Practice Profile: Clavell Urology

Urology Times’® Practice Profiles series takes readers behind the scenes of US-based urology practices. From solo practitioners to large groups, each installment highlights these practices’ unique qualities, successes, and challenges. To have your practice featured in this series, please email Hannah Clarke at hclarke@mjhlifesciences.com.

Jonathan Clavell, MD, FACS

In this installment, Jonathan Clavell, MD, FACS, highlights Clavell Urology, his private practice within Robert J Cornell MD, PA, that provides urologic care for men’s health conditions in Houston, Texas.

Could you provide some background on yourself and your practice?

I'm in Houston, Texas right now, and just a brief overview: I'm originally from Puerto Rico. I did medical school in the University of Puerto Rico School of Medicine, and then did my Urology residency here at the University of Texas in Houston and MD Anderson Cancer Center. I then did my fellowship in Sexual Medicine at the same institutions. It mostly focused on sexual medicine and prosthetics. I graduated from my fellowship back in 2018, and my goal, as many doctors who graduate from fellowships, is to focus on what we're practicing and what we specialized in. So, I wanted to get into a practice where I could focus on men's health. That's what I did during my fellowship years, and I wanted to continue the same thing once I graduated.

When I graduated, I had the opportunity to join someone who already had a practice that mostly specializes in men's health, which was great. The good thing about it was that he focused on some aspects of men's health that I didn't focus on and vice versa. I was able to bring in a broader approach for the treatment of Peyronie's disease, which increased the scope of our entire practice. However, my challenge, and we'll talk about challenges later on, was that he had an established name in the community. I mean, he had been practicing already for 15 years, so patients didn't want to see me initially, because I was “the new young doctor”. I needed to work hard to let patients and doctors around me know that I was here, willing, and eager to help men in the Houston community.

Could you expand on some of the challenges that you faced getting started and how you overcame those challenges?

The number 1 challenge that I had early on was getting my name out there. When doctors graduate and go on to be a part of an academic institution, a big hospital system, or a large urology group, it is easier to get your name out there since your partners and the entire system will be making sure that you stay busy. When you are in a small private practice, like me, it is a little bit tougher. It is a little bit different because you do not necessarily have that support. So, you need to think outside the box, be more proactive, and get your name out there so other doctors can refer their patients to you.

Some of the things that I started doing, for example, I was able and fortunate enough to get my name out in the radio. And for my first 3 years, I had a radio show, which initially didn't bring anything, but as time passed by, I started receiving many patients from that radio show. Then those patients will be talking to their friends, their family members, and to their doctors. If I had a patient who was very happy, I would tell him, "Hey, who's your primary care doctor? I want to reach out to him or her," and that way that I can get my name out there so the others are able to find me.

I also started targeting social media, and with social media, I was able to establish a name and presence online. Then everything eventually started booming. Now I'm at a point that fortunately, I'm extremely busy doing exactly what I enjoy doing, focusing mostly on men's health, and I can refer the other aspects of urology to other fellow urologists in the community.

The other challenge, [is that] in academic medicine, they don't teach us what we need to build and run a successful practice. For example, how to hire and manage staff, getting credentialed and established contracts with insurance companies, billing, what are reasonable reimbursement rates, appeals, how to appeal insurances to get things paid for, how to negotiate contracts, among other things. These are things that we learn along the way. We learn these business and administrative skills by communicating with senior partners, colleagues in the field, [and] other physicians. I would sit down and call other private practice urologists to see how they did things, how they were able to learn these skills, and how they were able to overcome them. You get as much information as you can from as many people as you can, and then you grab what you think is going to work for you. That's how I was able to overcome that challenge.

Now again, I'm still learning. It is still a big process. I'm by no means an expert in private practice, [but] at least I'm not scared of it anymore. Initially, I had fear thinking about the business and administration aspects of medicine. Now, I understand that it is a process and you just have to enjoy the ride while you're learning through it.

On the flip side of that, what are some of the wins that your practice has experienced since you've gotten started?

It puts things into perspective to really evaluate where I was when I started and where I am now. For me, I would say one of our biggest wins is to see how my practice continues to grow, focusing specifically on the urological conditions that I am passionate about. I have been able to establish, in less than 5 years of practice, [a practice] that offers high quality care for men with specific urological conditions, not only for men who live in Houston, but for men from around the United States and around the world. I have the wonderful opportunity to help men from all over the world. We've had men traveling from Europe, Asia, South America, the Caribbean, and Africa to get specific surgical procedures. To see that and be able to establish that within 5 years, it's been a true blessing.

Another win, at least for me, is having the opportunity to work with a team and staff that is proficient in helping our patients and a team that enjoys working with us as physicians, and most importantly, seeing how patients trust us. Most of our patients nowadays come in through word of mouth. For me, it is a true blessing to see when your patients refer their family members or friends, sometimes their spouses, etc. Whenever you have patients coming in by word of mouth from other patients, that means that you're doing something right, and you should continue delivering care that patients will truly appreciate.

What conditions do you treat in your practice? What are some of the services that you offer?

My practice is mainly structured to help men with specific urological conditions. The main condition that I treat is erectile dysfunction. The main procedure that I do is penile implant surgery or penile prosthetics, which is currently the bulk of my surgical practice. I also focus on the medical and surgical management of Peyronie's disease and other aspects of men's health, [such as] low testosterone, enlarged prostate, male incontinence, vasectomies, [and] we now started to do more stuff for male cosmetic enhancement. Again, our practice is mostly on men's health.

I call ourselves the Gatekeepers of Men. Many men start off with a specific condition; for example, erectile dysfunction, and then when you start digging into their history, he has never had a colonoscopy, he [hasn’t] seen a primary care doctor in 5 or 6 years, the [patient] doesn't even know he has diabetes, or high blood pressure. We've been able to be those gatekeepers to guide them towards taking control of their health and live a healthier lifestyle. It's been a true blessing to have that type of practice. So to summarize, our practice is basically tailored to men's health. I still do a little bit of general urology, but right now [about] 95% of what I offer is tailored for men's health.

What is the makeup of your staff and the roles associated with your practice?

We currently have 13 employees. Again, it's me and I have a partner, [so] it's only 2 physicians, and then we have 13 employees underneath us. We have a manager who helps manage the practice and deal with the day-to-day logistics. We have a new patient coordinator, who focuses mostly on scheduling those new patients. We call her “the face” of our practice. I believe if you really want to be successful and have a niche and provide a boutique type of practice, you need somebody who's really good to be answering those initial phone calls. Whenever the patient calls our office, I want to make sure they feel comfortable, they feel appreciated, they feel like they're being understood, because again, what we treat are mostly conditions that make most men feel vulnerable, and they're very self-conscious about these conditions. I want to make sure that they feel comfortable. So, we have a new patient coordinator that takes care of those new patients right of the bat.

We also have several people in the front desk, who take care of the day-to-day ins and outs of patients, checking in [and] checking out. We have a scheduler who takes care of the surgical cases. We have medical assistants who assist us throughout the day [with] rooming patients and setting up equipment whenever we need it. And then we have a billing staff. We have a full billing team, so everything is done in-office. We don't refer anything out for billing. We've been fortunate enough to have staff that cover all those aspects to make sure that we have a good, strong, and successful practice.

What are some unique elements to your practice?

For me, number one is [because] I am fully bilingual, I speak both English and Spanish. Therefore, we have the ability to provide comprehensive urological care in both English and Spanish, which is great. Spanish is not a second language to me, it's actually my primary language. I'm fully bilingual and I can communicate well with patients both in English and Spanish.

The other thing is even though I am in private practice, I still remain active in research and academic medicine. I try to contribute to research, I train doctors who want to learn more about penile implant surgery and Peyronie’s surgery, serve in committees within our urological societies like the SMSNA [Sexual Medicine Society of North America], AUA [American Urological Association], and ISSM [International Society for Sexual Medicine]. I also serve as the section editor of the Peyronie's disease section for the AUA core curriculum. Research, academics, and education are unique elements that I have tried to maintain. Most private practice urologists, their only focus is on private practice and all the administration and business side. The same thing is very common for the academic medicine doctors; many only focus on academics, and they don't go beyond that. One thing that makes my practice unique is, like my wife says, I'm “an academic doctor working in private practice”. I don't want to focus only on private practice, or academic medicine [alone]. I believe we can have the ability to do both, which is fairly unique in our field.

Is there anything else that you’d like to add?

I've been blessed to be one of the highest volume surgeons when it comes to penile prosthesis surgery, and that is exciting because that's what I'm passionate about. That's what I've tailored most of our marketing and most of our resources to, to make sure that we are able to let men know that we are here for them. It's great to continue to grow in this wonderful field.

People think that I have everything already figured out. We're still learning. If there's something that we should focus on in this article is making sure that people understand that this is not something that we figured out right off the bat. Even my partner, [Dr. Cornell], who's been doing this now for almost 20 years, he's still also learning how to continue to grow the practice and how to continue to provide adequate care for those men who need it. The important thing is to remember that it is a process that requires trial and error. There will be failures along the way, but as long as you stayed focused, you will learn to appreciate and trust the process towards reaching success.

You can learn more about Clavell Urology here.