Marketing a phlebology practice is necessary to assure maximum and continuous success. There are two primary reasons to market. One is to educate both physicians and the public about phlebology in general and about the modern advances in diagnosis and treatment for this remarkable new specialty. The other is to assure a competitive advantage in a new and growing medical arena where seemingly everyone wishes to become a vein doctor.
Marketing can be in the form of expensive television, radio, newspaper and magazine ads, and can also be in the form of lesser expensive internal practice methods. “Word of Mouth” referrals are the least expensive and perhaps the most powerful of all methods. This report is our experience with a successful phlebology practice built primarily on word of mouth referrals.

The Alabama Vascular & Vein Center began as a one-doctor and one-nurse back office with two supporting front office employees. We transitioned from a comprehensive vascular surgical practice to a full-time phlebology practice over a three-year interval. Initially we used one 30-second television commercial that ran infrequently for one month. We also developed a 30-minute infomercial for inexpensive cable television, which ran for one month sometime in the middle of the night, never seen by the author. We then concentrated on what patients considered important in terms of accepting this new specialty.

Initially we were concerned when the practice income plummeted during the early stages of transition. We were pleasantly surprised when the business seemed to grow quickly without additional external marketing. We were almost shocked when the volume of requested consultations outpaced our ability to keep up with the demand.

The Alabama Vascular & Vein Center expanded to now include three physicians with others being recruited. Our facility in Birmingham, Ala., located in a pleasant mall, consists of 7,000 square feet and four operating rooms.

Our wait list for surgery and sclerotherapy remains nearly six months, even though we keep adding physicians and physician assistants. By request of physician colleagues and patients, we are adding major clinics in Atlanta and on the Alabama Gulf Coast. In 2007, the physicians of our practice performed more than 1,500 endovenous ablation operations while the author also traveled to Japan and Australia to participate in outstanding scientific symposia.
In brief, this has been an exciting and wonderful professional ride. Our marketing budget is only 2 percent of our annual income. Our success is “word of mouth” referrals based upon the following internal practice methods.

We consider four criteria the essence of patient acceptance and the reasons for our internal marketing success:  
1. The initial patient exposure and consultation must be very good, imparting knowledge and creating patient confidence in our ability to deliver what they are seeking.
2. The experience must not be painful if we are providing the service outside of the hospital with less than general anesthesia.
3. The outcomes must be very good and should meet and exceed patient expectations as much as is professionally possible.
4. The post-operative care beginning with discharge from the Vein Center should be a memorable experience.

Most phlebology specialists follow these principles. We have perhaps emphasized these criteria more than many competitive physicians as we have devoted our efforts solely to phlebology. This alone provides some advantage, as many of our competitors tend to practice phlebology as a sideline of their primary specialty. A summary of our “word of mouth” marketing criteria is as follows.

‘Word of Mouth’ Marketing
The initial consultation should be impressive because patients seeking treatment for vein problems understand very little about the specialty. In addition, their own doctor often has little knowledge of the modern methods available. Most patients and referring doctors consider vein problems relatively minor in the grand scheme of medicine.

 However, a large number of patients are seeking an improvement in the quality of their life: a means to be free from leg pain, leg swelling, and unsightly varicosities.

Our initial consultation includes:
1. Two weeks prior to the consultation day, patients receive via mail a packet of information including an informative professionally produced DVD. A vein questionnaire is included as well as the standard medical history form. A description of the consultation day appointment prepares patients for the events.
2. On the consultation day, patients undergo a diagnostic duplex venous ultrasound, are entertained by a 30- to 45-minute group lecture describing vein problems, including cause and treatment, and receive a private examination and consultation with a physician.3. At the conclusion, the patient is scheduled for treatment, whether adequate compression therapy or endovenous ablation or simple sclerotherapy.
The consultation often requires two to three hours of our patients’ time, and they are advised so in the initial mailing. Surprisingly, almost all of our patients consider this visit one of the best consultations they have ever encountered in a physician’s office: They are fully informed, understand the information clearly and appreciate the efforts and time devoted to them by the professional staff.

No Pain, Our Gain
During the course of the patient group lecture, the doctors describe endovenous ablation and sclerotherapy procedures. Inevitably, our patients become uncomfortable as their eyes widen and look down, and with body posture and shifting changes while they envision the procedure. When the doctors indicate that a comforting “mickey” sedative will be provided during the ablation procedure, smiles light up the room. Many patients openly say that they wish to be “knocked out.” In our practice experience of more than 5,000 endovenous ablation operations, only one patient requested no sedation. Our observations and practice experience therefore are the following.

1. Patients do not wish to have any procedure that requires them to endure pain not any place nor any time.

2. Patients frequently are referred to our practice by other patients because an ablation on one leg was performed elsewhere without sedation or with “talkesthesia,” and the experience was very unpleasant. Patients come to our practice every week from all over the Southeast for this very reason.
3. Although IV conscious sedation cannot be offered to patients in the office setting in some states, there is always a means to provide comfort to patients in the form of medical pharmacy – that really is the essence of modern medicine.

We believe that modern phlebology can be offered to our patients with minimal associated discomfort. IV conscious sedation with proper monitoring and standard safeguards during endovenous ablation allows a virtually painless procedure.

 Sclerotherapy alone is not very painful, and most of our patients do not seek sedation for these treatments. However, if they wish a glass of wine, or bottle of beer or a valium pill pre-treatment, we are more than happy to accommodate their desire.

Exceeding Expectation
As with any operation, the outcomes of treatment must meet standards of care with minimal complications. In a successful phlebology practice, the outcomes must meet and frequently exceed our patient expectations. Our opinion and success has been to offer treatment that provides the very best results in the least amount of time. To accomplish this goal, our program includes the following.

1. We are very careful to assist our patients with the time frame of expected results, telling most patients that vein treatments often require up to one year or longer to achieve the best cosmetic outcomes.

2. We give hope and encouragement to our CEAP Class 6 patients with venous stasis ulcers, for most have been treated for an extended interval and have endured substantial pain. We have been able to achieve 93 percent complete ulcer healing without reoccurrence after the initial ablation procedure, and these are some of our most grateful patients who market our practice frequently.

3. All abnormal vein problems are treated during the initial procedure, as we simultaneously perform endovenous ablation with the adjuvant micro-phlebectomy and sclerotherapy procedures.  We also perform cosmetic sclerotherapy during the same setting, for patients appreciate the initial treatment while sedated. Our experience has been that most ropy varicosities do not disappear after the ablation, in contrast to two somewhat weak reports. Our practice is frequently referred patients because of this approach.  

4. The above method provides the best outcomes in the least time, for repeated uncomfortable procedures are not necessary. This is the best for our patients, and they clearly understand this to be the case. They also tell family and friends.

Memorable Post-op Care
Finally, the post-operative care must be memorable and completely comfortable for our patients, for these procedures are performed in our Vein Center outside of the hospital. Patients appreciate personal service from their doctor, and they want to have easy access to the doctor and his staff should they have any concerns.

 
“Blood clots” are a red flag to all patients, fearing for their life based upon numerous tragic stories. They are aware that blood clots will form, and there is some risk for migration of the clot into the deep vein system. Consequently, these patient wish and deserve virtually instant access to their doctor should they have any concern about their recovery.  Our efforts to assure their comfort are these.

1. After each endovenous ablation operation, our physicians including the author, personally transport the patients by wheelchair to their waiting automobile. This personal attention is appreciated and commented upon far more than the treatment. Family members meet the doctor and ask questions during the brief trip. The doctor is assured by his observation that the patient is well and safe for travel home.

2. Each patient is given the doctor’s mobile telephone number, with advice to call if there are any questions or concerns. This avoids an hour or more of delays and effort going through answering services and assures the patient that access to the doctor is easy and instant.

3. If a patient wishes to be examined for reassurance at any time post-operatively, he or she is encouraged to return to the office on the day of the request. Usually a brief doctor visit, sometimes a brief ultrasound examination, gives the patient reassurance that there are no harmful blood clots.
4. Follow-up ultrasound and physician examinations are performed at two weeks, six months and one-year to assure our patients the best results long term. More than 1,000 of our patients have been followed for one year, with 99 percent successful ablation and greater than expected clinical outcomes in many cases. These patients are extremely grateful and frequently indicate so with words or gifts.

The methods described have proven successful for our practice. We continue to see at least 50 new vein patients every week, and our referral volume does not reduce in spite of our lack of external marketing. In addition, although more doctors in our market area have developed vein programs and are performing ablation procedures, our referral volume remains steady.

Competitor physicians currently market with glamour billboards and television ads, and I am sure they are capturing patients as a consequence. Yet still to my surprise, our referral volume remains strong and unchanged, and our procedure schedules remain booked six months in advance. I am told daily by patients that they have referred several family and friends. “Word of mouth” marketing remains the very best and least expensive and easiest to accomplish.

Adopting the country doctor approach to our patients while providing the very best in quality gives the ultimate satisfaction to both doctor and patient.  This is the essence of medicine and is one of the reasons our new world of phlebology provides such an incredible professional experience. VTN

About the Author
Dr. John Kingsley, MD, FACS, RVT, is the founder of the Alabama Vascular & Vein Center. He is doubly Board Certified by the American Board of Surgery as both a General Surgeon and as a Vascular Surgeon, one of only 3000 certified. He can be contacted by calling 205-802-6959 or see alabamavascular.com.