01 March 2012

Never go to a doctor whose office plants have died.

Erma Bombeck


I recently cut my toe, and the cut got infected. I spent a week (okay two weeks) putting on polysporin and hoping it would heal itself, but alas, it became clear this was a matter for a medical professional. So, I got a referral from my father and called my very first podiatrist.

Unfortunately for me, the only time the podiatrist had to meet with me was 2 weeks away. Even after explaining that this was not a routine visit that could easily be pushed off, I was told that if I couldn’t wait then I should go to the emergency room.

Since I wasn’t going to go to the emergency room for a small infection on my toe, it was time to dial for podiatrists. I ended up finding a great podiatrist on yelp that was able to fit me in that day.

As an entrepreneur hustling to sign up my first customers, turning away a new customer is blasphemous. Business owners know that finding new customers is ten times more difficult than keeping existing customers, so for any business to tell a new customer to take a hike is shocking for me.

I don’t want to be presumptuous and tell business owners what they should and shouldn’t do. In fact, for people at the top of their fields, flatly turning down new clients is commonplace. However, in medicine, this phenomenon is not limited to people at the top of their fields.

A few days ago I went to a tech event where a company pitched an iphone app that took pictures of your moles and alerted you to the risk of those moles developing into melanoma. They had contacted countless dermatologists asking if they would pay for a lead of someone located close to them who needs a dermatologist. They found that not a single dermatologist was interested because they had all filled up their schedules and didn’t care about or need new customers.

Keep in mind that most of these customers become customers for life. As long as your podiatrist or dermatologist does a good job, why would you ever switch?

When an industry as a whole does not care about finding new customers, there is a major structural issue. The supply of dermatologists must be too low, otherwise they would be thrilled to find a new customer. I happen to know that the supply of dermatologists is kept artificially low because dermatologists like making tons of money for a comparatively cushy job, so even though lots of young medical students want to go into dermatology, they only let a small fraction learn how to become dermatologists. How this is not considered monopolistic is beyond me.