Future-Proofing Your Practice Against AI
Welcome back to the cash practice solution podcast. In today’s episode, we’ll discuss one sure way to future proof your practice against the impact of artificial intelligence. Granted AI will reduce the need for some basic cognitive processes, but it’s unlikely it’s going to replace physician judgment altogether.
I mean, I would say it’s impossible. But, AI can’t replicate the personal connection between the doctor and the patient. The doctor patient relationship is the key to everything. Regarding the low level stuff, things that people Google now and have other methods to research, certainly AI will replace some of that research.
But AI can’t do one of the most important things that there is for a doctor, and that is to actually physically touch a patient. Make them feel like they’re connected to the world around them, make them feel cared for. And AI definitely can’t perform complex procedures.
The Role of Hands-On Procedures in a Sustainable Practice
Something that I’ve been doing my whole career and I find immensely gratifying is procedural medicine. I’m an osteopath, so I do some manipulative medicine, but because not everybody has that skill or training, that’s not a procedure I will focus on. What I will talk about is technology and how that is going to impact everything, in some ways, in a good way, and in some ways it’ll be somewhat negative.
There’s only so much use for technology that doesn’t create distance between the doctor and the patient. But, hands-on procedures offer something that AI can never do. It’s that personal touch that technology will never replicate. Not only that, in my practice, patients really appreciate the convenience of being able to receive everything that they need at our office.
In the same context as their office visit, doing their blood pressure medicine, or dealing with a skin problem or, they have pain or there’s something else that they want to get handled. They don’t want to come back again and again, and especially they don’t want to see somebody they don’t know, or have to make an appointment with someone else and wait who knows how long to be seen.
They want somebody they trust and especially if they can do it in one visit. And here’s the thing with a cash practice, you’re not limited by the insurance company as to how many procedures you can do or, how often you can do them, or when you can do them, or whether or not you can do them at all. You are able to practice the best medicine that will yield the best result for your patient that they can choose.
We remember that outcome = income from episode 11? Listen here. If it improves the patient’s outcome, and it’s neutral or improves your income, well, that’s probably a pretty good choice. And almost all the patients that I work with far prefer to have one visit and receive all the necessary services in that visit than making multiple trips.
In fact, in a Medicare setting, the procedure cryosurgery, which is getting a gun, which has a little liquid nitrogen in it and freezing off a very mild actinic keratosis or an early, real benign slow growing cancer. You can do one per visit and that’s it. And then the patient has to come back for another visit the next day or the following week or but they have to come back for a different treatment each time in order for it to be covered by Medicare. You’ve probably seen this in some patients. They’re covered with all sorts of questionable skin lesions. You want to take care of them and you want to take care of them early. Some people have as many as 30 or 50. So can you imagine making a patient come back 30 times, under the control of insurance. Or you can take care of it all in one visit, saving the patient time and money. We don’t charge a lot of money to do it, but we sure can help them out and keep them from having to spend the rest of the next month running back and forth to the doctor’s office so they can have one little spot treated with cryo.
Essential Procedures Every Physician Should Offer
It doesn’t make any sense, by integrating procedures into every practice, they don’t have to be expensive, or cost a lot of money and they can provide huge value. Let’s talk about some procedures that are easy to incorporate into your practice. One of the ones that’s the easiest, it costs about a buck, for the lidocaine and the syringe and the needle, are trigger point injections.
Arguably, pain is the number one reason that people come to doctors for care and trigger point injections are one of the easiest things in the world to do, that provide an amazing benefit to the patient. For this procedure, I usually use a 3cc needle, a little lidocaine with some bicarb, draw that solution out with maybe a 20 or 21cc, or a gauge needle find the affected muscle, and then, shoot it with a 27 gauge needle, maybe an inch, inch and a half or an inch and a quarter. You’ll see a little twitch response when you’re at the exact point. There’s extensive literature about this procedure, Janet Travell a pioneer in the field. If you’re interested in learning more, there’s a body map of exactly where they are. It takes a little tiny bit of time to learn and certainly in my case as an osteopath, I have a pretty good feel for tissue. I can find a trigger point and inject it in about a minute. Depending on how you choose to charge for it, that one dollar cost to you can be fifty or a hundred dollars or whatever you think is reasonable and the patient agrees upon. That’s so easy and so helpful. Trigger points can keep people in pain for years. Sometimes a single injection is enough to resolve the pain permanently. That’s a pretty good deal for everyone. Trigger point injection classes like Janet Trevelle’s are easy to find to get trained in. It takes a day, tops. Joint and tendon injections are a little bit more involved, orthopedic specialists do it of course, sports medicine guys, family docs, the whole spectrum of primary care docs should be able to learn and do them pretty easily.
Injections can be done with ultrasound, which is my preferred way. I used to do them as a young doc without ultrasound, I didn’t have access to it, but joint and tendon injections are super easy.
A little bit of dexmethasone and some lidocaine with bicarb, same setup, a little 3cc syringe, learn the anatomy and how to give an injection and give some tremendous relief to people. This procedure might be a $10 cost to you in terms of materials and can result in a $150 – $200 procedure. The patient gets what they need all in one place, all at one time and for a less price. It’s a win for everyone.
They can come to you for their medication refill and then mention, “I got this bad knee doc, what could you do for me?” You can respond with, “Well, sorry, I can’t help you out.” Or you can help them out. Are there other things you can inject? Certainly PRP, stem cell, all those things. Much more training required, but, and there’s a little bit more cost involved, but of course you can charge more.
Another procedure that helps the patient and your bottom line are skin biopsies. Super simple, every doctor who’s trained in primary care should be able to do them. A little bit of lido with epi, a little bicarb, you can use a punch, you can use a shave, or you can do a sharp excision, however you want to do it. There is a shortage of dermatologists, massive shortage, huge waiting lines.
Most skin lesions are not urgent. Melanoma, unless you’re super well trained, you should probably refer, but all those intermediate lesions, you should be able to handle them. You should be able to make a little biopsy, send it off to the lab for a hundred bucks, and then be able to give that patient great guidance. Either they don’t need anything further, you’ve completely excised it, or they need further treatment.
And one of my favorite procedures is hormone implants. I love doing testosterone and testosterone estradiol implants. I’ve been doing it for 20 years. If you want to get a high level of patient satisfaction for treatment in a procedure that’s easy to do, you’ve got to learn how to do hormone implants. It’s very, very simple. There’s lots of good training programs available and you should avail yourself of it because patients need that kind of treatment. They appreciate that kind of treatment and they will come back. We’re going to talk about this in the next episode about recurring treatment and how that is the key to financial stability.
If you’re super interested and you want to contact us at CashPracticeSolution.com, we could possibly get you a training program that I’ve put together. It’s a whole day training program and maybe we can get you a copy of that. Subscribe and we’ll see. Next year we’re definitely going to be talking about it in further depth.
And then of course there is the cosmetic world, aesthetic procedures like Botox and fillers. There’s a lot of people who are not really highly trained or I wouldn’t even say highly qualified, who are injectors. Compared to you as a provider. Boy, you should really be taking advantage of the opportunity to do simple things like Botox. Botox especially, it’s super simple. I mean, if you know facial anatomy and the muscles, it’s a simple procedure. Fillers are a little bit more demanding. I like to be super conservative. I’ll treat a patient very conservatively and then I’ll have them come back for another visit and and build on that filler. I don’t want to turn somebody into someone that they’re afraid to look at in the mirror. That’s not good. But all these things are fairly easy. They’re easy to do and they’re so appreciated. Patients really, really appreciate it because you physically have to be involved. In these procedures, they tend to be pretty high profit margin.
In other words, you put in your effort, and because your time is worth a lot of money, you tend to make really good money. I think most importantly, back to the outcome income model, patients really appreciate it. I’ve been told this by patients relatively frequently. Thanks for not taking insurance so you can actually take care of me and do the work.
Taking Action: Start Small, Think Big
Once you start getting good at it, and procedures start to become a normal part of your day. You can either have the procedure materials in the room or have a little caddy bring them with you to the room or have your staff bring them. I recommend starting with really low cost procedures. If you’re not doing a bunch of procedures now, start with low cost stuff, some trigger point injections, some joint injections, a cryo unit for the Brimill gun and a Dewar, it’s a thousand bucks, maybe $1500 bucks. And you can make that back in a week. So that’s a really good thing to consider. A little more expensive stuff, which I think is also so super helpful. On the low end, there’s EKGs and pulmonary testing, those kinds of things. On the higher end, ultrasound imaging, but it’s coming down in price all the time. You can get a really, really good unit for about $20,000. And with two probes you have comprehensive imaging capability.
So you should think about that. I’m building a procedural practice. It’s about more than just adding a service. It’s about creating the environment where patients feel like, man, I get everything I need here in this place. At some point you’re going to get really good at integrating extra procedures into the day in terms of your scheduling.
Training your staff is really important. You’ve got to have the right equipment. You’ve got to plan on training. There’s a lot of ways to do that. You can learn the basics and kind of get familiar with the idea on YouTube and then have someone actually directly guide you through it. You know, see one, do one, teach one, that kind of thing.
Most people who do procedures, really have a great willingness to help. What you really want to do is find the procedures that your patients need and that enhance their experience of your practice where they walk away from your practice saying, I really, really appreciate being able to see Dr. J, because that’s the ultimate practice building tool, that’s where referrals come from. People appreciate your care for them and they tell everybody it doesn’t take long for people in the fast paced world of insurance based medicine for people to really have an incredible experience of your practice.
That’s it for today’s discussion on the importance of procedures, getting in there, touching patients, letting them know that you care, and it is the future of a sustainable medical practice. AI is going to have an impact. And less and less of your cognitive skill will be required. You’re still going to need it, you can do straight cognitive medicine and still be helpful. But next time we’re going to explore some really great ideas on how to generate recurring revenue in your practice. That’s one of the other keys to building a 2 million practice. Thanks for joining us.
Thanks for tuning into the cash practice solution podcast. I’m Dr. Jay, and I’m here to remind you that a fulfilling cash practice is within your reach. And we can help you get there. If you wanna optimize your current cash practice, or start a new cash practice on the right foot, check out all of our resources at the cash practice solution.com.
So until next time, listen to your patients, learn their stories, and love them with all of your heart. You will be unstoppable.
