by Regina Druz, MD, FACC

There is no shortage of business advice to the integrative practitioner. Practice development strategies, whether articulated on the web or in the media, can provide practitioners with a valuable set of tools to leverage.

Yet, many fall short of a major objective: to position anyone for success from the very beginning, before they open their doors or invest a dime into any attribute of their practice, be it a software for marketing automation, social media promotions, or other common vehicles of practice development. They also fail at helping those who may have been stagnant in their growth, hitting a plateau, or strapped for funds as they need to work relentlessly to keep their practice afloat. While there are individual success stories, from several settings, why do the established systems not work for everyone? Why, despite a range of offerings, no particular method has emerged as a definitive model that can enable any practitioner to achieve success specific to their practice without spending valuable time and money?

To answer this question, one needs to realize that fundamental differences exist between practice of traditional medicine and any practice that involves integrative, holistic, or functional medicine.  I am not referring to the practice philosophy or clinical services. The major differences are those between the established players and  the newcomers.

In the practice of medicine, traditional practices, usually insurance-based, operate in the market that is well-established. Practitioners have patients whose likes and dislikes are known and predictable, whose demographic characteristics, behavior, and buying power have been studied, and are well-defined through statistics and relevant metrics. The success for these established entities lies in refining their practice offerings to track along with the known and established likes and dislikes of the stakeholders, while periodically sampling the opinion of all parties to readjust. The traditional practice market has formed over decades, is the backbone of the American medical system, and is the behavior of all participants, such as health systems, practitioners, patients, insurance companies, suppliers, and business associates.

The integrative practice, or any medical practice based on anything other than the mainstream medical model, is a journey into unknown. For each integrative practitioner, the market and behavior of the stakeholders is unpredictable. Moreover, what actually constitutes a market for a given integrative practice is not defined. There are virtually as many practice models and associated markets as there are practitioners. The usual well-oiled medical machine and all of its moving parts has little use for an integrative practice.

Simply put, mainstream medicine is similar to a large corporation, where a multitude of departments are all involved in refinement of the existing model. On the other hand, the integrative practice is essentially a start-up, an incumbent that disrupts an existing market of medicine, either resegmenting it or creating a new market all together.

For a large corporation, tools such as marketing automation, sales funnels, patient pre-education, and branding make sense as they can address facets of their well-known market models.  These tools allow us to measure success against industry-specific milestones or metrics. For a start-up, such tools are often prohibitively expensive and ineffective as the customers they need to reach are simply unknown, and the market that such practices serve is undefined. In other words, the refinement tools of established players are much less relevant to the integrative practices in early stage of development, which are testing unknown waters.

The Lean Start Up model, developed by Steven Blank at Stanford University, and presented over a decade ago in his book, Four Steps to the Epiphany, provides a useful framework to offer a path to development for a start-up. I reframed this model to bring it into the fold of the integrative practice, and to highlight critical steps in practice development.

In his book, Blank identifies four steps that are critical to the launch and survival of any start-up. These steps are:

  1. Customer Discovery
  2. Customer Validation
  3. Customer Creation
  4. Company Building.

Since we do not necessarily deal with product to customer transactions in medical practice, but rather build therapeutic relationships that may involve transactions, I reframed these steps into four stages more relevant to the integrative practitioner:

  1. Patient Discovery
  2. Patient Validation
  3. Patient Creation
  4. Practice Building

Patient Discovery is the process by which an integrative practice identifies its patient group, learning its characteristics, and refining its offerings to provide the best fit to the needs and problems of this patient group. Remember, that since integrative practice is relatively new, and its path is unknown, it is critical to identify the specific problems that patients are looking to solve through integrative medicine services.

This is very different from identifying a medical or clinical problem category or creating a niche. At this stage, an integrative practitioner is not asking what clinical problem their patients have. Rather, they are learning about the patients with clinical problems and zeroing in on the specific needs of such patients that can be addressed or met through integrative practice services.

While the vision for these services comes from the integrative practitioners (who are the founders of the practice, similar to any start up founders), this vision needs to be refined in the Practice Discovery step to see if it can be made into reality.

In the next step, Patient Validation, the model that was developed during Patient Discovery by learning from the patients needs, and addressing those through developing a range of services, is now offered to a larger group of patients, to see if it sticks. It is at this stage that service fees, packages, membership models, and patient pre-education as well as some initial branding takes place.

Notice that the goal of this stage is not to amass a large following but deliver targeted services to a small group that has been identified in Patient Discovery to have a substantial need or want for practice services. This is a critical stage of practice development as the success at this stage is absolutely essential to secure a viable future. In this stage, practice owners learn how to deliver the services they identified in Patient Discovery. If the practice passes the Patient Validation stage successfully, that’s great. However, if it does not, the practice founders need to go back to the Patient Discovery stage, and iterate on their assumptions.

Finally, in Patient Creation, a model that works, and has shown promising results at adoption, is now being put forward to recruit additional patients into the practice. At this stage, marketing automation, sales funnel, and engagement technology are relevant but have to be focused and relevant to Patient Discovery and Validation findings. Those become even more important in Practice Building stage.

Notice that this process is iterative and purposeful, and has nothing to do with any clinical problem, practice niche, or a particular technology. Rather, the process provides a learning opportunity for a practitioner to proceed stepwise to build their successful practice, with limited resources that are producing high yield, all focused to define your market, and your patient group.

I can envision practitioners saying, “Well, this sounds great, but how would I know where to begin?”

The answer is simple: just ask your patients and listen. Go beyond your usual questions aimed at medical history, clinical work up, etc. To start the Patient Discovery process, I often ask patients what would they change or get if they had a “magic button”.  Ask yourself what would you change if you had a practitioner magic button?

If a practitioner skips these beginning steps, they may eventually be able to acquire knowledge to have some idea of who their patients are, and what is it they want or need help with. However, such strategy is backward and wasteful, low yield, takes a lot of time, and is expensive. To set yourself up for success, go through all the steps in the Four Steps Practice Development model. There are no right or wrong answers. Rather, it is the learning acquired in this process that yields results.

Editor’s note: This article is part of a series, which will cover each of the four practice development steps in detail. Please leave any questions and/or comments below.