d like to challenge you to talk about how things are going to progress over the first three appointments.

You might say to them:

“Here’s what we’re going to work on during the next two sessions – I’d like to see your pain reducing and ankle range of movement improving during that time.

At session number three we’ll re-assess, and you and I are going to make a decision about how we go forwards. We are going to decide whether or not you’re on track and if we can progress you with plyometric activity and return to sport drills.

If your recovery is stalling, we may decide to send you for an MRI and possibly an injection.

We may need to decide upon calling in an orthopaedic surgeon’s opinion. I would anticipate that if things are going well, then after six or seven sessions we will be getting you back to your beloved football.”

This is good clinical care. Full Stop.

If you don’t have this conversation you are denying the patient the ability to make the decision about whether they want to fully embark on their recovery with you – and their time and money with your care.

It also shows the patient that you know your stuff and that you aren’t just ‘winging’ it. Chances are, this kind of conversation makes them realise that you’ve probably treated somebody like them before, and are trustworthy.

It’s our duty as clinicians to help patients to get better.

If you’re an ethical practitioner, (and I know you are), then this is a process that sits very well with private practice. After all, you are helping patients get to a destination that they want to get to and achieve the results that they want to achieve.

They come to you in need, they want to invest, and you can give them the opportunity.

Sometimes, we all need a little extra help in building our practices – from a business perspective, as well as a clinical one.

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