Medical Tourism for Surgeons: How to enter the vast blue sea that is the marketplace

As a surgeon, chances are very high that someplace in the world, you work in an independent medical practice setting and compete for market share or are employed by an academic institution or a hospital that competes for market share. Generally, the "marketplace" upon which you focus your brand promotion (assuming you engage in professional brand promotion of your skills and outcomes and unique style of medical delivery - most never dreamed of doing so) is local or regional. You establish yourself among your colleagues and the general public, earn appointments and referrals for consultation and surgery, earn your pay and live your life.

But some wish to venture out into the vast blue sea that is the "global" marketplace. Many do so by hiring a website developer to make a website for them. Then, just like that, they expect that the new marketplace will receive them and treat them kindly and beat a path to their door. Just like that! No special differentiating product or package, no program established, just them, their skills, and appointments that lead to surgical procedures. They know little of international business regulations, visa and immigration, hotel site inspections and benchmarks, travel, tourism, or managing non-standard continuity of care.

But for some strange reason, they believe that they can venture out into the sea without the knowledge of how to assess the tide, swim, or even carry a buoyancy compensator vest or life jacket. And...without a business or marketing "strategy". So they enter the water and the sea suddenly turns inhospitable. The water thrashes them into directions they didn't plan to travel, largely because they never set a course and direction to arrive at a planned destination.

In their mind, they choose one of two popular choices: a value driven path, along which their business expands through quality and service, or a low-cost strategy, trying to compete on price. Rarely do they choose a third option - to differentiate and innovate in a way that their rise among medical tourism hopefuls aims them in a direction that leaves the competition in petty battles while they sail the sea into marketplaces that are entirely untouched and essentially undiscovered by their competitors and the consumers.

The sea in which this third option surgeon sails is wide open and full of opportunity. What sets this surgeon apart? Three things:

1. a wider horizon of thinking
2. a way to motivate "people" to support the option you chose, and
3. to have the "market-creating" tolls to transform your dream into a product that is attractive to customers and referral partners.

I don't believe that you'll find many marketing and referral agents in that sea because they don't know it exists and they too don't know how to swim, where to swim to, how to assess the tides, or own a BC vest or lifejacket (my euphemisms for adequate startup capital). Nor do they have the means to hire and pay someone a prevailing wage to help them fill these gaps in readiness. So in essence you have two non-swimmers, ill-equipped for the sea and its perilous risks, venturing with a half-hearted toe in the water and a website. They reach out day after day asking for "cooperations" and "collaborations" from experts hoping one will accept their invitation to share that trepidatious risk with them and swim with them on the promise that eventually both will enjoy the spoils of the swim and split the profits.

What surgeon do you know would bring their craft, their training, experience and professional liability to a business and operate now and deliver services to a business startup in hopes that the startup would eventually thrive and pay them back, whenever? Okay, so why ask someone else to do the same things? That's either a case of ego and little respect for the thing the surgeon is incapable of doing alone or ignorance of what's involved. After 40 years and 19 days in the business of medical tourism, I can assure you - there's a bit of both happening out there and the rare breed that will succeed is not among them.

The rare breed of surgeon who will swim that sea to success has a product fully developed, an effective and sustainable promotional and branding strategy, an effective means to connect with the market, adequate capital for a new expanded business venture, and the qualified guidance to fill the knowledge gaps paid to advise how to best achieve their goal.

How much is adequate capital? In USD, that adequate capital just to pay for the media and advertising (not the graphics, print, digital and other collateral creation and the person to coordinate the media buys and advertising and promotional management so that the surgeon can keep busy in theater) is about USD $250,000 for the year. In your locality, some costs will be lower, but are you buying in your locality or are you buying to connect with a remote market in another place. Are you seeking US patients? Well then, you'll be paying US media and advertising opportunity prices for the placements in the USA to connect with the US market.

If you are wondering why you aren't getting a steady stream of US patients of any significant numbers, and you aren't advertising on all channels in the USA to the USA, with the right messages and the right offers, I've just solved your mystery.

How does one create a market for a new product, service, or expansion?

As a hands-on, working part-time Director of Business Development for a small 4-OR ambulatory surgery center, this is my raison dêtre. I must create market for its new products, procedures, technology acquisitions and the surgeons who operate there. I cannot promote individual surgeons because of regulatory compliance issues. To do so provides value in cash or in kind and can be said to influence the value of the referral stream of cases to the ASC. I can advertise, but must do so fairly and equally for all surgeons, as a side effect of marketing the ASC. I cannot provide private consulting to an individual surgeon who performs surgery at the ASC without fair market value compensation for my work because to do so while working on the clock for the ASC would also be deemed "value in cash or in kind" to influence the referral stream from that surgeon to book the surgery at the ASC. I cannot split the profits and be paid later for my work from the proceeds of a surgery because "referral brokering" for health services is illegal in the USA. No media outlet (billboards, magazines, television, radio, print, event marketing, or otherwise) will accept my insertions or ad placements on speculation and "success".

My work, while working in this role is that of disruptive innovator. I don't have a never-ending and unlimited fountain of capital to spend on disruptive innovation, either. I have a budget, revenue objectives, and limited opportunities. Once the competitors see what I am doing, they copy me. At that point, my sea transitions from wide-open and blue water to a bloody red sea of competition. As the leader and pioneer, I know that eventually I must design another disruptive innovation, and another, and another, and they must produce results while the others catch up, again, and again. That's fine. I am used to this after 40+ years in the business. But what happens to those who are not accustomed to this race and what it takes to disrupt and innovate and keep besting your last achievements? And what of those who trust the incompetent and unqualified advisors who look "just like" me on the outside?

One the outside, I wear a suit - a jacket, blouse, skirt, shoes. I carry a cell phone, iPad, laptop, briefcase, and I know things. I have degrees in health administration. I also bring experience in surgery as a former OR nurse, and as a healthcare administrator. I have training no one can see or measure as a health law paralegal, a mediator, a Google certified digital marketer, and a health plan contract negotiator. The lookalikes have none of this. So from the outside, give or take a few pounds, I look just like my competitors.

I have immeasurable expertise as a strategist, negotiator, a content creator, an author of 19 (soon to be 23) peer-reviewed book titles that are commercially published by an international (Informa) life sciences industry publisher; not some vanity press that prints what anyone will write for a fee. The only metric for these things is that I function daily in these roles and guide paying clients and my employer to growth outcomes and revenues. Meanwhile, my so-called competitors are busy speaking for free at numerous medical tourism events - because they don't have clients to otherwise occupy their time. They don't have the same qualifications under the suits they wear. If they did, the event organizers would have to pay more or organize fewer medical tourism conferences, congresses, and events because they would not be able to so easily make profits on events as they do at this time with free "costs of goods (the free speakers with all this time seeking to be discovered and hired for paid assignments) sold".

For example, as a former OR nurse, I know how total and partial knee arthroplasties are done. I can assist, pass instruments, set up cases, and be ready for the surgeon to drop the knife. As a former administrator of hospitals and ASCs, I know how to purchase, deploy, and promote new technologies. Now we purchased a NAVIO robot- an investment of more than half a million dollars.

Austrian economist Joseph Schumpeter describes when a new innovation overcomes earlier technology and it disrupts the industry, as "creative destruction". I must figure out how to position the ASC as the leader with the new technology, while the competitors in the market have spent their money on another technology. I cannot make claims about the technology or its indications for use that exceed regulatory permissions from the FDA. I cannot advertise outcomes of a certain characteristic because I may exceed accepted regulatory permissions. I cannot use comparative hyperbolic language of better or best without measurable proof.

Meanwhile those other consultants in similar dress and appearance on the outside attempt to apply non-healthcare marketing, advertising and branding tactics and expose the surgeon or the facility or the technology developers to claims of false or improper advertising. The healthcare marketplace is different and requires different, specialized skills. It won't tolerate their unqualified generalist tactics applied to healthcare. With these generalist applications, come infractions, fines, rebuke from the marketplace, loss of trust, brand scandal and ultimately - failure to succeed in the sea of disruptive innovation and lost investment opportunity and resources. And this isn't something I talk about at medical tourism events in hopes of getting clients. This is something I deal with daily and keeps me too busy to travel to appear at all the competing medical tourism congresses, conferences, and events - especially without replacement compensation for the lost billable hours. I must reserve time off for travel to special appearances and there's no need for me to appear at all of them. To what end? Exposure? I have work. I am not trolling for clients. Heck, I must manage my existing availability by appointment in a diary managed by five secretaries! And I would not have the work and clients if I didn't deliver success and revenues.

But my job when working as the Director of Business Development for the ASC, even if only part time, is to create markets for the ASC and its surgeons through disruptive innovation. I also use tactics and strategies for non-disruptive creation, whereby the markets we aim to persuade to use the ASC and its surgeons are neither destroyed or replaced. I must create a new market without changing the nearby hospital, local hospitals people trust and utilize in their source market locations, or competing ASCs in our local and regional marketplace. And I can tell you that it is extremely challenging to do this only part time, two days per week. For one reason, when I am "in the zone" of creativity, the clock times me out and I lose momentum until I am able to reconvene and get back in the zone. But as a former administrator, I get it. The ASC cannot afford to hire me for more hours until the fruits of my labors realize cash to hire me for more hours. And I too, cannot afford to work for the wages I am paid as an employee, which are a tens of percentages lower than my freelance consulting rates. The trade off? A worksite that is 12 minutes from home, income regularity and consistency, and I don't have to market to acquire new clients all the time or spend the money on the marketing and advertising costs - one of which is all those appearances at free events and the time and expense to travel to them. And... I love love love what I do for the ASC.

In this role, marketing the surgeons and ASC to potential customers from 40 states and provinces in Canada, I am forging new markets by solving a previously unaddressed problem - affordable health access within the USA, and faster access for Canadians. I must redefine existing problems to turn the industry on its head - within the USA. The product is breakthrough. It replaces existing ones, identifies and solves a brand-new problem through package price transparency for a good product, and redefines our approach to an existing market-based problem.

As a surgeon seeking to enter and thrive in medical tourism, to attract new market share outside your locality, these are your tasks. You must "do" or "hire" someone "just like me" with the experience, training, and expertise to do what I do. I can coach or mentor your new hire, but I am not available to cooperate or collaborate at risk of "do now/pay later". I get paid a retainer to assure my availability for your assignment. If that's not in the realm of possibility (which for most surgeons entering medical tourism is the case) then you must hire someone else or do it yourself. Just like treating the leaky toilet at home. Make or buy, but regardless, the task must get done. If you believe that success will come because you have a website, good luck. I know better.

How to make the shift to broader horizons

1. Reconceptualize the industry. View the medical tourism industry and healthcare overall as malleable. Don't accept conventional modes of advertising and promotion (e.g. engaging and collaborating with inexperienced, unqualified, marketing and referral agents and agencies, who themselves are unqualified to be "facilitators" and who could endanger your patients and your reputation and outcomes with improper planning and execution, or depending on a web page that says and produces nothing). How can you reconceptualize "your" market? Write down your ideas as you read this.
2. Render your competitors "obsolete". You aren't there to beat the competition. Find approaches and swim lanes where there are no competitors. That takes creativity, research, analysis, data, and observation - all of which must be interpreted and from the interpretation, a strategy and deployment tactics formulated and skillfully executed by someone with the training, experience and expertise to do it. You won't find the experts who can do this and manage a variety of clients at most medical tourism events because they are too busy doing to always be on the road speaking and trolling for clients. Instead, look for those successful at rending competitors obsolete and ask who helped them.
3. Produce new demand. Make your medical tourism product appealing and attractive to prospective patients and organic referral sources. It must solve a patient's problem in a practical and reasonable way. And pitch where the problems exist. Don't aim to attract "American patients" because you believe they are rich. The richer they are, the less they need your solution. They can buy the best of the best wherever they want.
4. Drive market attraction with a specific plan. Your plan must be both affordable /low cost and distinct at the same time. Set yourself apart, but be mindful of the cost to market and promote because there's no endless fountain of cash from which to draw to achieve year-round marketing and advertising. You have to do what I do: Devise an approach to squeeze 7 cents from a 5-cent piece.
5. Atomization. Break down seemingly daunting and overwhelming tasks into bite-size chunks, focusing on only one or a few at a time.
6. First-hand discovery. You must invest time, effort, research and resources to develop new perspectives, critical thinking approaches, and new experiences that shape your new approach. Everyone employed by you or influenced by you and your practice must live your new brand and feel a need for change as a result of their own thinking, not as a preordained decision by you or your marketing or branding consultant.
7. Develop a fair and ethical and compliant process. Three principles guide this process: engagement by organic means, explanation and clear expectations. By engagement, you bring all stakeholders - not just prospective customers - into the decision-making process. There's no place for decision by fiat. Give a clear explanatory breakdown of decisions and ideas that are rejected. Also give clear expectations of what people will experience and that for which they are responsible.

The last phase to preparing to venture into medical tourism and the international marketplace is to use tools that work.

A strategic map for success. Develop a reality chart that helps you determine your position in the marketplace. The purpose of the reality chart is to get an objective sense of your product, your reputation, and your value to someone who might become a customer. You'll categorize your products as "pioneers" - products with clear innovative values. They are the key to your distinctive touch and future profits. The next category is "settlers". These are comparative products based on that which your competitors offer. Settlers imitate the competition and only marginally improve on what others are offering or doing. The third category is "migrators". This category provides greater value than your competitors, but isn't truly innovative.

Draw your map as I have done below and assign circles in each section to depict and reflect the revenue that each product generates. The larger the circle, the greater the revenue. The more your surgical practice depends on settlers, the greater your vulnerability. Aim for larger pioneer circles and move migrators up a row whenever possible.

Build a strategy canvas. This tool creates an overview of your comprehensive business strategy and identifies competitive drivers of your industry. It maps how much value prospective buyers derive from each of competitive factor. Sorry to inform, but it isn't about you. It's about them. If you focus on you, your ego, your vision of yourself, and how great you are, those are features, not valuable benefits your customers receive for doing business or entrusting their medical care to you. Nobody.Will.Care.

In your canvas, the horizontal axis indicates the primary competitive factors of surgery on the international/domestic/regional market. The vertical axis indicates the offering level of each factor from high to low. These range from percentage of each dollar that goes to the bottom line and the costs incurred to market or drive business and revenues.

For each key competitive factor, select 5-12 of them. For each, choose a competitive rival to whom you can compare yourself. Choose the industry leader so that you are assured you are comparing and benchmarking properly. If you believe you ARE the leader already, select your closest rival. Now rate your offerings against your competitors for each factor, plotting your graphs. If there is a strong resemblance between your curve and that of your rival's you are not in a position to render your competitor obsolete. If your curve is all around lower, your offer is probably inferior.

Discover hidden pain points of your customers. For this, you must KNOW YOUR IDEAL CUSTOMER. As a surgeon, you are smart enough to do this, but not educated and trained enough nor do you have the time to do this yourself. Accept it and hire an expert to assist you for a short time. This is a one off assignment. You won't be hiring someone for an ongoing, unlimited engagement. The deliverable will be a "buyer utility map". The map is simply a 6x6 table where the columns represent six stages of your buyer experience cycle:

1. selection of provider
2. consultation
3. surgery
4. recovery
5. progressive aftercare management and rehabilitation, and
6. outcome.

The rows are utility levers:

1. Customer productivity
2. simplicity
3. convenience
4. risk reduction
5. customer delight and image, and
6. environmental friendliness or other social responsibility factors

Now let's use the deliverable. What impedes customer productivity (shopping and comparison or selection)? What prevents simplicity? How is convenience hindered? How can prospects reduce risk? What inhibits delight and image? What hinders environmental friendliness? What do these things have these effects? What can you do to address each pain point?

Once you figure this out, you can attract patients who are not yet purchasing the products you offer. As a result, people who would not normally participate or consider medical travel will open up and consider the possibility.

Alternative pathways. In this exercise, your task is to determine "WHY" customers choose one provider or facility over another. This too is a part of knowing your ideal customer.

1. Alternative medicine. Some people with osteoarthritis elect to have their knee replaced without robotic assistance, while others will elect to choose a provider who uses the robot. Still a third group select stem cell injections. WHY?
2. Value proposition. WHY do some people choose high value vs low cost?
3. Influencers. Whom do your ideal prospects trust and WHY? Focus on the prospects that influencers and marketers ignore to carve a new pathway.
4. Solutions. Assess the context your product operates and what occurs before consultation and option of surgery , during and after treatment.
5. Redefine orientations. Rethink the balance of functionality and emotion within medical tourism. How can you elicit positive emotions about traveling to obtain health services? Remember, in a perfect world, people need not travel to obtain healthcare.
6. Shape external trends. How can you either adapt or influence trends about medical travel? At our ASC we have price transparency and bundled price packages that include everything needed and exclude fluff and pricing surprises.

An action framework

The next tool is an actionable framework.

1. Which factors do most healthcare facilities and other surgeons in your specialty take for granted? Change what you can change to differentiate yourself. Cut costs for fluff and stop passing them on to the patient. We did this with our cash pay program. We chopped out the national average of 28% cost to collect and bill and float on the cash and revenue management by requiring cash paid on or before the day of surgery.
2. Which factors can be reduced will below the industry standard? At the ASC, our infection rate is 0.037% while the national average is about 2.3%. That's one factor we can and do control. Another is your complications rate. Knee replacement revision is said to be 20% overall. Ours is less than 1%. Those are two examples. What can you do?
3. What factors can be raised well above industry standards? Ours are patient satisfaction, clinical outcomes, and cash savings per case. Another we raise is utilization of state of the art technologies. We also raise the standard on our medical tourism patient accommodations (photo above). 5-star, externally-rated luxury for the cost of a standard chain hotel room.
4. Incomparable amenities and features not offered elsewhere. We offer concierge service that is brand standard from administration to patient facilitation to nursing care. Everyone on our team is a multitasking brand ambassador.

Once you have undertaken and completed the above assignments, you'll be ready to begin thinking how to roll out a medical tourism expansion of your surgical brand. The next task is to choose your approach, design your product and program and put it into practice. This is where most surgeons fail: at the point of execution of their dream strategy.

I get that your training included none of this. On the other hand, mine did. Respect your advisors for their expertise, experience and insight instead of thinking you are so clever. Maybe you aren't as clever as you need to be? Get help from qualified advisors. I'm not saying "hire ME". I don't have time to help everyone who needs this sort of help. Yes, I have an hour from time to time to sell you at my usual and customary billing rate. But most surgeons absolutely abhor paying other smart people to do what they do best. So, with the list above, there's your DIY recipe and pathway. If you can't DIY and you refuse to pay for appropriate and qualified assistance, that's on you. That's your prerogative. Just remember that it is also what is keeping you from success in medical tourism market creation and penetration.

If you would like to get in touch, call or email me. +1.800.727.4160 or [email protected]