A Dog-Eat-Dog Business, Part 7

When a travel insurer sent me to the Airport Marriott, I remembered that the hotel hadn’t called in a year, so I decided to reintroduce myself.

“We don’t have a doctor,” said the lady in the security office.

“I’ve made hundreds of visits.”

“I never called you,” she insisted. She summoned a nearby officer who agreed that no one knew about a hotel doctor. She accepted my card and put it in a drawer.

My next stop was the concierge desk, but it was vacant. When times are tough, concierges are the first employees to go.

The front desk clerks agreed that having a hotel doctor was a wonderful idea and thanked me for my cards.

“I guess no one’s been sick,” said the bellman cheerfully when I queried him. I had no doubt that whatever doctor he called tipped him $20 or $30 or $50 for the referral. This is illegal but a common practice. The bellman thanked me for my card and put it in a drawer.

If you assume that general managers hate choosing a doctor on the basis of his kickback, you’d be right. Sometimes. When I informed the GM of the Westin, he took action. When I informed the GM of the Beverly Hills Hotel he merely passed my letter on to the chief concierge who phoned to announce that I need expect no calls from the Beverly Hills hotel.

Sick guests often call the operator, so I dialed the Marriott’s number.

“Hi, Doctor Oppenheim. It’s been a long time.”

That was a pleasant surprise. The operator explained that she had worked there for twenty years and spoken to me many times. She admitted that the hotel had no policy on doctors nor was any name in their directory. She would be happy to take down my number and pass it around. 

I left feeling pleased with myself because I hardly ever market myself to employees. I continue to make the occasional visit to the Marriott but always at the request of a travel insurer. The hotel itself remains silent.

How a Hotel Doctor is Like a Prostitute

I make the majority of my calls at the request of national housecall agencies, international travel insurers, airlines, and a sprinkling of miscellaneous sources including other hotel doctors. That’s fine with me.

A few dozen Los Angeles area hotels call me exclusively. That leaves over a hundred, all of whom have my number but who call another doctor or no doctor and sometimes me. Competition for these hotels has become so cutthroat that I’m happy to leave it to others.

If you’ve followed my posts you’ve learned about my excellent skills and low fees. Why would a hotel bother with anyone else? The answer is that service and price are useless marketing tools in medicine where the law of supply and demand doesn’t work. 

Providing a doctor produces no revenue for the hotel, and guests don’t demand one, so most general managers pay no attention. Asked for help by a guest, employees are on their own. 

They may simply give out a number, but many prefer the traditional arrangement once used to summon a prostitute. A bellman made a phone call. As the lady left, she stopped at the bell desk to drop off a portion of her fee.

It’s illegal for a doctor to pay for a referral, but what are the options for someone yearning to break in to the glamorous and lucrative world of hotel doctoring? Claiming to deliver superior medical care sounds weird. Advertising a low fee is vulgar. Whoring works better.

A Dog-Eat-Dog Business...again

Waiting at the local carwash, my eye ran over a sheet of ads along one wall. Among notices for personal injury lawyers, pest control, acupuncturists, and pizzas was a photo of a smiling young man in a white coat carrying a doctor’s bag. According to the text, a phone call would bring him to your door at a fee less than an emergency room’s. All ads for housecalls deliver this cheerful boast, never mentioning that the average ER visit has passed $1500.    

My first instinct was to chuckle at the waste of money. Few customers at a carwash will pay the going rate for a housecall. My second instinct was to worry. This fellow was ambitious. His web site features the same photograph plus testimonials from rating sites such as Yelp describing him as a healer of Christ-like compassion.

My third instinct was to recall a visit to Le Petite Hermitage, a small boutique hotel off the Sunset Strip. The guest had spoken to this doctor the day before, decided against a visit, and expressed pleasure at finding me and my lower fee. Since Le Petite Hermitage was a regular, I assumed he’d gotten the name from the internet. Now I’m not so sure because this occurred early in the year, and hotel hasn’t called since.

In large hotels employees know me by sight and take for granted, even without an official announcement, that I’m the official doctor. Since it has only 80 rooms, I may not visit Le Petite Hermitage for months at a time, so I’m not a familiar face. As a result, when an entrepreneurial physician makes an appearance to extol the benefits of his service including, perhaps, an amenity for the employee who refers a guest, he makes an impression.

A Dog-Eat-Dog Business, Part 2

“Doctor Lusman is out of town. Could you speak to a guest at the Fairmont?”

That was a jolt. Lusman was an ambitious young doctor who had phoned months earlier to introduce himself and offer to cover my hotels when I wanted to get away. I declined but suspected he was poaching. For Lusman to instruct his answering service to send me to one of my regulars showed immense gall or perhaps immense confidence.

In private practice it’s unethical to solicit another physician’s patients, but hotels are a grey area. Established hotel doctors who want to remain on friendly terms do not step on each other’s toes. I had made hundreds of visits to the Fairmont.

After the visit, I stopped by the concierge desk to mention that a guest had called another doctor.

Her eyes widened. “Gosh, I don’t know what happened, Doctor Oppenheim. The guest never talked to me.”

I felt better. Maybe it was an innocent mistake. This feeling lasted until I passed the front desk, and a bellman called out.

“Doctor! My name is Andre. I’m glad to meet you.” He hurried over, holding out his hand; we shook. “It was me that called you for the guest. Is he doing OK?”  I knew what this meant.

“Who do you think I am?”

The bellman cocked his head. “Aren’t you Doctor Lusman? People say I should call Doctor Lusman.”

“I’m Doctor Oppenheim, the hotel’s doctor.”

He looked confused. “Where’s Doctor Lusman?”

“He’s not available. You should call me in the future.” I walked away, pleased at frustrating the bellman who clearly expected a payoff. Bellmen were hopeless, I told myself. Concierges were the key to a hotel’s loyalty, and it looked liked they were still in my corner.

But this happened some time ago, and I haven’t heard from the Fairmont since. 

I Get Letters

In my dreams, agents write, suggesting a book, perhaps entitled “Hotel Doctor to the Stars.” So far these haven’t arrived, but physicians occasionally E-mail me. They want to know how to become a hotel doctor.

I advise them to (1) let local hotels know they’re available and (2) wait. It helps if (3) there’s no competition. That worked for me although I began in 1983 and it wasn’t until 1992 when my yearly visits passed 1,000, and I quit other jobs to become a fulltime hotel doctor. By then others were entering the field, so newer doctors will wait longer.

My only advertising is a dignified letter to general managers three or four times a year. Aggressive competitors who extol their services to desk clerks and concierges often take over my regular hotels, at least temporarily, but it didn’t work when I tried it. At better hotels, employees are nice to everyone, so they listened intently, eagerly accepted my business card, and promised to keep me in mind. The first few times, I left feeling pleased with myself, but calls never followed. At cheap hotels and motels, staff seemed mystified at the concept of calling a hotel doctor. No one ever got sick, they insisted.

It’s possible I was missing the key inducement: money. Paying a bellman, desk clerk, or concierge “referral fee” has a long tradition in hotel doctoring. It’s illegal, and all my competitors condemn the practice, but I suspect it happens.

Advice

Note: I originally wrote this for hotel general managers, but any reader will learn a great deal.

Having a house doctor may be the best service you provide that doesn’t cost the hotel anything. Except… how do you know guests are getting good service? How much control can you exert over a doctor? The answer is: a great deal. You would never dream of setting your family doctor’s fees, choosing his office hours, or insisting he respond immediately when you call. Not only can you influence all these factors, you should. If you’re reluctant, here are some questions whose answers might unsettle you.

1. Is your doctor charging $600 a visit? It happens, and guests pay. But they don’t like it.

2. Is he liberal with phone advice, and how much does he charge? The answers may not be yes and zero, but they should.

3. How does he respond at 2 a.m.? Is he a bit testy? Does he send everyone to an ER or suggest they wait till morning? Does he tell your staff to summon paramedics even if there’s no emergency? You don’t want that.

4. Does the doctor, as he leaves, slip $20 to a bellman or concierge? That’s illegal but a tradition among hotel doctors. Your employees will never mention this, but you may not want them to choose your guests’ doctor according to the size of his kickback.

THE NATURE OF HOTEL DOCTORING

When I began during the 1980s, only luxury hotels had a “house doctor,” usually a local practitioner who did it as a sideline. Nowadays, in a large city even the lowliest motel receives blandishments from a dozen individuals plus several agencies that send moonlighting doctors if they can find one. “Hotel” doctors often acquire hotels by dropping by to extol their virtues to front desk personnel, perhaps with the promise of a tip. I got my start in Los Angeles writing letters to general managers, but this was 1983 when no doctor served chain hotels (Hiltons, Holiday Inns, Ramadas, Sheratons). Despite this, responses were slow; it was 1992 before I became a full-time hotel doctor, and there will never be another.

During the 1990s, half a dozen housecall services sprang up. Working from a central office with an 800 number, they accepted calls from around the US and then phoned a local doctor to make the visit. At that time, their base fee was about $200. The doctor received half but could keep whatever extra he charged for drugs and injections. Finding someone willing to make a housecall on the spur of the moment turned out to be difficult. Agencies quickly learned about me, so I made hundreds of visits for organizations with names like Hoteldocs, Expressdoc, Travel Med, and Medical Express. An agency that clears $100 per visit requires an immense volume to make a profit, so most have vanished. I once made visits for AMPM Housecalls which charged $350 per visit around 2001-2. AMPM Housecalls remains in business.

Since GMs hear about only the most disruptive problems, they underestimate how often guests want medical attention. A hotel generates one to three requests for a doctor per month for every hundred rooms. As an example, my records over recent years show that the Ritz-Carlton in Los Angeles (304 rooms) called me 77, 84, 83, 77, 100, and 66 times.

Guests who ask for a doctor want a doctor. They don’t want directions to the nearest emergency room or a list of clinics. In my long experience, about ten percent of Los Angeles hotels refuse to name a doctor because of liability fears. The hotel lawyer has explained that when a guest sues the doctor, he’ll also sue the hotel that recommended him. That’s right, but it doesn’t matter! Having a good hotel doctor doesn’t cause liability problems, it prevents them.

Here’s the scenario. A guest feels ill, consults the staff, receives a list of clinics, returns to his room to think matters over, and dies. Under this circumstance, lawyers will fall over themselves in their eagerness to sue the hotel. After all, the guest asked for help and didn’t get it. When I visit guests who need urgent care (it’s not always obvious), I take them to my car, drive (gratis) to a clinic or ER and usher them inside. This is not only good medicine, it’s self-defense. I’m responsible for that guest, but once he settles into another facility, I’m off the hook. Your staff could offer the same service, but they lack a doctor’s authority. When I decide a guest needs to go somewhere, I don’t take no for an answer.

THE RELATIONSHIP

In the old days, hotel staff summoned a doctor in the same way they summoned a prostitute. A bellman made a phone call, and the lady arrived. Departing, she stopped by the bell desk to leave a portion of her fee. This custom has not vanished. In my regular hotels, I was always aware of a few employees who called competitors because they wanted the tip.

Even in the old days, a European hotel’s doctor was not an employee, but these things were managed better overseas where general managers chose the doctor. This is clearly not the case in the US because I recall only half a dozen interviews in thirty years. Of course, hotels that chose me sight-unseen never had cause to regret it, but this was not invariably the case. Google Jules Lusman.

An encounter with a doctor sticks in a guest’s mind, so you should do your best to ensure it’s a positive experience. This means an interview and a check of credentials. To find candidates, phone other hotels to ask who they use. Any experienced concierge or bellman can provide names if approached tactfully. Asking your family doctor might help, but most doctors hate doing housecalls, and you wouldn’t want someone with a busy practice. Internet searches are skimpy (“housecall doctor” works better than “hotel doctor”). Your mail may turn up publicity from housecall agencies, but these are a crapshoot because they employ an ever-changing cast of moonlighters.

Determining a doctor’s competence is essentially impossible (fortunately most are OK), but you want to make sure there are no skeletons in his closet. Don’t spend money on internet companies that claim to uncover a doctor’s background. Simply do a search for “(your state) medical board complaints” to find a site where you can enter the doctor’s name and learn if he has come to the board’s attention. In California, this turns up http://www.medbd.ca.gov/Lookup.htm where you can check me out.

Then you or a trusted colleague should ask him to drop in. The interview shouldn’t take long; your guests will form an opinion based on a quick first impression, so why shouldn’t you? It’s a good idea to keep in mind the following.

WHAT GUESTS WANT WHEN THEY WANT A DOCTOR

1. When guests call the doctor, they should reach the doctor.

I’m amazed that physicians still use numbers that reach answering services, beepers, and receptionists. Mine reaches my cell phone. Guests love that I answer in person. Other doctors express horror that anyone can call my “home number.” I point out that hotel doctoring is a luxury service and expensive. Guests should get what they pay for. Since it’s also highly competitive, a GM should have no trouble persuading a doctor to respond quickly. It’s something you can check on by dialing the number now and then.

3. Phone advice should be free.

Lawyers agree unanimously that doctors should never, never give advice over the phone. Some obey, but you don’t want one to serve your hotel. More than half of guests who call me don’t require a visit, so this is no minor matter. Here you’re out of luck if you use a commercial housecall service, because the guest will speak to a dispatcher whose sole duty is scheduling a visit.

Every few months a guest will unpack and realize his or her heart medication or birth control pills are at home. They will be in despair, because they assume getting a replacement will be a tiresome, expensive process. They love hearing that the house doctor will simply phone a local pharmacy. I do that regularly, and I don’t charge.

4. When the doctor agrees to come, he should come.

Since competition moved in, my greatest source of new clients is doctors who take hours to show up. Patients will fume quietly in a waiting room, but hotel guests are quick to complain. Staff then call the doctor’s number, reaching the answering service who promises to page him. After a while they call me. In thirty years, no one has called to wonder where I am because I always tell a guest when I’ll arrive and call again to apologize if I’m delayed. This is such common courtesy that you should be deeply suspicious of any doctor who gets complaints. If asked about housecalls during the wee hours, all candidates will proclaim their eagerness, but your staff should keep a record of guests who ask for help late at night. You’ll soon learn if the doctor doesn’t like to get out of bed.

5. He should not charge an arm and a leg.

I charge $200-$250 during most of the day plus $50 for calls that get me out of bed. Guests at cheap hotels pay less. My only extra is for distant hotels which varies according to the distance and how reluctant I am to make the drive. I don’t charge for supplies or medication, and that includes injections. These turn out to be surprisingly cheap; I rarely give out anything that costs me over $10, and most guests get everything they need. My housecall fee is less than the going rate which is probably around $300 plus medication. Don’t assume this is because of my deep humanitarian instincts; it’s a rate that I feel comfortable quoting, and I’ll certainly raise it as time goes by. But it does cause resentment even among rival hotel doctors with whom I’m on speaking terms. They probably think I’m trying to steal hotels, but, if pressed, they’ll admit that hotel management doesn’t care what the doctor charges and most probably don’t know his fee. As long as patients aren’t complaining, management doesn’t don’t care. I’ve never acquired a hotel because my fee is lower.

Don’t be reluctant to tell the doctor how to run his business. An office practice may have several thousand patients. At my busiest I had forty regular clients and twice that many who called irregularly, so a single hotel represented a major source of income. No sensible doctor will ignore your suggestions. Here’s one that worked. Long ago, I charged $100 for a visit, but expenses were rising, so I decided it was time for an increase. Shortly after, I visited the JW Marriott in Century City, a regular. All upscale hotels and many chains will pay my fee, adding it to the guest’s bill (a good idea; guests like it, and it enables you to keep track). When I handed my invoice to the concierge, she examined it, hesitated, then said: “I see you’ve gone up to $120… Doctor Lusman stopped by a few weeks ago. He said he’d see guests for $100.” What could I do? Thereafter, guests at the JW Marriott continued to pay $100. Guests everywhere else paid more. Wasn’t that easy?

At midnight in the hotel restaurant, a guest asked the waiter to light her cigarette. When he complied, her finger burst into flame. She had recently applied acrylic nails, and the cement is flammable. The guest was drunk and abusive, and she refused to go to an emergency room… I’ll save that story for an essay in which I recount times I’ve saved a hotel’s bacon. This won’t happen often, but you’ll thank your lucky stars when it does.

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