The Hotel Business in 2014

My records show 685 calls during 2014, slightly fewer than 2013. This represents my first decline since 2001 (the months after 9/11 were bad for tourism).

In my defense I took more time off because we bought and remodeled a house in Lexington, Kentucky where I plan to retire in the future. The distant future.

While this is comforting, the painful truth is that hotel doctoring has grown brutally competitive.

If you google “Los Angeles house call doctor” half a dozen names appear but not mine. Furthermore, these newcomers are amazing: Christlike in their empathy, compassionate, brilliant. For proof, read comments on Yelp or Healthgrades: five out of five stars every time, unanimous praise.

These doctors market aggressively. They have web sites. They visit hotels, speaking to concierges, bellmen, and desk clerks, undoubtedly emphasizing their compassion and brilliance.

Most hotel managers ignore this area, so when a guest asks for a doctor, the choice is up to the employee. While I’m the best choice, most doctors are adequate although you must google “Jules Lusman.” He arrived, acquired a flourishing hotel practice, and left the country in 2003 in a flurry of publicity and minus his license.

Every Los Angeles hotel has called me. About twenty call exclusively, but even their employees are not immune to the charm of these newcomers.

Luckily, calls directly from hotels make up less than half my business. I’m the doctor for half a dozen travel insurers with offices around the world. I also work for national housecall services which solicit the general public as well as hotels. I care for airline crew when they lay over. When Frenchmen living or passing through Los Angeles get sick, they call a French lady who calls me.

These businesses pay attention to the bottom line: quality of service and fees. They have less interest in charm or the amenities that appeal to hotel employees. I don’t foresee a problem with them.

No Housecalls Today

A guest dropped an ice bucket on her toe. Pain was excruciating, and blood poured out. Holding the toe under the tap didn’t help.

Over the phone, I explained that running water won’t stop bleeding. She should apply pressure over the wound and add ice to dull the pain. When I called an hour later, she was having dinner in the hotel restaurant.

A man had developed a slight cough, in his opinion a prelude to full-blown bronchitis. He wanted something to knock it out. I explained that, in a healthy person, viruses cause almost all coughs. I could come, but I couldn’t promise an antibiotic. The man said he would get a second opinion.

A teenager bumped his head on a bedpost and developed a lump the size of an egg. The parents asked that I check him for brain injury. That requires a CT scan, I explained. He would certainly get one if he went to an emergency room, but the injury didn’t seem serious enough for that. It was OK to wait. He did fine.

A guest had missed his flight because of an upset stomach. He was well now but needed a doctor’s note to avoid an expensive ticket-exchange fee. These requests arrive now and then, and they put me in a difficult position. I can’t write “The guest was unable to travel because of an upset stomach” because I don’t know if that’s true (sometimes the patient admits that it isn’t). So I offer to write the truth: “The guest states that he suffered an upset stomach and could not travel.” I sweeten the pot by offering to fax it to the hotel at no charge.

Guests usually accept. To date, no one has complained, so the note may work.

Concierge Doctors

I belong to the American Academy of Family Physicians (AAFP), the leading organization for family doctors with about 100,000 members. My physician brother, more activist than I, belongs to more  liberal physician organizations which are much smaller.

I bought a lifetime membership years ago, so I’m stuck with it, but its heart is in the right place. The AAFP wants members to practice high quality, compassionate medicine and requires that they stay educated and pass a test every seven years. It expresses deep concern with Americans who can’t afford medical care but refrains from urging doctors to greatly inconvenience themselves to remedy this. Most doctors are conservative; the AAFP’s leadership is more politically sophisticated than its members, but, in the end, it reflects their interests.

That brings me to today’s subject. I was perusing the AAFP’s weekly news bulletin. One article cheerfully announced that direct primary care was piquing everyone’s curiosity and that two physician-entrepreneurs would provide the “inside scoop” in a web workshop free to AAFP members.

I was preparing to move on when, with a shock, I realized that direct primary care is a euphemism for concierge medicine. The AAFP was plugging concierge medicine!!! That’s like promoting Mexican cancer clinics!

If you’ve followed this blog you know my low opinion of concierge doctors. They don’t accept insurance. Patients usually pay a monthly or yearly retainer in addition to the usual fees; in exchange, they receive quick access, longer appointments, and, if necessary, housecalls. This money pays for the doctor but nothing else. Tests, X-says, therapy, specialists, and hospitalization cost extra. It’s a luxury service.

When concierge doctors address the public they extol the superior care they deliver to a grateful clientele. Around the lunch table with only doctors present, they extol the pleasures of a cash-only practice. I've never met a concierge doctor I could respect. 

Finishing the article, I hit the “comment” button and forgot my rule about not responding in the heat of emotion. The satisfaction of delivering my opinion which included the adjective “sleazy” evaporated when I read the avalanche of abuse that followed.

Later that day an E-mail from an AAFP official explained that readers were complaining at the lack of respect shown in my response, so it was being deleted. It vanished, but the angry responses remained. You can read them at http://www.aafp.org/news-now/practice-professional-issues/20130508directwebinar.html. If that’s too much of a mouthful, google “inside scoop on running a direct primary care practice” and it will turn up.    

Ever Hopeful

I made a housecall to the Four Seasons recently. Years ago, I shared the Four Seasons elevator with Robert Duvall. He was reading a script, and I pretended not to notice.

I’ve responded to half a dozen calls from that hotel over thirty years, but this was not one. Assistcard, a travel insurer, had sent me to see an 18 month-old with a cold. I took care of the child and left without introducing myself to the concierge.

The Four Season’s house doctor is the only colleague who has been around longer than I, and he serves half a dozen premier luxury hotels around Beverly Hills. In the distant past I covered for him when he wasn’t available. My records show 45 visits to the Four Seasons and several hundred to his other hotels. I loved those calls.

I retired in 2003 and unretired in 2007. During my absence he found someone else to help out. While he welcomed me back, I’m no longer his main support, but he phones at rare intervals.

When insurance services send me to hotels that don’t call, I remind the staff of my superior qualities. This has proved an excellent source of new clients but, ever hopeful, I don’t solicit this doctor’s hotels.  

"Do You Go To Ontario?"

“Do you go to Ontario?” asked the dispatcher for Expressdoc, an agency that sends doctors on housecalls. Travel insurers who don’t call me directly use Expressdoc. It’s a mystery why because it costs them extra, but I charge the same no matter who calls, so I don’t mind. Ontario is in San Bernardino County, fifty miles distant, but this is small potatoes. My record is ninety miles to Carpinteria. Freeway traffic, not distance, determines if I drive. I delay distant, late afternoon visits until the evening. Morning drives are acceptable; the hours between ten and noon are golden because traffic slows after the morning rush; it builds again after twelve, and there is no afternoon decline. The Ontario call arrived at 12:20, so I was not optimistic about the return. But it worked out fine. I took the Pomona freeway, bypassing downtown, and the hour’s drive passed with no significant slowing. I listened to Slaughterhouse Five on my CD; highly recommended.

The patient was a Brazilian lady visiting her son; her upset stomach presented no problem. Accompanying me to the elevator, the son he told me he was reevaluating his decision to remain in the US because the political atmosphere had grown so shrill and confrontational. I agreed. Did you ever think there’d come a time when South Americans considered their governments more stable than ours?

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.

-0-