Perspectives on Private Practice: Interview with John Coverstone, AuD
Douglas L. Beck, AuD, speaks with Dr. Coverstone about private practice location, costs to open the door, marketing, and more.
Academy: Hi, John. Thanks for your time. It’s good to speak with you again.
Coverstone: Hey, Doug. Thanks. My pleasure.
Academy: John, I should note that you consult for a number of private practices; you are the president, founder, and CEO of Sentient Healthcare, Inc., in New Brighton, MN, and you are involved in many committees for state and national audiology organizations. You are also currently on the Board of Governors of the American Board of Audiology (ABA) and you were previously on the Ethics Committee of the ABA, too, as well as being the past chair of the Academy’s State Leaders Network.
So then…I get lots of e-mails and correspondence from students inquiring about private practice. They usually want to know how and when to start their own practices, and so I thought it would be fun to get your perspective as a private practice owner, and as someone who has initiated many different entrepreneurial pursuits.
Coverstone: Absolutely. I am happy to help.
Academy: Okay, so let us start with your experience. When and where did you get your audiology degrees?
Coverstone: I have been in practice for just about 10 years. I actually earned my BS from Portland State University in 1993, and then my master’s (from Portland State) in 2000, and my doctorate from PCO in 2008.
Academy: And I know you worked for two different hearing aid manufacturers back in the day?
Coverstone: Yes. I worked for Argosy and Danavox before receiving my master’s. In fact, I started a consulting company with a marketing specialist, and while that company was up and running, I decided to start my own private practice—but I would never recommend going about it that way. Clearly, the best way to start a private practice is to first work in a private practice! It’s much better to practice for a number of years and then start your own, because there are so many issues to learn about that have little to do with being a doctor…marketing, business plans, how to buy products, advertising, billing, CPT codes, how to schedule patients, and so much more.
Academy: And so, when you actually made the switch into private practice, you had a few years of experience as a hearing aid manufacturer’s rep, and a year or two in your own marketing group, but relatively little clinical experience?
Coverstone: Exactly, and again, that is not the way to do it!
Academy: Yes, I have to agree. I was an audiologist for some 15 years or so before I went into private practice, and back then, we did not have the course work, which many programs now offer with regard to billing, CPT codes, writing a business plan, etc. Essentially all I had were my personal clinical skills, but fortunately, I partnered with a fellow who had extraordinary business skills.
Coverstone: Yes, well that is a good way to go, too. Absolutely your clinical skills must be very well developed, but as you noted, you need business skills, too. In the private practice world, both skill sets are critical to survive and thrive.
Academy: John, is there a minimum “number of years of practice” you would recommend before someone starts his or her own practice?
Coverstone: Well, I am certain it varies terrifically based on the individual skill set, age, financial situation, and more…but I have to think at least two or three years of practice makes sense before going out on your own.
Academy: Yes, well…I’m not sure I can define a number either, but I would think at least two years makes sense, and it seems to me that should include at least one year in a successful audiology private practice to really see and learn how things are done, what works, what doesn’t work, where the patients come from, which software works and which is not necessary. I think one has to really understand the costs of the equipment, real estate, taxes, insurance, employees, and more.
Coverstone: Right. Everyone wants the best and shiniest new audiometric equipment, but between OAEs, ASSR, ABR, audiometers, tympanometers, a microscope and other cerumen tools, the sound booth, office equipment, and all the necessary hand-tools—it can get pretty expensive to open the door! Frankly, I initially opened in a medical setting, but the rents were astronomical and that drove me to find a more financially friendly setting. So now, I am located in more of a business complex, rather than a medical building, yet still—the rent is expensive. There are other medical offices in the building, such as an optometrist, a dentist, and myself, so the building has a little bit of a medical identity, but it is not a traditional medical setting, and I occupy about 1,000 square feet.
Academy: How did you pick that particular site?
Coverstone: Well, the primary thing is location, but as you know, the local demographics are very important, too. The seniors we serve really do not like to drive great distances and more importantly, they really do not want to drive on the interstates. In addition, keep in mind, it is not just the distance—they really are concerned about “drive time” more so than miles. They consider how long it takes to get to you, not just how far it is, and we have learned that 5 to 10 minutes is about the limit of comfort for many of our patients.
Academy: So it really does boil down to the same three old tried and tested real estate truths—location, location and location?
Coverstone: Yes, exactly right. The location has to be right and the location has to take into consideration where the patients live, but also of importance—where they are willing to go and how long it takes to get there. Your office has to meet their needs. It is not just zip codes. Quite often, the patient may decide to visit you (or not) based on your office neighborhood, or perhaps particular buildings within a neighborhood that appear inviting or threatening from the patient’s perspective. In his or her mind, it may all pivot on the parking lot, or it may have a lot to do with stairs, handicap access, elevators, cleanliness, wheelchair access, and more.
Academy: Excellent points. My first office was in a very busy retail strip center. We located a few doors away from a very busy food store, in fact, the biggest food store in the state. Initially, I was reluctant to not locate in a medical setting, but I soon learned that every one of my patients needed to eat! Moreover, location in the major strip centers near the major food retailers were very good as they already were “destinations” and the patients were driving and walking past us every week (or more) to get their groceries, and so with good signage and marketing, they quickly learned our name as they walked right by the front door.
Coverstone: Exactly—and that is a valuable lesson. Of course, I think most of us prefer to locate in medical buildings, when that is possible, but if that is prohibitive, there are many other locations worthy of consideration. I see tons of optometric and dental practices in more traditional retail locations, and it makes sense. It is good to locate where the patients are already going! So rather than teaching them a new location and explaining how to get there, it is great to be able to piggyback on a location they are familiar with.
Academy: What are your thoughts regarding staff?
Coverstone: Some audiologists in private practice have their “e-staff.” That is, they have their cell phones on and they record and respond quickly to patient and professional queries, and they do everything via the Internet as far as professional and personal communications—and for some people that can work very well. It is my preference to have at least one “patient care coordinator” on staff to take care of those things in parallel with me actually seeing patients. Of course, as I said, the “e-staff” idea does work for many people and maybe when a practice is brand new it makes financial sense, but it also limits human interaction and growth and it means after the audiologist sees the patients personally, they have to attend to all the other details like thank you notes for the referral, charting, billing, scheduling, ordering, tracking product, sending out reminders for payment and for reminders for appointments, sending out referrals and other professional correspondence, and selling batteries and assistive listening devices over the counter. Therefore, I really prefer a very competent, friendly, and professional human assistant.
Academy: I have to agree. What about marketing? How much money do you recommend putting into marketing?
Coverstone: Well, my thought is, you can never put enough money into marketing. That is just one of the golden rules to me. When you open a brand new practice, it takes a long time to have people become familiar with your name, your brand, and to develop enough trust in you to spend thousands of dollars in your office. Of course, it all starts with consumer responses that are very small, a trickle at first, and then hopefully as time goes on, the response improves. I think it took us a year of good solid promotional events as well as direct mail and newspaper marketing before we got our first excellent response. It takes time, and lots of money invested, and you need to be consistent.
Academy: Yes, and consistency is so important as you are building your brand and your image. One really must think this through ahead of time as to what your message is going to be, because if and when you change the message to the consumer, you confuse the audience as to who you are, and you have to start again to build and establish an audience.
Coverstone: Exactly, and there’s no single “magic bullet.” Some people try to establish their practice on price, some on quality of service, some work on creative and clever marketing protocols, some base their image on very high-tech products, and some on professionalism and on other things too…but the point is, whichever part of the market you decide to go after, you need to be consistent in your marketing message.
Academy: Based on your personal experience, what does it cost to open a private practice?
Coverstone: Well….I got a little lucky in that the landlord did the “build out” for me, so he moved walls and took care of light fixtures and paint, which meant I signed a little longer contract than I would have liked, but it worked fine for both of us. As I said, I have just over 1,000 square feet, and I should mention that when I got into practice, I looked long and hard for great deals on used equipment…so the bottom line is, it probably costs about $200,000-$300,000 to open a brand new office in a great location.
Academy: Thanks, John. It has been a pleasure chatting with you and I appreciate your time.
Coverstone: Thank you, too, Doug. It has been fun for me, too.
John Coverstone, AuD, is a consultant for a number of private practices, as well as the president, founder, and CEO of Sentient Healthcare, Inc., in New Brighton, MN.
Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.