Do Well By Making Nice

Once a year, physical medicine specialist Steven Warfield buys some snacks, dusts off his practice’s audiovisual system, and clears out his conference room. There he hosts a handful of Jacksonville, Fla.’s new primary-care physicians, whose referrals Warfield hopes to generate, along with several doctors who already refer to him.

Warfield welcomes the newbies, explaining to them just what treatments his practice provides, and chats it up with the doctors who already send him patients. He also does a short lecture on new treatments for common problems. Afterward, there’s a tour of the office and introductions to staff.

Warfield’s annual meet-and-greet sessions go a long way toward keeping his referral base robust, while simultaneously expanding it.

"It shows the new doctors who we are, what we do, that we keep up with new treatments, and that we’d like to help their patients," says Warfield. "It shows the physicians who already refer to us that we’re on top of things and that we appreciate them. Plus, they get to see other established doctors who refer to us. That helps give us the Good Housekeeping seal of approval."

Adds Warfield, it’s all part of what’s at the core of any successful practice: building and maintaining good relationships - whether they’re relationships with referring physicians, the phone company, medical supply companies, pharmaceutical salespeople, or the guy who waters the plants. Without all those folks, a practice couldn’t function. But to do more than that - to make operations flourish - it pays to put aside time to nurture all such alliances, and to always work to improve them.

Building referrals

The most obvious place to start is with referring physicians.

"A lot of physicians look at patients as the customer, but don’t forget that the referring provider is also a very important customer," says Douglas Backous, a neurotologist at the Virginia Mason Medical Center in Seattle.

Backous suggests thinking like a businessperson, researching exactly who your market is, and asking yourself: what type of doctor is most likely to refer to me? Then spend time getting to know as many of them as you can, he says. How? Many physicians agree that simple, friendly visits are all it takes.

Gynecologist Paul Gaither points to several of the new pediatricians near his Wellesley, Mass., practice, as an example of how to please a potentially referring physician.

"They come to us and say, ‘I’m new in the neighborhood and I’d like to say hi,’" explains Gaither. "We get to know the face. We see that this is a very nice person, empathetic, eager to take care of our patients. It’s important that our personalities mesh, because recommending them to our patients is like fixing them up on a blind date."

Gaither adds that the visit doesn’t have to be long. The doctors need only stop by with a warm greeting when they’re new to town, followed by a few other informal visits throughout the year, just to say hello.

But personality is key. You have to have one.

"The fastest way not to get referrals is to have the personality of a wet floor mop," says Sean Weiss, senior partner of the LaGrange, Ga.-based CMC Group healthcare consultants. "A doctor may be the best surgeon or infectious disease specialist in the business, but if he can’t communicate effectively with patients, patients’ families, and other physicians involved in their care, no one’s going to want to work with him."

Personality not only goes a long way with fellow physicians, but with nurses, who can also affect referrals. Explains Weiss, there may be three physicians on call in a hospital on any given night, but the nurse is likely to call the kindest physician, the one who’s easiest to work with - not necessarily the doctor who’s most renowned.

To keep referring physicians calling, Backous says he makes sure to see their patients right away - usually within a day of getting their call. He leaves three open slots in his schedule each day for this purpose, and if those get filled with other emergencies, he stays late or comes in early to accommodate those patients.

Also, he keeps detailed notes on how each of his referring physicians likes to be contacted. Shortly after the patient has been seen, Backous makes sure to e-mail or write the referring physician a letter detailing diagnosis, treatment, and recommendations, or to call the doctor personally. The last thing he wants, he says, is for primary physicians to face an appointment with a patient Backous has seen without having had a chance to review the notes from that appointment.

Backous also makes sure all his referring physicians have his cell phone number, so they can contact him about a patient even when he’s on vacation. Sometimes, he says, a quick call is all that’s needed to tide the patient over. "They may just need a little tidbit of information to get their patient through until I can see them," he says.

Another key to getting and keeping referring providers is to be courteous when working as part of a care team. When you’re requested for a consult and several doctors must meet, never be late. Weiss adds that he’s seen physicians lose referrals for all the doctors in their practice by inconveniencing referring physicians in this way.

How to thank the physicians and nurses responsible for referrals coming your way, and keep them coming? Just keep doing what you’re doing - being affable, providing good care - says Weiss, and supplement that by occasionally dropping off a plate of brownies, a basket of fruit, or catering lunch one day for referring physicians’ staff.

"It doesn’t have to be anything extreme - just something to let physicians know you’re grateful," says Weiss.

What about vendors?

Once you have all the principles in place for forging and maintaining fruitful relationships with referring physicians, what about vendors that are needed to keep your practice running smoothly? Experts say many of the same principles apply.

Go to lunches sponsored by pharmaceutical sales reps or medical supply companies - even if your schedule doesn’t permit, says Weiss. "Just show up, shake a few hands, explain nicely that you can’t stay, and get back to work," he suggests. After all, says Weiss, you want to keep those free drug samples coming for your patients who can’t afford their prescriptions, and you want to make sure you have a reputation as a friendly doctor, because healthcare tends to represent a small world in any given market. You never know - that pharmaceutical rep you just brushed off might make a comment about you to her next client, who might just be that physician you’ve been hoping to get referrals from. Pharmaceutical reps can help lead you to research grants for studies you may have in mind, he added.

Most medical office managers find their practice’s vendors - from ISP providers to accountants to the janitor service - via word of mouth. If their fellow office managers liked the service they got, they’ll give the company a shot. Other times, some of the businesses a practice uses are controlled by the building in which they reside (think phone systems and T1 lines) or by the hospital system they’re part of, which can help them get discounts if they choose certain vendors over others.

Debbie Croes, MBA, a principal with The Croes/Oliva Group, a Burlington, Mass.-based healthcare consulting group, also suggests calling up the purchasing agent of your hospital and asking which vendors they like.

"These guys are the local gurus on that," says Croes. "They go to and conduct conferences that are all about finding the perfect vendors."

Croes also suggests that, once all the vendors are chosen and in place, practices designate a point person who deals with each one.

"Make sure there’s someone whose job it is to relate to vendors," she says. "Give different people different duties - so-and-so is in charge of the medical supplies company, etc. The vendors should be able to deal with the same person each time they call. This leads to better communication and very consistent expectations, and hopefully that person will build some expertise around price."

From there Croes suggests a maintenance check-in about once a year with each vendor, just to make sure all is going smoothly and expectations are being met on both sides. "That makes the relationship more personal, and in turn they are willing to be more accountable and do more for you," she says.

In the end, no matter who you’re dealing with, being positive is key. After all, you get more flies with honey.

"No matter what field you’re in, so often in this day and age, we never hear the good stuff," says Gaither. "Tell them they did a good job and that you appreciate them coming out. Say it in person. We’re all people - we like to be treated nicely."

Suz Redfearn is a freelance writer and editor with more than 10 years of experience writing about business and healthcare issues. She can be reached via editor@physicianspractice.com.

This article originally appeared in the September 2005 issue of Physicians Practice.