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Creating A Niche in Medicine

In this post I want to emphasize how important it is to focus on a niche in your practice, rather than treating everything you’ve been trained to treat. Focusing on a niche in medicine could be a career satisfier, as well as financially lucrative.

A Niche in Medicine

By a medical niche I am referring to hyperfocus in your clinical practice. You can still see other patient types, but the goal would be to continually gear your practice towards a niche disease or chief complaint.

There are several companies online which are doing this well. Roman is a great example of this. Curology is another. And I have mentioned others over the years.

Recently I came across another great service, DearBrightly, for whom I did some consulting work.

Examples of Niches in Medicine

I knew an orthopedist who only managed PFPS. He would get referrals from all over the country. And he had partnered up with a MSK radiologist and a PT in order to own that niche. Which he did.

Dermatologists do this commonly – think aesthetics. Or a laser tattoo removal clinic. That’s as niche as niche gets.

My dentist mostly did preventative dentistry in San Diego. Though he would still do the occasional filling; but nothing beyond that.

Some physical therapists only do CTS – nothing else. Imagine, you’ll get referral from all sorts of work comp groups to manage these wrist issues.

There are diabetic clinics run by Family Medicine doctors. And hypertensive clinics run by Internists.

Some neurologists have build itch clinics. That’s all they work on. They work with psychologists and they only treat people with severe itching. Amazing. These are called “itch centers” – and yes, they get tons of referrals.

I can go on and on about examples. The point is, there are other clinicians doing this.

Practicing Niche Medicine

What’s enticing about practicing niche medicine is that you can get great at one thing. And you get to master what you do, collect data, and improve.

The workflow gets easier and advertising sort of takes are of itself.

Again, you don’t have to stop seeing other kinds of patients. But they become the background part of the practice. Your aim becomes owning a niche in medicine.

You might only offering second opinions on treatment plans – not even prescribing medications or performing surgeries.

The Niche Medical Practice

Here is how I think the business model would look for such a niche medical practice.

#1. The Clinic

You’ll need a lot less space since you’ll be seeing fewer patients, most likely. You’ll need fewer staff and probably less equipment.

If you are running a trigger injection clinic or a cryotherapy clinic where you’re freezing off warts and skin tags, you’ll get by on a 300 sqft space. Imagine how cheap the rent is.

With the latter example your patient volume might be higher but you can get them in and out very quickly. Even more so if you don’t take insurance and charge cash. That would make the billing much easier.

#2. Marketing

I recently ran a Google Ad campaign which was a disaster. It cost me a lot of money and I had too much competition for the keywords I was bidding on.

But when you have a UTI clinic or melasma clinic, advertising is much easier. And getting referrals from primary care clinics or other specialty clinics nearby is easy.

#3. Income

If you’re doing something more specialized, like a neuropathy clinic, you can charge $300-500 per visit, cash. People will pay a lot for pain and aesthetic related concerns. Especially when they believe you’re the expert on it.

For simpler stuff like cryo or joint injections or a “pelvic clinic”, you might charge less, but still cash. It would be quite easy to see 100 patients in a metropolitan city in a single day, only doing cryotherapy.

If you have a podiatry clinic (you don’t have to be a podiatrist) and you’re just trimming nails, shaving corns, and scraping calluses, imagine how many patients you’d get per day. It would be more than you could handle.

How much to charge? Something affordable, ~$30 for the simple stuff. $100 for a basic aesthetic procedure. And probably around $300-500 for something a lot more involved.

#4. Expertise

You sort of become the world expert on the topic when you’re the only clinic in town doing “pediatric ear pain”. If that’s all you do then you’ll get damn good at it.

You’ll have your patients teach you as much as you already know. And if you are genuinely interested in the topic then it’ll make you an expert that much faster.

#5. Digital Nomading

And, of course, you can be a digital nomad physician with such a niche practice. At some point you can delegate the work to your associate(s) and manage some of the consults remotely.

Especially if you’re offering mostly 2nd opinions, doing the work remotely is quite possible. And now that patients have accepted the telemedicine workflow, it’s even easier to have a niche in medicine virtually.

#6. Burnout Antidote

As an Urgent Care doctor it’s a little anxiety inducing when my next patient could have anything under the sun. I see a dehydrated 2-day old, followed by a feverish 98-yo.

Burnout has different reasons for each of us. But I know for me it was not feeling fulfilled and having a lack of autonomy. The more I practiced the more I realized how little I knew and how much control my employer had over me.

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