Bring in the Business

It's been said that the way to a man's heart is through his stomach. True enough, a good meal can do wonders for a budding relationship. And how can physicians get through to one another to establish the ever-important referring relationship? One way may be through the palate.

When Reproductive Medicine Associates (RMA) opened a new office in Morristown, N.J., the physicians in the clinic invited all the OB/GYNs in the area to a wine tasting and presentation on their services. "We didn't have a track record with them, and we thought that the best way to tell them what we had to offer was in a social setting," explains Michael Drews, MD, one of the clinic's founders.

Physicians like the fertility experts at RMA depend upon referrals from community primary-care doctors for a robust patient base; developing and maintaining relationships with those physicians is essential for business.

RMA took special care to open their doors in an area where there were no other fertility clinics, and the physicians sponsored the wine tasting to get their names known. The strategy worked: Drews reports that in the year and a half since the practice came to the Morristown area, the 12 physicians in the practice's three offices each see 20 to 40 new patients a month.

The physicians at RMA took the common approach of starting their practice in an area where there was little competition. "We opened up several new offices, and each time before we chose a particular location, we wanted to find if that area was adequately served in our particular subspecialty," Drews says. "If there's an established practice in the area and you hope to open an office there, it's going to be that much harder."

Who do you know?

Since referrals are generally tied to specific levels of service, physicians should clearly promote their professional focus and capabilities -- and be sure that they understand what other physicians have to offer so they can make the most appropriate referrals, according to Susan Miller, administrator for Family Practice Associates of Lexington, a seven-physician practice in Kentucky.

Build upon your relationships with other physicians, which may stem from medical school, a continuing medical education (CME) course, or other networking function. "Most physicians know each other through hospital affiliations," says Lorraine Lansing, a personnel manager for Stevens Healthcare in Edmonds, Wash. Some specialists offer seminars at local hospitals about a specific service they offer, or a new piece of equipment -- it's helpful to attend these types of events whenever possible.

One of RMA's employees goes "on the road" to deliver patient education pamphlets to referring physicians' offices, inviting them to special events, and informing them about RMA-sponsored weekly support groups for infertile couples. The practice also offers lunchtime educational seminars to the office staff of referring physicians, and provides opportunities for CME and social activities, like the wine-tasting event, to increase awareness among physicians in the area.

Working in tandem

"What matters most is that the specialist is easy and quickly accommodating," Miller says. "It's important that [the primary-care physician and the specialist] have the same insurance plan and the patient can see the specialist without too much delay."

When a primary-care physician calls the office to make a referral, Miller instructs office staff to put the call through to the specialist immediately so the physicians can discuss the patient before the appointment is scheduled.

Primary-care physicians give high marks to the specialist who provides timely and thorough communication about the care of the patient. Miller advises specialists to follow up with a brief, concise report that includes findings and recommendations. "Many specialists send eloquent letters or gifts," Lansing says. "We just need to know about the patient."

Drews says that he usually calls referring physicians to inform them of patients' progress. "We find that the [referring physicians] respond really well to a direct, personal approach," he says. He always tries to meet new physicians face-to-face "because it helps to associate a name with a face."

Whether by phone, letter, or e-mail, make sure to follow up with the correct physician if dealing with a large practice, to maintain a seamless continuity of care. "We don't want a patient getting referred back to a different obstetrician after she becomes pregnant," Drews says.

Keeping patients happy

The key to encouraging repeat referrals is the patient's positive experience with the specialist. "Once patients are sent to us, then they act as our emissaries," Drews says. "We hope that they will return to the physician and say that they were treated well." When this happens, referring physicians tend to have greater confidence making future referrals to the specialist.

If patients have negative experiences, referring physicians generally wait to see if a pattern develops. "Sometimes, people merely don't like what the doctor has to say," Lansing says, or there may simply be a personality conflict. Too many patient complaints, however, will likely have a negative impact on the flow of referrals.

Lansing adds that the information transferred to the specialist's office has to remain confidential. "Patients are assured of this," she says. Miller explains that there is an "unspoken sort of privacy" between the two physicians during the course of the patient's treatment.

Although RMA counts on new business from local OB/GYNs, Drews says satisfied patients are responsible for about half of the practice's referrals. "We know that for most people, [fertility treatments] are something that they really would not go through by choice, and so we make the experience as palatable as possible," he says.

Patient satisfaction surveys are distributed to identify areas of the practice in need of improvement. "Everyone -- from the employees in the front office to those in the procedure room to those performing the procedures -- is extremely sensitive to the results of those surveys," Drews says. Staff raises are based on the results; the surveys are also used to assess the effectiveness of office operations.

To develop and maintain relationships with referring physicians, make sure they know who you are and what services your practice offers. Sponsoring special events can certainly be a plus, but the real key is the quality of care you provide. Referring physicians will gain confidence when their patients report back with a positive experience, and are apt to send more new patients your way.

Andrea King can be reached via editor@physicianspractice.com.  

This article originally appeared in the March/April 2002 issue of Physicians Practice.