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blog articles
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better marketing solutions
blog header image

A Marketing Manifesto

manifesto [ma-nuh-fe-stoh]: a written statement declaring publicly the intentions, motives, or views of its issuer. Related to a 14th century English term meaning “easily recognized.” 

(nb: At least, I hope what you see here will be easily recognized. If not, that’s ok. But if you will indulge me, and you have the time, I’m confident we will get there.)

Manifesto Index

  1. What is the 7R+1 Marketing Strategy? 
  2. Our Vision: Resilience for adapting and succeeding in a COVID environment
  3. Our Purpose: Positioning you as a premium services preeminent practice
  4. Flywheels: How To Do Better Ophthalmic Marketing
  5. Postulate 1: Rethink how you think about things
  6. Postulate 2: The less we know about something, the more we think we know about it
  7. Back story - who am I and why am I telling you this? 
  8. Postulate 3: Information is not the same as knowledge
  9. Postulate 4: There is a science to marketing
  10. Postulate 5: Good marketing is an investment, not just an expense
  11. The 7Rs and the one R to rule them all

You practice evidence-based medicine.

Why don't you practice evidence-based marketing?

This, in a nutshell, is the premise of our 7R+1 Marketing Strategy Manifesto. In order to practice evidence-based marketing, your marketing endeavors should be measurable, repeatable, scalable and automated. This is accomplished by mapping all of your marketing campaigns (as much as possible) to the 7R Strategies:

  1. Reputation
  2. Review
  3. Retain
  4. Resell
  5. Reactivate
  6. Recruit
  7. Refer
7R pyramid
7R Strategy Pyramid, Ultimate Ophthalmic Marketing Guide

We first described this in our book “The Ultimate Ophthalmic Marketing Guide.” We’ll go more into detail on these later. But, first I would like to describe the genesis of the 7R strategy and what makes it more than just a clever tagline.  

Side note: Ophthalmology is almost equal parts medical, surgical, and retail and thus much of what we cover here would apply to other medical specialties. So, to any of our non-ophthalmic colleagues who may have stumbled upon this site, welcome, and I hope you will some find some useful nuggets.

Second, in this chaotic time of a pandemic, 7R has evolved to become 7R+1, signifying that we have now added another “R” to rule them all: Resilience. So this is the one major change since we first launched the 7R concept.

Our Vision: Resilience for adapting and succeeding in a COVID environment

modern definition of resilience

I think most of us would agree that the practice of medicine - if not all business in general - has forever been changed by the COVID pandemic. Can you yourself ever hugging or shaking hands with a patient?

And how long and how severe the financial effects are/will be we can’t even begin to assess at this point.

According to a survey of members by the American Academy of Ophthalmology, a majority of practices did not believe that they would return to pre-COVID levels of either size, volume or financial health:

  • 47% will be smaller and financially unhealthy
  • 26% will return to pre-COVID size and volume, but financially unhealthy
  • 14% will be smaller, but financially healthy
  • 6% will no longer practice ophthalmology (!)
  • 2% of practices will be sold
  • Only 6% believe that they will be back to pre-COVID size, volume and financial health.

Our Purpose: To help position you as a premium services preeminent practice

So what is the point of all of this? An Authority Marketing Strategy? Resilience?

Your business may be down for who knows how long so it is easy to pivot to a mindset of cutting costs during these difficult times - and, yes, reducing expenses will be necessary - and marketing (and sales) are usually one of the first things to go on the chopping block, in large part because marketing has traditionally been a squishy expense item with no measurable return on investment.

Firms that cut costs faster and deeper than rivals don’t necessarily flourish. They have the lowest probability—21%—of pulling ahead of the competition when times get better - Harvard Business Review

So this is an opportunity to reassess the role of your practice marketing and to subject it to the same scientific method that you use for new surgical techniques or therapeutic modalities. Because we know that we can be fooled by anecdotes, biases, and poorly designed studies. 

Case in point: the hubbub around the treatment of COVID19 with hydroxychloroquine. And, yes, many doctors were also sucked into it. Based on the results of a single French study headed by a scientist of dubious reputation, everyone (including the federal government) started stockpiling the medication for themselves and family members. After all, many of us monitor patients on Plaquenil for potential maculopathy and we never really heard about any serious side effects. So, we asked ourselves, “what do we have to lose?”

But soon after, the randomized trials started dripping out their findings and the
results were not so rosy: no real benefit, especially for sicker patients, and reports of serious cardiac events. It turns out that medications don’t necessarily behave the same way for different diseases, even at the same doses.

Thus, the importance of applying scientific critique to the study of medical therapies lest we do more harm than the disease itself.

Why should the non-clinical aspects of your practice be any different?

If we were going to asses a new procedure or therapy in your practice, we might do something like this:

Design the study > Allocate your resources > Measure your results > Make any necessary changes to how you practice

If we were going to get scientific with our marketing, we would describe the same thing this way:

Map > Build > Track > Optimize

Now, that's not so hard, is it?

But before we get into the granular details about the 7R+1 Strategy, I want to set the framework for our discussion. Because without the proper context, all of this might seem superfluous, particularly in this time of crisis. I would submit, however, that this is especially the setting in which to consider that.

Postulate 1: Rethink how you think about things

First of all, let me start by saying that it would be very easy, but lazy, of me to just throw a lot of information at you and presume you will simply accept it. The problem is that the validity of information decays over time. And, anyways, most of what we read and see we forget shortly after.

forgetting curve
Forgetting Curve - David Handel, MD

What does stick in our brains, however, is a concept or a way of thinking. What is known as a mental model.

From Wikipedia:
A mental model is an explanation of someone's thought process about how something works in the real world. It is a representation of the surrounding world, the relationships between its various parts and a person's intuitive perception about his or her own acts and their consequences. Mental models can help shape behaviour and set an approach to solving problems (similar to a personal algorithm) and doing tasks.

A mental model is a kind of internal symbol or representation of external reality, hypothesized to play a major role in cognition, reasoning and decision-making. Kenneth Craik suggested in 1943 that the mind constructs "small-scale models" of reality that it uses to anticipate events.

10x engineer mental models
Mental Models - 10x Engineer Blog

For a more detailed explanation and real-life applications, you can check out what Charlie Munger of Berkshire-Hathaway fame says about mental models.

So let's not get bogged down in facts and figures so much - although they do provide context - and instead let's try to look at some old things in a new way. And speaking of how things are looked at….

dilbert marketing is fraud

…why is marketing always looked upon as a necessary evil? Why are most physicians so down on marketing (notice I didn’t say down with) and yet, so quick to proclaim how much they know about marketing? Well, those two seemingly incongruent beliefs are actually explained  by science (more on this in a bit).

Now while I may know a lot about marketing, it doesn’t make me an expert. To be considered an expert, I would need to know more than 99.9% of you reading this. The more I read, study, or watch, the more I realize what there is to know, and it’s very humbling. In other words, the more I think I know, the more I realize I don’t know (see Postulate 2).

So I’m not THE expert on ophthalmic practice marketing, but I feel I’m safe in saying that I have acquired enough relevant knowledge and information over the past 25+ years that there is probably something of value I can impart to my colleagues.

Hopefully you will agree.

Now back to the science and why we think we know more about something than we really do.

Postulate 2: The less we know about something, the more we think we know about it

dunning kruger ophthalmistslogy

Dunning Kruger curve for ophthalmologists, Ultimate Ophthalmic Marketing Guide

I have written about the Dunning-Kruger effect  before in our book, The Ultimate Ophthalmic Marketing Guide, in explaining why so many of us doctors - all very bright and highly-educated people - think that our intelligence translates to all other fields and all disciplines.

The graph has been iterated in numerous industries and the Y axis is usually labeled as confidence, but if you google Dunning-Kruger you will see a multitude of different takes, most serious, some hilarious. Regardless, the curve is fairly universal no matter which area of expertise is studied.

As Michael Simmons from the Accelerated Intelligence blog describes:

In 1999, psychologists Justin Kruger and David Dunning wrote a research paper, that introduced us to the Dunning-Kruger Effect.

The idea is simple but counterintuitive: In learning any new domain, our confidence is actually highest when we start. This is surprising because, rationally, we should have the lowest confidence when we know the least. However, Dunning and Kruger found that when we don’t know what we don’t know, we overestimate our abilities. Or, as philosopher Bertrand Russell famously put it: “The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt.”

Of course, once we have our bubble burst and learn enough to recognize our ignorance, most people’s confidence takes a huge dip. It only slowly rebounds if we keep going. Unfortunately, many give up during the dip phase.

Now it’s possible you may know more about something than 99.9% of the population. But consider this: even those few special people that are at that level of expertise rarely express how smart they are. It just goes without saying. This is really just to point out the Importance of having humility about what you don’t know. Chances are pretty good when someone tells you they know more about something than anyone else (sound familiar?), they really don’t know diddly.

So I’m not going to try to tell you there is a better way of doing things. Rather, I hope to help you persuade yourself that there is a better way of doing things.

But first.....

Click Arrow for Back Story

Who am I and why am I talking to you about marketing? (feel free to skip ahead if you’re not big on stories and sentimentality)

I have been in practice as a cornea specialist since 1995 and for many years was a managing partner of our large multi-subspecialty ophthalmology practice in north central Florida.

I have written, blogged, and podcasted on a variety of technology-related issues, including a long-running column in Ophthalmology Management magazine on EMR implementation. I probably learned more about EMR from researching and writing about it than I would have known otherwise (but don't ask me which EMR system you should get - I've been out of the marketing for a long time). I also currently blog on Healio and Covalent on ophthalmic practice marketing.

I first developed an interest in marketing in the 1980s when my father reluctantly left academic medicine and started a private practice at the age of 50. Also an ophthalmologist (and also a cornea specialist as well as the inventor of the cornea double forceps, founder of The Castroviejo Society - which became The Cornea Society, and founding editor of The Cornea Journal - which became the official publication of The Cornea Society), he was a great clinician and teacher but he wasn’t much of a businessman. He got talked into some expensive advertising campaigns - filmed, not digital, in those days - which were not very effective.

Actually it was not his first foray into private practice. When he was junior faculty at Columbia, he had a private office in another town after-hours (with the permission of his professor, of course). In those days, doctors were not allowed to advertise their medical practices. He once told me you could only put a sign in your window (literally!) and the medical society had the authority to come by and measure it to make sure it did not exceed the allowable dimensions for that jurisdiction.

But after having been in academic medicine for so long, he didn't really understand the business of medicine at a time when it was becoming increasingly important. It was not enough to be a 'world-famous' eye doctor - in fact, he was known more around the globe than he was in his hometown of Gainesville, Florida. An ophthalmologist in his shoes, 30-40 years ago, would have been shocked to know that successful practices today are not run by the doctor's spouse but by a certified administrator who might earn more than a primary care doctor.

Anyways, I worked for a short time in his office before my residency training as well as for a year after my training before ultimately joining the group I am currently with. In between, I completed a cornea fellowship. So I have a unique perspective having experienced the workings of a solo practice, an academic practice, and then a group practice.

Over time, my interest in marketing, coupled with a practice whose partners were visionary, never satisfied with the status quo and willing to try new things, led to many firsts among our peers including:

  • a website (check out what our site looked like decades ago - go ahead and laugh but almost no physicians had websites at the time)
  • a formal marketing department with a dedicated marketing director
  • trademarking of corporate names and logos (and one of my first tasks was to change the original 'horse' logo - which met a lot of resistance by the way; although horses mean a lot to Ocala natives, since this is thoroughbred country, most outsiders thought we were veterinarians!)
  • social media marketing before it was cool
  • corporate style sheet
  • use of a CRM (customer relationship management) system
  • marketing funnels
  • online patient education assets
  • and operational process mapping.

Postulate 3: Information is not the same as knowledge

Google the following:
- when is the mating season of the love bug?
- how many aircraft can the USS Nimitz carry?
- what was Tom Hanks’ first movie?

OK, did you get your answers? So now you have three pieces of information that you did not have before (unless you are a Tom Hanks fan).

Now, what useful action can you take or important decision can you make using that information? Not much probably.

Information is data.

Knowledge, on the other hand, is the awareness and understanding of a subject.

There is more information today than we know what do to with. According to Forbes, 90% of the data in the world was created in the
last two years!

data never sleeps
The amount of data created every minute of every day, www.domo.com

So it is important to be able to separate useless information from actionable knowledge.

In the former pot I would throw things like webpage clicks and Facebook likes, metrics that are often sold to practices by agencies as proof that their marketing tactics are effective. So, while they may not be totally useless, they are generally not very useful unless they are linked and tracked to a specific campaign.

rory sutherland

Rory Sutherland 

Ogilvy & Mather

" Just because you can easily measure something doesn't mean it is useful."

Postulate 4: There is a science to marketing

periodic table marketing metrics

Most commonly used digital marketing metrics, www.freshsparks.com

This is just a sample of some of the metrics that might be used in a digital marketing campaign. And no, there won’t be a test on this later.  It is merely to make the point that marketing, despite the fact that most people might think of it as just so much psychobabble, actually does have a science to it (in addition to the creative side).

Some savvy online marketers might split test a campaign (compare two different versions by alternating specific variables) and find the conversion rate only goes up 1%. But if they are spending tens of thousands of dollars on online advertising, this could translate to millions in gross profit.

What you want to get away from is the traditional medical practice marketing mantra of “There’s room in the budget for it!” That is, if there is unspent money in the marketing budget, then someone just needs to up and spend it; less important is why the money is being spent.

What you DO want to move towards is evidence-based marketing.

Postulate 5: Good marketing is an investment, not just an expense

If you have the right information and you are using an evidence-based approach, then your practice marketing shouldn’t be viewed as an avoidable expense but as an investment.

Just as a diversified financial portfolio offers a better return on your investment, so does a diversified marketing portfolio.

marketing portfolio
A well-diversified marketing portfolio, Ultimate Ophthalmic Marketing Guide

So where do we start? If you are like most practices, it begins (and ends) with new patient acquisition, the most expensive kind of marketing there is.

From our Ultimate Ophthalmic Marketing Guide, these are three common practice marketing myths that still persist:

  • Myth 1: To get new revenue, you just have to get more new patients
  • Myth 2: Buying tactical campaigns without a cohesive marketing strategy is okay
  • Myth 3: Revenue growth requires the majority of your marketing dollars be spent on branding and name recognition

Unfortunately, they persist because the traditional marketing philosophy of spitballing a marketing budget and delegating it to an agency takes the least amount of effort on the part of the owners. Concentrate primarily on new patients, focus on social media, throw in some monthly reports showing useless data such as clicks and likes and a year-end spreadsheet showing that every dollar was successfully spent, and you’ve got a recipe for a marketing ‘strategy’ that is on autopilot (and likely headed nowhere).

Lather, rinse, repeat…

peter drucker

Peter Drucker,

Marketing Guru

"You can’t manage what you can’t measure."

The significance of that quote to our discussion is that if you don’t track your marketing efforts, you can’t measure them, and therefore you don’t really know if they are working.

Which brings us to….

The What:  

7R+1 - The 7R Marketing Strategy

and the One R (Resilience) to Rule Them All

All of our previous discussion was to make the case for having an evidence-based approach to your practice marketing. As much as possible, every marketing campaign should map to a specific strategy below, it should be built with an end goal in mind, and have a method of tracking its metrics in order to continuously improve or optimize its results.

To recap, the 7R Strategies are:

  1. Reputation
  2. Review
  3. Retain
  4. Resell
  5. Reactivate
  6. Recruit
  7. Refer


Reputation as we describe it refers to practice reputation. Because practices develop a reputation distinct from the doctors.
...coming soon


Review refers to physician reviews. There is likely no physician practicing today that isn’t aware that their patients review them on online sites. But very few leverage these for marketing purposes.

...coming soon


Patient retention is one of the most overlooked strategies. Existing patients are often taken for granted. But the public is constantly barraged with messages from all sorts of businesses. So if they don’t feel like they are valued by their current provider, they will walk out the door and across the street to the competitor.

...coming soon


Reselling means that existing patients are made aware of a practice’s other services and offerings. It is surprising how often this is neglected. Many physicians are alarmed when a patient returns for a yearly exam and find out that they had a procedure or service elsewhere because they didn’t know it was offered at their current doctor’s office.

...coming soon


Another low-hanging fruit is reactivation of dormant patients. Appointment cards might be lost or forgotten so patients need to be reminded so that the practice is kept ‘top of mind.’
...coming soon


Recruitment of new patients is typically what most practices think about when the word marketing is mentioned. And while new patients are important life-blood for most practices, especially surgical specialties, they are also the most expensive to acquire.
...coming soon


Referrals are the pinnacle of medical practice marketing. If a practice could rely solely on referrals, their cost of marketing would be practically zero. Alas, this is not possible. But at least it is something to aspire towards. By leveraging the other 7R strategies, referrals become more commonplace.
...coming soon

The How:

bom tagline

More to come so stay tuned...