Your Referral Network

Building Good Relationships With Other Physicians

By William J. Sonn
William J. Sonn is a writer for Physicians Practice

When it became clear that his mother needed a specialist’s care, John DeMaio, M.D., was not sure which doctor she should see. With time, he might have asked one of his colleagues at Pennsylvania Hospital in Philadelphia, where he is a neonatologist. But that day, standing in a primary care physician’s office, he heard himself asking the nearest trusted professional — his parents’ doctor’s nurse — for a referral.

DeMaio recalled the episode as an illustration of how support staff can influence the way referral relationships between physicians are built. Yet it might also be a reminder that building a referral network, one of the most critical business functions physicians have, can be full of subtleties of which physicians should be aware.

Most physicians, however, rarely get training in this aspect of managing their practices. Many assume that convenient locations, shared or compatible payer contracts and their clinical reputation are the only factors that drive referrals to them. Consequently, observed Natalie Bass, whose Washington, D.C., marketing firm specializes in health care, “a lot [of physicians] believe they don’t have to market. A few do get by just on their reputation. But most doctors find they need to actively go out and develop referrals.” When they do, moreover, they probably will be talking to strangers. Physicians often do not personally know the people or practices they need to approach for referrals.

Happily, physicians and marketing experts have developed a number of effective techniques to help physician-colleagues approach one another. To develop referral sources, physicians often hold educational events, distribute white papers, send out direct mail, sponsor social gatherings, write newsletters — and do what one Denver health care strategist called “the bagel thing” (delivering bagels or other treats to an office as a way to build awareness of one’s practice). But all those tactics will sputter unless they are infused with two principles: concern for each other’s practice and concern for the patient’s well-being.

Without those principles, maintained Robert Goldszer, M.D., associate chief medical officer and vice chair of the Department of Medicine at Brigham and Women’s Hospital in Boston, referrals are not likely to be made. If they are made, they are not likely to be repeated.

“The main thing is that the referring physician knows the patient will hear only positive things about [him or her] from the specialist,” he said. The specialist then needs to communicate often and aggressively with the referring doctor.

“Being respectful of the reputation of the person who made the referral to you is very important,” DeMaio said. Especially for specialists, “It’s not uncommon to be receiving a patient who might not have had optimal care. The referral may have been delayed until the referring physician identified the issue or until previous care proved inconclusive. Whatever the reason, the [referring physician] may have called us late in the game. How you manage that is an art in itself.”

Build trust and respect
“At the heart,” DeMaio added, “it’s just good communication that you will be highly respectful of the physician who made the referral and that you will go out of your way to keep the physician in the loop. All too often, the referring physician is left in the dust. It’s very awkward when you don’t know what the specialist is up to.” Specialists, he stressed, need to make it clear that the referring doctor will get “predictable feedback” about the patient.

And, of course, referring doctors have to be confident they will get their patient back.

All in all, “there’s a professional risk in referring,” DeMaio said. Good referral development programs will reassure the referring doctor that the risks are minimal and then deliver on their promises.

Trust, in other words, is a big part of building referral relationships successfully. Needless to say, the referring physician also has to trust that the patient is going to get expert care. “They’ve got to know you’ll order the right tests, get good outcomes and be mindful of providing cost-effective care,” Goldszer said.

“At the end of the day,” DeMaio concurred, “you want to send someone to the most competent person available.”

Show your expertise
The next step in building a network is finding the right doctors to approach for referrals. The best place to start the search is in the practice’s own database, where it’s possible to identify which doctors already send patients to the office. “A lot of doctors don’t necessarily know who’s already referring to them,” Bass said. “Where are they geographically? What kind of patients are they referring?” The same kinds of people who are the best current referral sources will be the best sources of future referrals.

Still other potential referral sources are medical societies and lists of health care professionals who belong to a shared health plan, like those at Physician Finder Plus at www.humana.com.

Deciding how to communicate effectively with them — through postcards, workshops, social events, newsletters,
e-mails, etc. — rests on the nature of the audience and on the message.

Erich Kirshner, a Denver public relations consultant who helps a radiation oncology practice develop and sustain its referral network, targets urology practices. He will arrange through the urology practice administrator to bring in bagels or muffins for a morning discussion of a new clinical issue or treatment.

DeMaio helped build his neonatology practice by doing similar clinical presentations at smaller community hospitals that did not have NICUs. Such events demonstrate the specialist’s expertise, build trust among the referring staffers by providing a friendly face and provide a chance to keep the specialist’s name in front of people who might not otherwise know them.

“Having your name on the referring physician’s desk on a regular basis is very important,” Goldszer advised. It might be through newsletters, e-mails or even low-tech devices, like magnets and perforated Rolodex cards.

Making the message short and sweet is also important. Kirshner found that white papers or reports about a new procedure or clinical issue should be kept to one side of one page.

“Usually referral sources are busy people,” Bass observed. “They want to know about the facts, about why you’re different from someone else. They don’t want to know about the wing chairs and the fireplace” in the waiting room. Stressing amenities is best left for brochures aimed at patients.

Ultimately, the relationship depends on how the practice treats the referring physician on a daily basis. “Are you prompt?” Goldszer asked. “Have you reassured the patient that you will get back to his/her physician? Have you called the referring physician about the patient?”

And, as DeMaio found out when he got a specialist’s name from a nurse, have you been good to the referral source’s staff? “Support staff are often key drivers in the referral process, and you need to be mindful of their influence. A patient will ask a nurse for a name, like I did for my mother. So if it’s the staff member who is calling me, I still need to be nice to them. They may not be mindful of who’s better, but they are mindful of who’s nice.”

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