These experienced surgeons share what they've learned over time.
By Alan N. Carlson, MD, Heidi Campbell, COT, Durham, N.C. and Eric D. Donnenfeld, MD, New York City
If you are considering the possibility of adding LASIK to your practice, remember one thing. Appearances can be deceiving. From the outside looking in, it may appear that it's easy to start offering this procedure and reaping the rewards. The truth is that it's actually a fairly challenging process. We would encourage anyone with an interest in refractive surgery to pursue LASIK. But we would also encourage you to enter the field with your eyes wide open. Here's a brief list of things we wish we had known prior to starting our LASIK practices. Hopefully these ideas will be useful to you as you build your LASIK practice, or decide whether to offer it at all.
1. Cost, not risk, is often the foremost issue on patients' minds. Surgeons often assume that the No. 1 concern of all patients is the procedure and its potential complications. In fact, many patients are more worried about how they will finance the cost. The take-home message is that to make your LASIK practice grow, you must communicate value and find ways to help the patient manage the cost.
Incidentally, some patients and even some physicians make the mistake of characterizing the benefits of LASIK as cosmetic. In other words, you can dispose of your glasses after having the procedure. None of us has ever had a patient express happiness about cosmesis after surgery. This may be because most patients do not consider glasses (if they wear them) unattractive. Rather, they find them inconvenient. Many patients are yearning for vision independent of their glasses for reasons of safety for themselves and their families ("What if there were a fire while we where sleeping?").
2. Very often, a surgeon's first complication does not happen during the first case, but rather after dozens of perfect cases. So if you've performed 50 beautiful cases, don't get too confident and think you are out of the woods.
3. Though flap complications do occur, they are usually not difficult to resolve. Neither of us has ever had to recut a flap for an enhancement. The more challenging problems often result from the laser ablation, particularly if decentration or surface irregularity is created. Fortunately, these are rare.
4. Complication prevention and management is critical to success. Remember that your worst case defines your ability, at least as far as public perception is concerned. We've seen several instances where a disastrous case derails a refractive surgery practice (one patient was a prominent hospital administrator). When you have a complication, stay very close to the patient, and treat him or her as wonderfully as possible. This person's perception and attitude is very likely a key to the future of your LASIK practice.
5. Understand that to make LASIK work, you will have to change your practice significantly. There's no way you can continue to practice and live as you are and "add in" a LASIK practice. You and your partners will have to think differently, act differently and change the way you lead your staff. Also expect that you will have to give something up, whether it's one day a week from your current patient schedule, or your Wednesday golf game.
6. You must have a passion for LASIK. There are some surgeons who just don't have a LASIK personality. You have to enjoy doing the procedure, and believe you are achieving something important for these patients. If you are simply doing it to compensate for managed care or declining Medicare reimbursements, you will fail.
7. Remember that the hardest thing is not performing your first 100 LASIK cases, it's finding your first 100 patients. You won't get any referrals from other doctors until you've performed at least 100 procedures. Consider patients now in your practice, relatives of patients in your practice, or some untapped patient group in your community (athletes, police officers and military personnel).
8. When it comes to building a LASIK practice, remember that your refractive surgery coordinator is more important than you are. LASIK surgeons are a dime a dozen these days. It's much harder to find a person who can make sure your practice truly meets patients' needs and builds patient loyalty. When selecting this staff person, don't compromise. You need a proven track record in dealing with people, great communication skills, tremendous attention to detail, and lots of energy.
9. Keep in mind that LASIK does not cure psychological or emotional problems. If your patients are unstable before surgery, they will be unstable after surgery. You and your staff must know how to sort through the candidates and screen out those who have the wrong makeup for refractive surgery. Remember, the stakes are high. Letting just one of these patients slip through the cracks can destroy a practice.
10. Be much more concerned about effectiveness rather than efficiency. Today's emphasis on efficient practice may be right for cataracts, but it's the wrong approach for LASIK. You and your staff must never rush, and never ever make the patient feel rushed.
11. Tell every patient that you perform LASIK. Tell patients who would never be candidates themselves, including cataract patients and patients with chronic or intractable eye disease. Every single patient you see can be a referral source, and may be your best referral source.
12. You must be comfortable with refractive surgery. Patients can sense your indecision or lack of confidence in the same way a shark can smell blood in the water. You have to feel totally comfortable with LASIK and truly believe in its value. If you are a candidate for LASIK, consider it for yourself. If you are not a candidate for LASIK, be sure to explain to patients that this is the only reason you haven't had it done.
13. Be confident, not arrogant. Patients really dislike arrogant surgeons, and they will not choose you for LASIK if they don't like you. On the other hand, if you are confident, you will instill confidence, and make patients feel good about their decision to choose you for LASIK.
14. Plan to spend time, not money. The key to LASIK is investing hundreds of hours in learning the procedure, in observing successful LASIK surgeons and their practices, and in carefully managing your own practice. You do not need to invest a great deal of money. Laser access is the most significant expense you'll have.
15. Focus on internal marketing, which really is just anticipating patients' questions and answering them honestly. You don't need gimmicks, and you don't need to bend your ethics. Among the things you do need are:
* A high-quality, personalized practice brochure that answers
patients' questions. We've found there are four things all patients
want to know: How safe is it, will it hurt, how well will I see
afterward, and how will they pay for it;
* A continuous loop video that plays in your reception area (take
the patient through the whole process, and show yourself performing
LASIK); and
* A professionally designed World Wide Web site.
Also consider:
* A "Wall of Honor" where you post photos of physicians
and local celebrities who have been your LASIK patients. With
the patient's permission, take a photo of yourself and the patient
right after surgery.
* A testimonial book that "lives" in your reception
area. Whenever a patient writes to thank you, place the card or
letter in the book. If a patient compliments you verbally, ask
him or her to write down the compliment for inclusion in the book.
16. Perform LASIK on your staff. There is no better proponent of LASIK than a staff member who's had it done. He or she will talk about it more effectively than almost anyone else can. This provides you with an on-the-spot reference: "Just ask Susie--we performed LASIK on her three months ago."
17. Offer patients total access to you. Give patients your e-mail address, beeper or home phone number, and urge them to call you with any problems or concerns. You'll find that very few do call you, and those will be reasonable calls (as long as you screened out all the unstable patients!). The others will simply feel thrilled that you care so much about them that you're willing to be disturbed at home.
18. Develop a scheduling strategy so that you do not mix LASIK patients in with a general ophthalmic population. It's also a good idea to schedule LASIK patients together so they can encourage one another. LASIK candidates can speak with post-op patients, who generally are thrilled. Your LASIK practice will appear to be busy, which is very comforting to patients. Be sure to schedule the chronic complainers (you mean you didn't screen them out?) separately from other LASIK patients.
19. Learn how to manage patient fear. Develop ways to talk about frightening topics that defuse fear and instill confidence. If the patient asks, "What is the worst thing that could happen to me?", you can answer, "You could get an infection and need a corneal transplant. But I've never had that happen in ___ cases."
20. Remember that happy patients do not build a practice. Patients
expect to be happy. The patients who build
your practice are the ecstatic ones-- the patients who rave about
how well they see, what a great doctor you
are, how nice everyone was to them. This is what you must strive
for in every patient encounter. That's
part of what makes building a LASIK practice different and somewhat
difficult to achieve. But anything worth having is worth working
hard for, and a successful LASIK practice is without question
worth having.
Dr. Carlson is the director of the Refractive Surgery Service at Duke University. Heidi Campbell is the refractive surgery coordinator at Duke. Dr. Donnenfeld is co-medical director for TLC The Laser Center in New York City.