Managing Your Practice



Did you notice that your practice was slower than normal last February? In fact, if you plot your patient census over a few years, you will probably discover that it dips every February. And you will discover other slow periods, like December, and busy months during other parts of the year.

Seasonal fluctuations are a reality in every business, including private medical practices. Why are people more or less willing to spend money at certain times of the year? Analysts usually blame slow business during January and February on reluctance to buy products or services after the holiday season. They attribute summer peaks to everything from warm weather to an increased propensity to buy when students are on vacation. It is not always easy – or necessary – to explain seasonality. The point is that such behavior patterns do exist.

It would seem that this behavior would be easy to change through advertising or by sending out an e-mail blast, but, unfortunately, altering a seasonal pattern is not an option for a small private practice. It can be done, but it is a deep-pockets game requiring long, expensive campaigns that are only practical for a large, nationwide corporation.

Take soup, for example. For many years, canned soup was purchased and consumed almost exclusively during the winter months because it was universally perceived as a cold-weather product. After years of pervasive advertising extolling its nutritional virtues (remember Campbell’s slogan "Soup is good food"?), the soup industry succeeded in convincing the public to buy their product year round. Obviously, that kind of large-scale behavior modification is not practical for a local medical practice.

Does that mean that there is nothing we can do about our practices’ seasonal variations? Not at all, but we must work within the realities of our patients’ seasonal behavior, rather than attempting to change that behavior outright.

Plotting seasonality is easy: You can make a graph using Microsoft Excel in a few minutes. Ask your office manager or accountant for month-by-month billing figures for the last 2-3 years. (Make sure it’s the amount billed, not collected, since the latter lags the former by several weeks at least.) Plot those figures on the vertical arm and time (in months) on the horizontal. Alternatively, you can plot patient visits per month. I do both.

Once you know your seasonality, review your options, which could mean modifying your own habits when necessary. If you typically take a vacation in August, for example, you many want to reconsider if August is one of your busiest months. Consider vacationing during predictable slow periods instead.

Although I have said that you can’t change most seasonal behavior, it is possible to "retrain" some of your long-time, loyal patients to come in during slower periods for at least some of their care. Use insurance company rules as a financial incentive, where possible. Many of my patients are on Medicare, so I send a notice to all of them in early November, encouraging them to come in during December (one of my light months) before their deductible has to be paid again.

If you advertise your services, do the bulk of it during your busiest months. That might seem counterintuitive: Why not advertise during slow periods to fill the empty slots? Because you cannot change seasonal behavior with a low-budget, local advertising campaign; physicians who attempt it invariably get a poor response. Advertise during your busy periods, when seasonal patterns predict that potential patients are more willing to spend money and are more likely to respond to your message.

Then, try to flatten your seasonal dips by persuading as many existing patients as possible to return during slower seasons. You can then encourage new patients to make appointments when they are receptive to purchasing new services, which would be the seasonal peaks. Once in your practice, some of them can then be shifted into slower periods, especially for predictable, periodic care.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. To respond to this column, e-mail Dr. Eastern at our editorial offices at

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