The Value Of Cross-Semination

This is a great place for me, since I've been Freelance for 40 years. and can speak to its freedoms, but also its foibles.

While it's fresh -- so fresh it's only been over for an hour -- I'd like to write about the value of cross-semination & fertilization of medical (and other) creative and productive minds, all with goal-directed drive and enthusiasm both to further their own interests and to make the world a better place.

I'm talking about the excellent Harvard Writers course put on by Julie Silver and her team in Boston. 3 days of intense learning, exchanging, and re-invigorating.

I have just finished responding to today's front-page article in the New York Times with a letter I hope they'll print, that is on the very subject for which I enrolled in the excellent conference from which I have just emerged, my head spinning with ideas. I was looking for an agent or publisher for my book which is about the life of a generalist and deals with the coming extinction of the true generalist physician.

The article in the NYT was about a daughter with a new family negating her father and grandfather's generalist career, which for them was all-consuming, and opting for ER medicine which she believed was "more challenging" but shorter hours.  I wonder how many read that article in the NYT and what their "take" on it was. This was mine:

"As a female Family Physician,with 3 children and 7 grandchildren, practicing solo for 40 years I must congratulate Gardiner Harris but also respond to "More doctors reject long hours.”

One can pace oneself for family, limit one's hours with creative arrangements and still render quality generalist care to one’s own patients over years. That includes caring for them when they are sickest in hospital, where there is no real proof that hospitalists deliver "more proficient" care than one’s own generalist. The management of ongoing and acute problems daily are just as creative and challenging, if not more so, than emergency work.

With true generalists extinct, we are all at peril. Everyone needs a physician, broadly trained, who knows and cares about the patient as an individual. Patients know that doctors are far from interchangeable. Hospitals and insurance companies wish they were, to facilitate what is becoming the "widgetization" of Medicine."

I am also very interested in other physicians', (generalist or specialist or superspecialist) opinions on what I call the coming extinction of the true generalist (not the recreated triage officer/midlevel "primary care"persons that are being equated w/ a serious, broadly-trained generalist physician, whether in Family Medicine, Internal Medicine or Pediatrics.).

About: Pepi Granat, MD is a Family Physician, Board Certified in practice in South Miami, Florida, and Clinical Professor of Family Medicine at the University of Miami.

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Nonclinical Careers: Owning Your Own Niche

"If you can, be first. If you can't be first, create a new category in which you can be first."  - Al Ries & Jack Trout, The 22 Immutable Laws of Marketing

There's something innately attractive about uniqueness.

To be unique you need to dominate a niche. I don't care what niche it is, but you need to dominate it.  If you can't dominate the niche where you are, you need to create a new one.

How can you tell if you're considered to be unique? Pretty simply. There's a single two word phrase that people use to describe someone who's dominating a niche. You'll hear it used all of the time as a recommendation: "The best".

It doesn't matter what you're the best at, only that you're the best at it.

Now all uniqueness is not created equal. If you're 'the best orthopedic surgeon in the country', you're going to be sitting pretty. If you're 'the best orthopedic surgeon in Evanston, Wyoming', it's less of a talking point.

Perhaps you're in cosmetic medicine like a lot of the docs that I know. It's probable that there are  dozens of plastic surgeons, dermatologists, and medical spas that are in your target area and trying to get to your target clients.  How are you going to set yourself above the noise as the single choice? How are you going to get those patient referrals?

How are you going to position yourself as 'unique' in order to compete?

You're going to find something that you can be the best at.

You may be in family practice or internal medicine. Fine. You're clinical practice is general in nature, but that doesn't mean that there's no uniqueness to be had. You always start where you are.

Sure you have patients that already love you. So what. So does everyone else.

Like everyone in cosmetic medicine, already know that you’re ‘target’ is generally going to be women. You’re right of course, more than 95% of your clients will be female, but what else do you KNOW about the women that want YOU to be their cosmetic medical provider. If you’re like the average medspa, even those that have been doing this for years, not that much. You’ll also be able to deduce pretty easily that women looking for Botox. or fillers, or cosmetic surgery are generally over 30 and less than 55 or so. Right again. That’s a ‘second qualifier’. In fact, those two items put you on par with 99% of what cosmetic clinics know about their Botox and filler patients… but that’s not the end.

If this sounds like you, then you’ve joined the 99% of other providers who think they should target EVERYONE instead of a small, focused niche. In the best case, these clinics limit their success, in the worst, they set themselves up to fail miserably.

You need to learn how to target your perfect client with laser-like focus. With the right niche targeting, you’ll be able to tailor and optimize not only your services, but also your medspas pricing. And when you learn to target your services SPECIFICALLY to this person – making it truly personalized – they will pay virtually anything, and they’ll thank you for it.

Of course targeting this way isn’t easy. It takes a little work so it’s generally ignored by the lazy.

Let’s go through a quick example to set the stage. Imagine that you’re hired by a medical spa or laser clinic and you’re told, “Help us get more patients.”

The first question you ask should probably be, “Who are you trying to reach?”

If the response is, “Well, everybody. We just want a lot of them.” Turn in your notice. You’re doomed.

What’s wrong with this approach?

Think about it this; when was the last time you went out of your way to purchase a product that was just right for you, but it was also “just right” for your retired father and your 18-year-old neighbors kid? If you found such a product would you buy it? Would you pay a premium price for it? Of course not.

You’re looking for something that speaks directly to you. That serves YOUR needs – not your needs and everyone else. That’s why a woman will spend $600 on a Kate Spade handbag instead of the Target knock-off, men buy ‘men’s razors’ when cheaper women’s razors work just fine, and why your perfect target patient will pay you a premium and beg you to treat them.

Take note of this point because it’s important: If you’re targeting to EVERYBODY then you’re selling to NOBODY.

It may sound counter-intuitive but it’s true: The more you niche yourself, the more money you can make.

An excellent example of this is Johnson & Johnson Baby Shampoo. It’s been around forever and you probably already know the ‘No more tears’ slogan. Know who their market is? It’s not babies. Babies don’t by shampoo. In fact, it’s used by adults far more than it’s use on babies. Why, because it’s ‘niched’. It says right on the label who it’s for… even though they know that more adults use it.

You’re not offering exercise videos… you’re P90x who’s blowing the doors of of sales by targeting the hardest workout for the hardest bodies.

You’re not selling cooking lessons…  you’re selling cooking lessons for new brides.

As a generalist, you have to make sure that you are one of the best in the industry, have unique service offerings, and you are considered accomplished in a few other fields. 

If you do it persistently enough, you will OWN that niche. People will not be able to imagine that niche without you.

The secret to commanding premium rates is in identifying a very specific niche that buyers demand, and focusing on that niche while excluding everything else.

There's no really good short cut around this. If you don't already have any unique skill set, you're going to have to develop one. You can't hoodwink everyone into buyers by just saying that you're better. Decide on a single special attribute or 'specialty' and make it your own. Actually BE better at it in some way.

Oh, by the way, you can only pick one niche.

Have the confidence to find your niche, define who you are, then declare it again and again and again and again.  If you target your martket smartly, over time you will own that niche.

Your Book & Its Niche

By Julia Schlam Edelman MD, FACOG, NCMP

Ten years ago, I set out to write a book for women 35 and over, with a focus on menopausal issues.

Not long ago, open discussion of menopause was taboo. Much has changed in the modern information era, and today women are inundated with facts and recommendations. All too often, the recommendations are contradictory. Women who try to keep up with the latest medical developments may become overwhelmed, frustrated, or even fearful.

My goal was to help women be informed and reassured, while enhancing their ability to manage their health. Based on my experience with patients, I expected that women who learned how their bodies change during midlife and beyond, would be positioned to make healthier choices.

Publishers did not find this compelling. They said I needed to have a stronger “platform.” This, I learned, is code for: “You are not a household name.” “You are not a famous actress whose cover photo will prompt women to follow your advice.” “You have not discovered a new cure for hot flashes, low sex drive, or aging.” Finally, “you have not been on Oprah.” As a board certified gynecologist and certified menopause practitioner with more than 25 years of experience caring for women, I watched with dismay as a dozen rejection letters from top publishers rolled in.

The breakthrough came when my literary agent suggested submitting the book proposal to Johns Hopkins University Press (JHUP). While I had heard the JHUP Executive Editor of Consumer Health speak at the Harvard CME Publishing Course for physicians, I had crossed JHUP off my list. After all, they had recently published “The Only Menopause Book You Will Ever Need.” Despite this, the JHUP editor and its physician board accepted the proposal and published Menopause Matters: Your Guide to a Long and Healthy Life in January, 2010.

Here are two examples of features that distinguish Menopause Matters from its competition. Perhaps they will help catalyze your thinking about positioning your book:

Discussing the rationale behind the medical recommendations

When discussing evidence regarding the use of natural and alternative remedies, prescription medications, and lifestyle changes, I provide a broad range of options. For example, readers are exposed to the risks and benefits of taking prescription hormones compared to taking bioidentical hormones, as well as discussing the implications of their lifestyle choices. There is no “one size fits all approach.” As readers, and their medical providers, are aware, “one size fits all” does not work when shopping for shoes, clothes, or medical advice.

Case Studies

Menopause Matters contains more than 50 short stories or “cases” that depict women with hot flashes, heart disease, breast lumps, thin bones, poor sleep, worse moods or low sex drive, and shows how these women make decisions with their physicians. This demonstrates how doctors and patients can work effectively together, and makes MM livelier and easier to read.

I hope that these examples help you with your book. If you would like to read a chapter of Menopause Matters: Your Guide to a Long and Healthy Life to see for yourself if I met my goals, please go to www.JuliaEdelmanMD.com, where the first chapter is posted, as well as the table of contents and four professional reviews.

About: Julia Schlam Edelman MD, FACOG, NCMP is a board certified gynecologist and certified menopause clinician with a private practice in Massachusetts. The North American Menopause Society selected her as their "2010 Menopause Practitioner of the Year".

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Dermatologist Stories From India

By Rajan T.D. MD

"Dermatologists make rash judgements" say our colleagues in a lighter vein, even though they are the ones who scribble notes to refer cases for our opinion. When the dermatologist opines that it is a case of, say, Haemorrhagic Chicken Pox, they exclaim, "I, too, thought so but wasn’t sure!" So, here we are - we have discovered our raison d’etre! Our job, it seems, is to help physicians, surgeons, paediatricians, gynaecologists be sure of their diagnosis!

The early days as a Dermatology resident is quite unnerving having to confront criticism from other branches of Medicine about the inability to offer a cure for many dermatoses or provide answers particularly to baffling questions from patients about the prognosis of Pemphigus, relapses in Psoriasis or the recurrences of Urticaria. It takes him or her quite a while to argue that neither do others have answers for Rheumatoid arthritis, Ischaemic Heart disease or Diabetes. One of our senior teachers once aptly put it, "The whole world needs Dermatologists, even if it is just to say that this is a case of Lichen planus and there is no definitive treatment for it." This statement attempts to clear the confusion of many young, confused, resident doctors in Dermatology departments everywhere about their perceived role in healthcare.

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Napping For Performance

What's the perfect lenght for a nap that boots performance?

Napping is an art that some physicians have elevated to a science, and there's plenty of evidence to show that it's a proformance booster, but for how long? Nap too long and you'll suffer from sleep inertia: the feeling of being drowsy for an extended period. Nap too little and there's no point. Where's the napping sweet spot?

Brooks & Lack (2005) compared 5, 10, 20 and 30 minute naps to find the best length. For increased cognitive performance, vigour and wakefulness, the best naps were 10 minutes long. Benefits were seen immediately after 10 minute naps but after longer naps it took longer to wake up. Five minute naps only provided half the benefit, but were better than nothing.

File this under 'good to know'.

Ignore Everybody & Nonclincial Jobs

By Mehul Sheth DO

A great book that I found to be a must read for anyone looking to expand their career opportunities is Ignore Everybody: and 39 Other Keys to Creativity.

Amazon link here

A short book that took me the better part of an hour lunch at Chipotle, it nonetheless has some powerful things to say for physicians. This book is not geared towards clinicians, but rather artists who are looking to fulfill their creative urges. In some sense, that was a great parallel for me when I was evaluating non-clinical careers. Although I had a great job, it wasn’t satisfying. I was frustrated with the idea that my entire CV was composed of clinical positions and didn’t really describe me as a total person. As I contemplated the transition from clinical practice to non-clinical I realized that without the ability to demonstrate translatable experience I was looking at the possibility of quitting medicine and either entering a full time degree program or taking an internship or other low paying job to gain practical experience.

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Falling In Love With Patients

By Pamela Wible MD

As Jill leaves, she always says, “I love you!”

Sometimes I whisper. Other times I scream down the hall: “I love you too!”

I think it’s illegal. Or risky. I’m supposed to contain my love, to practice professional distance. But why dissociate from myself or from those I care for? Why pretend to be reserved, restrained, aloof when I’m naturally warm, affectionate, friendly?

One day during med school I decided to break the rules, to celebrate my life without shame. And on that day I fell in love with myself and I gave myself permission to fall in love with my patients, to hug and kiss them, to sing and laugh with them, to look deep into their eyes, cry, and allow our tears to flow together.

On Valentine’s Day at my first job, I admitted an elderly man dying of heart disease. His wife–unable to bear the pain of watching him die–left his side. I could have left too, but it didn’t seem right to let this guy die alone on this romantic day so I sat with him, held his hand, and cried. A cardiologist, startled by my emotion, exclaimed, “You must be a new doctor,” then disappeared down the hall. Maybe old doctors don’t cry, but I don’t want to close my heart to the world.

Why is it unprofessional to love patients? Maybe love isn’t valued in a male-dominated profession. After all, love is not easily measured or reimbursed. Love is hard to control.

About: Pamela L. Wible, MD is a pioneer of community-designed medical practices who blogs at http://www.idealmedicalcare.org/blog/

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