What does your practice look like from the outside?

Speaking at the Practice Management Symposium for Practicing Orthopaedic Surgeons on Tuesday, Thomas J. Grogan, MD, emphasized that successful practices must take into account the public face of their offices.

“What I have found is that my receptionist drives more work to my practice than anybody else…probably including me,” he explained. “If she’s empathetic when she’s on the phone, the patient will often come to see me eventually, even if that person chooses another physician initially for insurance reasons, just because he or she liked my receptionist.

Attendees at the Practice Management Symposium for Practicing Orthopaedic Surgeons.

“Secret shopper”
Dr. Grogan began his investigation with a short customer service survey of 25 consecutive patients and found that they liked several basic things about his practice. They appreciated that a real person answered the phone; that they could make an appointment quickly; and that the receptionist could give them a general cost estimate up front.

Thomas J. Grogan, MD, describes his “secret shopper” survey

“In my particular area of Southern California, large deductibles were commonplace,” he explained. “Health savings accounts were being implemented by employers, so many patients realized that coming to the office would require them to bring along a credit card or a checkbook, and they simply wanted to know what it would cost.”

To follow up on his findings, Dr. Grogan asked his son to serve as a “secret shopper,” calling a random selection of 45 orthopaedic surgeons around the country. Dr. Grogan’s son called the offices and explained that he had a fracture of the radius from snowboarding.

“He told them it was already splinted,” said Dr. Grogan. “He said he had his radiographs in hand and that he was paying from his health savings account. He asked what would be the earliest available appointment and what it would cost. All very reasonable questions.”

Out of the 45 offices called, 24 used a phone tree that eventually led to a person, and 21 calls were answered directly by a human.

About a third of the offices were able to schedule an appointment in less than 3 minutes—a time Dr. Grogan had laid out in advance as a reasonable target. The longest phone call took 15 minutes to make an appointment.

Two of the offices offered to see him on the same day; nine were able to schedule an appointment within 24 hours of the call, and five said he could have an appointment within 48 hours.

“About half of the surgeons we called would have taken longer than two days to see him,” said Dr. Grogan. “One office set up an appointment for 28 days later, and one would have taken 30 days. Seven of the offices were unable to make an appointment at all—they either wanted to see the radiographs first, required an introduction letter, or requested that he fax copies of all the reports to them.”

Overall, 29 of the offices were able to provide a solid cost estimate, five offered a price range, and 11 refused to provide any cost estimate at all. The quoted estimates ranged from $55 to as much as $2,000 for a short arm cast.

“Most of the responses were on the order of, ‘We won’t know until you check out,’” he said.

Driving patients away?
Today, Dr. Grogan said, transparency is very important to patients. In a world increasingly focused on deductibles, co-pays, and health savings accounts, he believes that more patients are going to demand cost estimates up front.

“I would recommend that everybody attempt to conduct a mini-survey as Dr. Grogan did, within their own office,” countered Karen Zupko, a practice management consultant and another speaker at the symposium. “I think many surgeons would do well to mystery shop their own practices to see if they’re satisfied with the way their staff interacts with the public.”

“I think all of us have this inherent trust that staff who are answering the phone have our best interests in mind,” agreed Michael Q. Freehill, MD. “I just don’t know that we can necessarily rely upon that.”

In his own experience, Dr. Freehill noted, staff told patients to call another office, even though the cases were well within the scope of the practice and, in some cases, the patients could have been seen on the same day.

“They were sent to a competitor for something we could have easily take care of,” he said. “I think it might behoove all of us to do some undercover customer service analysis of our own offices, just to make sure that things are being handled the way we think they’re being handled. You may be surprised at some of the responses, and those issues could have a long-term impact on your practice.”

Resources for every practice can be found in the online Practice Management Center, as well as at the Practice Management booth in Academy Row at the AAOS Annual Meeting. For more information, please visit

Prepared by Peter Pollack, staff writer for AAOS Now.