Physician focus groups revisited

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Health care research Quirk's Marketing Research Review June/July 1996

Physician focus groups revisited
By Murray Simon

Editor's note: Dr. Murray Simon is president of D/R/S HealthCare Consultants, Charlotte, N.C.

About 10 years ago I wrote an article that was published under the title of "Physician Focus Groups Require Special Techniques." In a recent reading of that piece, I was amazed at how much had changed in the wonderful world of marketing research with health care professionals and decided it might be beneficial to compare yesterday's thinking and experiences with today's.
     The original article led off with the statement that doing marketing research with doctors is far more difficult than with children . . . and not nearly as entertaining. This was a reference, in part, to the ego factor that is sometimes a problem in focus groups with doctors. I am pleased to report that although the ego is still alive and well in these focus groups, it does not seem to prevail or get in the way with the same frequency and intensity that it once did. Health care professionals are more relaxed and less competitive with each other in the market research setting and in general, groups and individuals seem to settle down to the task more quickly and with far less posturing and preening than was once the case.
     This is probably due in part to the fact that managed care has had a major impact on medicine during the past 10 years and physicians are more oriented towards group dynamics. They aren't the stand-alone individualists they once were. Many may not like the situation, but they are far more accepting of it as a reality than they were previously, particularly the younger members of the profession.
     There is another possible influence on this tendency towards greater cooperation in the focus group setting and it can be used as a potential advantage in recruiting professional respondents. Managed care has imposed strict guidelines on how medicine is practiced, what fees are charged and the specific drugs and medical devices used, particularly in the hospital setting. Physicians have seen their influence on the choice of specific drugs, instruments and devices erode significantly: manufacturers concentrate a sizable amount of their detailing/sales efforts on purchasing agents and hospital formulary members and doctors are bothered about being left out of the loop in these matters. Focus group recruitment can be enhanced if the initial call emphasizes that the study involves obtaining physician feedback on a new technology or service or relates to modifications being contemplated for an existing product or service. Changes in medicine have been rapid and profound and professionals continue to demonstrate a strong desire to stay on top of things.
     One particular recommendation in the earlier article certainly holds true today - the entire project can be won or lost at the crucial point of recruitment and, therefore, a recruitment service that specializes in health care professionals should be used. Doctors calls are filtered by very protective front office staff people but experienced recruiters know the nuances that can get them through more frequently, which in turn can have a positive influence on the quality of the groups.
     Ten years ago you had to take special care to convince potential respondents that they were being asked to participate in a true research project and not some form of sales or product detailing in the guise of market research. There were two common reasons for their suspicion:

1. Market research was not as prevalent among health care practitioners as it is now.
2. Marketers were frequently selling and/or detailing under the guise of market research.
     Doctors today, whether they be physicians, dentists, or veterinarians, are much more attuned to the presence of market research within their respective fields, but we still use a sales/detailing disclaimer up front in every recruiting script.
     While professionals are more familiar with market research, it is still important to persuade them that their participation will result in one or more of the following happening:
     1. Their input will have an impact on anticipated changes in an existing product or service or in the development of a new product or service
     2. They will learn something about a new product or service currently in development.
     3. They will have an opportunity to learn more about what their colleagues are doing. This is a particularly useful approach when recruiting focus groups held in conjunction with conventions, where the group makeup is more geographically diverse.
     A gift of some personal or professional value - a sports watch, a quality pen, an American Express gift certificate, etc., usually is better than money. That was my thinking with regard to incentives 10 years ago: Be careful to avoid the appearance that you are trying to buy their attention and input. But experience today indicates that when it comes to putting together a focus group of professionals, money speaks loudest. They have always put a high value on their time, but now managed care is forcing them to look more closely at professional cost/benefit ratios and the true cost of their time. This should not be misinterpreted to mean that incentives have to be astronomical: today's physicians net incomes are down and they seem more willing to spend a few hours after work discussing their attitudes and experiences when a meal and a respectable cash incentive are involved.
     Ten years ago recruitment screeners seemed to be a lot shorter. Typical screener questions used to focus on areas of specialization, years in practice, group vs. solo and previous participation in focus groups. Today's screeners are more complex and must be carefully thought out and developed to ensure that the group or individual interviews will properly meet the client's needs. The nuances of sub-specialization, percentage of patients that are managed care, incidence of HMO participation and demographics of the patient population are just some of the considerations that must be carefully weighed and evaluated in constructing a good screener.
     Not too long ago we did focus groups with urologists on the subject of prostate cancer, a disease found in older males, and I was rather embarrassed to discover that there are a small number of these practitioners who specialize in pediatric urology. I found this out the hard way; I wound up with two of them in one group. Fortunately that group worked out well and my client was understanding and willing to share the responsibility for not having picked up on this fact.
     Some factors in market research with health care professionals have not changed in the intervening decade and are worth repeating:

Facilities - Convenience to hospitals and professional office parks, as opposed to convenience to the airport and hotels, should be a primary prerequisite in facility choice. Physicians often run late and are subject to emergencies and as the day runs on, the prospect of a long drive in traffic can lead to last-minute cancellations or no-shows.
Food - In the overall scheme of things, the cost of serving a meal to a group of respondents is minimal and it is not worth the potential of upsetting or disappointing some of your respondents by only having cookies and soda or a fruit/cheese platter. Any professional groups that start between the hours of 5:00 to 8:30 p.m. should include food service. It doesn't have to be elaborate or fancy. We often use sandwiches or deli platters and many doctors who come into the facility after a day on the run seem very happy to have it available. A word of caution: all sandwiches and deli platters are not created equal. After the third time of arriving at a facility to find a platter of "mystery meat" awaiting my respondents, I learned that if we are not familiar with the facility it is important to inquire about the quality of their deli resource. When in doubt, choose a simple chicken dish and salad.
Group dynamics - One of the major difference between a consumer focus group and one made up of doctors is the likelihood that some of the doctors will know each other. It is not uncommon to have a group of professionals shown into the conference room with two or three engaged in an intense discussion and they will generally sit next to each other at the table. Usually this does not prove to be a problem or concern. If all of the standard control statements fail (Ladies and gentlemen . . . please, the cross conversations are overwhelming our sound system. I'm sorry but I can't hear what this person is saying), manipulation of the seating arrangement can be an effective ally. One of my favorite methods is to rearrange the group for an evaluation of print materials or products into specified mini-teams by having certain respondents change seats with others. After these evaluations, they are asked to stay where they are.
The moderator - This is a rather subjective topic about which there is room for debate. My personal opinion is that health care providers consider themselves to be authorities. They do not like to feel that their time is being wasted and they respond best to an authoritative approach from the moderator. It is important to establish in the opening remarks that the moderator is experienced and comfortable in the field of health care market research. Beyond personal appearance (I always wear a tie) one of the best ways to convey authority and control is to make sure that you have a reasonable grasp of the technology being discussed, that questions are appropriately phrased and technical terms are correctly pronounced. The Helen/Harry Helpless approach - Please people, you've got to help me understand this - should not be used as a substitute for thorough advanced preparation. Which is not to say that the phrase "I'm not sure what you mean" doesn't play a valid role in moderating physician groups, but you have to be able to demonstrate that you have grasped their meaning("Before we move on I would like to summarize what has been said to make sure I understand it correctly.")
One constant has remained over the past 10 years; while market research with professional has its own particular demands and levels of difficulty, well planned and executed qualitative studies can provide valuable input for the clients who commission them. Whether it relates to advertising concept testing, troubleshooting a product already in the market, prototype evaluations or just getting a read on a market's future potential, there is no substitute for going out into the field to talk with highly educated people who are in the trenches using these products and services every day. As health care continues to change in its complexity, the need for good health care market research will undoubtedly continue to grow and it is the research industry's mandate to develop the level of skill and expertise necessary to properly meet the demand. Researchers who prepare themselves for the complexities of this type of research will be rewarded by their efforts.