Hi, it's Dr. Weitz. Thank you so much for joining me for this episode of the private medical practice Academy. During this past year, many medical practices were freaking out because they were totally unprepared for COVID and sure COVID has been terrible for everyone. Medical practices have been forced to find ways to deal with the pandemics challenges. And I'm sure you're thinking to yourself,

I'm prepared. I've been in place all of these things this year in case there's another emergency like COVID, but in reality, COVID is a once in a hundred year event. And while it certainly has changed the way medicine is practiced, COVID didn't knock out the power. It didn't knock out the internet. It didn't take away the water supply. It didn't make roads and passable,

and it didn't cause mass evacuations given the recent ice storms and the devastating aftermath. I want to use this opportunity to talk to you about emergency preparedness in the context of a natural disaster. And it doesn't have to be an ice storm, depending on where you live. There are hurricanes, there are blizzards tornadoes or earthquakes. Pretty much every place has something.

And all of these happen on a much more regular basis than COVID. Look, you don't have to look further than this past week, right? I live in Louisiana during this ice storm. We lost power and we lost our internet service for days. Was it inconvenient? Sure. Was it a big deal? No. Why? Because we had a plan and why did we have a plan?

Well, because we'd been through this before, so we have a generator, we got gas for the generator. We got firewood for our fireplace. We had extra water. We already knew what to anticipate just in case, but that was not always the way it was. Okay. In 1989, I was an anesthesia resident at UCF and lo and behold doing a rotation at the San Francisco VA.

We were struck by the 7.0 well Loma Prieta earthquake. I had just dropped off a patient in the ICU and I was about ready to leave. The shaking lasted for maybe about a minute. Seemed like it went right for forever. But after it stopped, I looked around and I thought, Hmm, it seems like everything is fine. Ask the nurses in the ICU.

Hey, you think I can leave? And they were like, sure. So I left, got in my car. It was a gorgeous sunny day. There was no apparent damage. It was only when I was listening to the radio that I heard that the Bay bridge had actually collapsed. Honestly, it's a good thing that I wasn't significantly impacted because I was completely and totally unprepared.

Now we went on to live in the Bay area for another nine years. My kids went to preschool and they learned the whole duck cover and hold thing, we bought some water. We got some food staples just in case there would be another earthquake. But other than that, there was really no well thought out plan. And as an employed physician, it never dawned on me to ask what the plan was going to be in terms of my workplace.

From my perspective, if the clinic had shut down, we were just going to get a day off. Then I moved to Louisiana and started my own practice. By the time hurricane Katrina hit in August of 2005, I had seven providers and 30 staff members. I'm sure you've heard the expression that the light at the end of the tunnel is actually the oncoming train.

This was a great example of it. Unlike the earthquake that I had been through, we had plenty of advanced warning that there was this major storm that was coming. But that didn't mean that I actually knew what to anticipate. This was my first major hurricane since moving to Louisiana, nor did it mean that I actually had a well-designed plant. The good news for you is that I learned some very valuable lessons and I'm going to share them with you.

So lesson number one, you want to identify the decision maker and the decision-making timeline. Now this may be obvious. You know, if you're the only owner and you are the only provider, then obviously you're the one who's going to make the decision. Whether you stay open or you close. The bigger issue here is deciding when you're going to determine whether it's right to stay open or to close.

Okay? And as soon as you make that determination, it's really important that you communicate it. One of the things I learned is that your staff and your patients are also going to be trying to figure out what the plan is. And so the sooner you make that decision, the less chaotic things are going to be first. Let's talk about your staff.

If there's going to be an event like a major hurricane, an ice storm, a blizzard, they need to prepare for that. And they may even need to evacuate, okay, they're going to want the lead time and you need to have that time. So it gives you a sense of how are you actually going to staff your business. If you decide you're going to stay open,

who actually is going to be able to come to work and be there with you, you may decide, okay, I'm not going to close my business. And then you find out that the schools are going to be closed. If you have providers and staff who have school aged kids, you may find that everybody is scrambling to figure out their childcare options.

And they may not even be able to come to work. If they don't have anybody to mind their kids, or you have to come up with a solution for that, you may also have staff who already know that they're going to have difficulty getting to work or that they know that they're planning to evacuate. So the longer in advance that you can think through this,

the better off you're going to be. On the other hand, I will admit to you that figuring out whether you should close is truly a balancing act. You don't want to stay open only to find out that you have no staff to run the business and that you have no patients because they're not willing to come out in the middle of a storm, right?

You also, shouldn't be surprised if your patients are canceling their appointments. Even if you say you're going to be open because they're afraid to be on the road, you know, you can look at closing and this would make you look great. You every you're trying to make sure that everybody is safe and you're offering them alternative ways to recapture the visits. But it is incredibly frustrating.

Okay? When you hear that there is going to be a major storm and you decided to close only to have a beautiful sunny day and realize that you could've stayed open. Right? So, you know, having grown up in the Northeast and now living in Louisiana for more than 20 years, there've been numerous times where there's been a blizzard or a hurricane,

and it was projected to hit us only to find out it went someplace else. And I'll admit that there are times where this really feels like the little boy who cried Wolf, but it takes only one hurricane Katrina to appreciate the forecast can really come true. And this is where trying to figure out when you're going to make that decision is so important. It's kind of like Goldilocks.

You don't want to make the decision too soon only to find out the storm went somewhere else. On the other hand, you really can't afford to make it too late. So from my personal experience, it's almost always going to boil down to the day before. So lesson number two, you have to communicate with your staff. Once you've made the decision to,

for how you're going to deal with this, whether you're going to stay open or you're going to close, doesn't matter. You need to be able to communicate that to the staff and you need to know who's going to do that communicating. So if everybody is still at work, then that's pretty easy, right? You decided, okay, we're going to do X.

You call a five minute staff meeting and you say, Hey guys, we're going to stay open or we're going to close whatever it is. But everybody knows what the plan is right then and there, depending on the size of your practice, you can have your practice manager or some other delegated staff member do this. If you don't have time, or if you need to talk to each person individually,

you can send out an email, okay. That would be another way to communicate with people. You can send a text to people who are maybe not onsite at the moment, but the point here is that you need to have a plan for how you're going to communicate. What's going to happen. And more importantly, you also want to be able to get input from each person and know what their plan is.

So for example, with hurricane Katrina, we had people who knew that they were going to evacuate to Houston because they live in an area that always floods. We knew that it was going to take them time to return home, even when it was safe to return home. And that when we were ready to reopen, they may or may not be available to actually come to work.

But yeah, I have to tell you that was on many levels. The easy part we had staff that didn't anticipate any issues with coming back to work, who were then unable to get out of their driveways because they had a fallen tree blocking their way. We had people who had childcare issues and we needed to come up with a plan for how are we going to accommodate them and their children.

All right. We actually ran a daycare in the middle of my conference rooms so that we could get people to come back to work. So if you don't discuss people's personal plans with them on how they're going to deal with this upcoming event, you're not going to be able to anticipate how to run your own business when you're actually ready to go back to work.

And then one of the bigger challenges is what happens if this decision is made after hours, right? What happens if it's a weekend and all of a sudden the forecast changed and yeah, indeed it looks like the storm is going to hit you, right? So as part of the, your plan, you're going to need to identify who's responsible for contacting your staff when you're not all in clinic together.

Actually let me take a step back and tell you that before you do that, you need to have a list with every member of your staff and have all of their contact info. So phone number, home, phone, email address, and by staff. I mean, absolutely everyone, including all of your physicians, your mid-levels and anybody who works in any capacity in your office,

you're going to want to have a paper copy of this list. In addition to the one on your phone and on your computer. Now, the reason you need to have a paper copy is that you may not have any power and you may not be able to access the list on your computer and trying to make phone calls on your phone. While you're trying to look up,

the numbers can be very difficult. Trust me, I've been there. I've done that. And then it's also assuming that you have a backup battery for your phone and that it has enough juice. Part of your plan needs to be to collect this information and have the list updated on a monthly basis. When there's news of one of these big storms, everyone is so panicked.

There's not enough time and there's too much going on for this to be the priority. Oh my God, we need to get a list together, have this done way in advance. Then depending on the size of your practice, you're going to want to delegate some of the responsibility for contacting your staff. I can tell you that by the time I had 50 employees and that wasn't even including physicians and mid-levels getting in touch with everyone was a daunting task.

The solution is a phone tree. You take that list that I described to you above and you break it down. And then you assign a set number of people to a specific staff member. Who's responsible for contacting the people on their short list by doing this again, it allows that personal context. So you know what each person's plan is, but you also then have a way of ongoing communication because sure,

the first time you contact them, you may be able to email or text them. But let me tell you that in the middle of a natural disaster, you're more than likely going to have to contact your staff multiple times. You're going to call them to tell them that you're closing or you're not closing. And then as the situation changes, you're going to have to contact them again,

to tell them the next steps. If you've closed, you need to call them and tell them, okay, we're going to be reopening tomorrow in three days, whatever it's going to be. So for example, you know, you may say, Oh, we're opening tomorrow. And then it turns out that there is some other event and really the building still has no power.

And we have no ability to see any patients. So we need to get in contact with you again, to tell you, no, don't come to work. So you will need to have a system in order to have this ongoing communication. And let me tell you that in the middle of a storm, there may or may not be power and there may or may not be any internet service.

And I know you're probably thinking to yourself, Oh, well, that's okay. I'll just call them by phone. So let me tell you a little bit about calling people on the phone, in the middle of a disaster. And there is a high likelihood that you're not going to have great cell service. Is that well, think about it. If there is no power,

there is no internet. Then everybody and his uncle is on their cell service. And as a result, there is not enough bandwidth. If you've ever called somebody who is in the middle of a disaster, all you get is this really fast, busy stuff. So I'll tell you the text is actually yeah, easiest way to communicate in the middle of a disaster.

Why? Because it gets sent in small packets of information of data. And as a result, we were able to get text messages through when we couldn't get any other form of communication through, including just making a phone call. One of the reasons, you know, not to hit you over the head with this over and over again, part of the reason that you need to have this ongoing communication is you need to make sure that when you do open again,

that you have enough manpower to actually run your clinic and accommodate the patients who come out to see you, right? Because I'll, I'll tell you that when you have been closed and then you open, then all of a sudden it's as if somebody opened the flood Gates, everybody needs to be seen like right this minute. So part of the preparedness plan needs to include a contingency.

Maybe you need to adjust the hours. You're going to be open. Maybe you need to adjust provider schedules, knowing where everybody is and what they're doing. And what they're thinking in terms of your staff will help you make those adjustments. Then the third lesson I want to talk to you about is letting your patients to know the plan. You know, obviously you need to tell them the plan,

right? Needless to say, patients are going to be extraordinarily annoyed. If they show up to a closed office, especially if they venture out in the middle of a natural disaster to see you. And if you don't think this will happen, it will have been there done that. Amazed that people are actually coming out in the middle of a hurricane to pick up a prescription.

But whatever, similarly, you don't want people to assume that you're closed and not show up. If it turns out that you are actually open, because the last thing you want to do is come to work yourself and bring all your staff in only to sit in an empty office. So there are a number of ways that you can let your patients know what's going on.

First. You can post on your website, whether you're going to be open or closed, just make sure that wherever you post that announcement, it is incredibly obvious on that page. You're going to want to use your social media channels to post notifications. You can change the auto attendant message on your phone to convey the information. So, you know, if you call my number and you say,

and you want to leave a message, right? You get the, Oh, our office will be closed, blah, blah, blah, blah. All right. Use any automated option that you have. It will decrease the chaos for you. And of course you can use your patient reminder software to either call or text people with a status update. Obviously,

if you're going to close, you're also going to want to reschedule these patients preferably at the time that you're telling them that you're canceling their appointment, this is the easiest way to recapture them. Now you may be thinking to yourself, Oh, well, I've just lived through COVID. I'm just going to do this visit by telemedicine. Yeah. Right? That works.

Maybe for COVID. It does not necessarily work in the middle of a natural disaster. In reality, I wouldn't plan on it telemedicine a stable platform. And in other words, it requires a good internet connection in order to make this work. If you don't have a good internet connection or your patient doesn't have a good internet connection, chances are, you're not going to have a telemedicine visit.

And you're just going to frustrate everybody in the process. I would tell you reschedule the appointment after the event passes. Now, if your office is going to be open, then the main thing you have to worry about is whether people will actually show up. And so I want to talk about that as an aside for a second, that even if you're open,

you need to anticipate that you are going to have a bunch of last minute cancellations and no-shows think through what your cancellation and no-show policy is. And whether you want to amend it in this situation. For example, you may want to consider weaving the cancellation and no-show fee in these extenuating circumstances. Also, my clinic had a late policy, meaning if you were late by 20 minutes,

then we had the right to cancel your appointment and reschedule you. But let me tell you that you aren't going to decide to close your practice every time there's a major storm. So if you decide to open and patients come and they show up late, assume that you're going to see them realize that the schedule in the middle of these storms goes out the window and that you just got to roll with the punches.

If you're going to open, probably the biggest issue is what happens if you need to cancel the clinic after hours, okay? You've made this decision. It's now that night, or it's on a weekend. How are you actually going to communicate with these patients? And you may say to yourself, well, I should be able to make that decision ahead of time.

Well, okay. But sometimes you're monitoring the situation and it doesn't seem that bad. And then all of a sudden, Oh wow, it's really headed straight for us. Or maybe you live someplace where it's a tornado or an earthquake that comes without warning. Oh my God, I didn't know. Three days in advance that I might have to close. So let's assume that there are going to be a time where it happens and it's after hours and you have to get ahold of these people.

Of course, you're going to do all the same things you would do. If your office is open, like post on your website, social media channels, but that's not enough. Okay. If you're going to close, you really want everyone to know. So they don't have to show up. You're going to want to set up a prerecorded automated message using your patient reminder software.

This is something that you can do well in advance. Okay? Most of the automated software options allow you to have multiple customized reminder messages. One of them should be a message stating your office is going to be closed. And the message should instruct the patient, how it is that they're going to get rescheduled. You can make that message long in advance when there is no events on the horizon and store it and have it ready for use.

The key here is though that you need to have a written protocol for what happens when you actually need to deploy that message. So back to lesson, number one, who is in charge, once you've made the decision to close the office, who's responsible for which aspect of notifying patients. If you have a tiny practice with limited staff and patients, the answer may be you,

you and you. So, you know, obviously the easiest thing for you to do is post on your Facebook page on Instagram, on all of your social media channels on your website. But don't forget, you have to notify the local radio station, the local TV station, the newspapers. Why? Because in an emergency, people are listening to the radio to hear about closures,

right? Don't miss that opportunity. If you are going to use your automated software, do you know how to program it so that it will deliver the message? You sure you may have gotten the message recorded, but do you actually know how to load it so that it goes out to the schedule patients and what happens if that fails? Hey, think through that contingency,

I want to point out to you that in the middle of chaos, the logistics are never as easy as you think. So as with everything else, that's why we have fire drills, right? Practice it, come up with a policy, write a plan before, and then test it. If you have staff, make sure that you delegate part of the plan and that there is a contingency plan.

There's redundancy. What happens if the person that you assign this to really can't do it, maybe they don't have power. Maybe they don't have internet. Then, you know, I want to tell you that you also need to think about trying to minimize patient phone calls and questions. The last thing you want to deal with is multiple calls from a patient or multiple calls from your answering service after hours asking,

how are we going to deal with this? Okay. You, if you're having an answering service, make sure you have a script with a clear set of instructions for patients so that the answering service can communicate so that you don't have to feel that phone call, print a copy of the patient list with their phone numbers and their email addresses at a minimum print,

one day's worth of the schedule worth of demographic information. Ideally you could print up two a week, right. But at least one day. So if you're leaving on Friday and you know, there's a storm brewing print out Monday schedule, I promise that we'll come back and help you on many, many, many levels. Right? And I know you're thinking to yourself,

well, why should I do that? A, I want to save the trees and B it's on my computer. Well, okay. But you're making a couple of assumptions first here, assuming that you or whoever is supposed to do it will have power and internet access. Second, if your practice management software is based on your or server in your office,

you have to assume that your office is going to have power and internet. Because if it's sitting on your server and you don't have any power or, or internet at your office, you're not going to be able to access it either. Even if your practice management software is cloud-based remember that being able to access it requires bandwidth and that in an emergency, you may not have the,

the bandwidth to actually access that server in the cloud. So you may find that you're stuck with individually calling or texting each one of those patients. If you can't manage to get the automated software to work. So in order to efficiently reach all of these patients, I would recommend to you that you're going to want to divide the list and the responsibility for notifying the patients the same way I told you about for the staff.

Okay? Now, if you're small practice and you only see 10 patients a day, this is not a problem. But if you're a practice with multiple providers, all right, those numbers become huge very quickly. In my practice, we would easily see 250 to 300 patients per day in clinic. And that's not even including our procedures or schedules. So there are not enough hours in a day for one person to call or text that many patients.

And you can only imagine that in the middle of a crisis, patients want to ask all sorts of questions. When's my appointment, getting rescheduled. Can I get my meds refilled? What about my, and you can name the problem, which was not a significant problem, but all of a sudden, because you're canceling their appointment has now become an emergency.

As you can see, there is no way to deal with this, but to divide and conquer, assigning 10 patients to each staff member, and then have a backup person just in case, which brings me to my left last point. You're going to need to equip who ever is going to be contacting these patients with a clear script of how to handle the questions regarding rescheduling medication refills,

and anything else that you think is relevant. Why, because they're not going to have hours to spend calling the patient and then calling you and trying to get an answer. And the chaos just becomes uncontrolled. If you have that script. And that script is based on the plan that you've already thought through. I promise you that weathering a natural disaster becomes way less of a big deal.

And then you can just turn your attention to actually managing your own personal preparedness. Thanks for joining me. Be sure to sign up for my newsletter below, and I'll be sending you tips on how to start your practice best run your practice, grow the practice, and then ultimately be able to leverage your medical practice into multiple other businesses. I hope to see you soon.