Attracting Referrals: Think Outside the Box

Traditionally, physicians have looked to other physicians as their primary source of patient referrals. Do not forget, however, that there are other professionals who can serve as excellent sources. Any effective marketing plan will identify the professionals and organizations that have the potential to refer patients. By pinpointing common areas of interest and approaching these other practitioners, you can create a need for your services or expertise. Most nonphysician professionals are eager to have physicians see their clients and patients. However, it is necessary to communicate with these nonmedical professionals about their clients, which requires written or spoken communication to these referral sources. Additionally, nonmedical professionals and organizations are eager to have physicians address their associations and share educational material with their members. They also are eager to refer patients to physicians who respect them professionally as peers.

For example, podiatrists see many patients with diabetic foot problems; therefore, a talk by a primary care doctor or an endocrinologist on contemporary management of diabetes would be of interest to that group. This is also an opportunity to discuss methods to improve communication between physicians and podiatrists. A presentation from a physician to a group of podiatrists might include indications for referral from podiatrists to medical doctors. You might consider providing the audience with a copy of suggestions for referral to your practice. Your follow-up note should contain contact information including your cell phone number and back line number to allow the podiatrist easier access to your practice.

Following any meeting with nonmedical professionals, send a letter to all who attended, thanking them for the opportunity to speak at one of their meetings and inviting them to your office if they were ever in the area.

Numerous benefits may result from these presentations:

• You can expect two to three referrals a month from podiatrists—which is two to three referrals you would not have received had you not contacted the podiatrists for a presentation. Also, there is the potential for the podiatrists themselves to become patients.

• An editor of a podiatric publication will certainly appreciate an article written by a physician to include in the journal.

None of these opportunities would have come about had you not approached the podiatrists about talking at one of their meetings.

Also consider reaching out to chiropractors. In addition to the dozens of patients with chronic back pain that each chiropractor sees, they also see substantial numbers of patients with medical conditions that may need a referral to a medical doctor. Reputable chiropractors do not treat medical conditions with spinal manipulations or adjustments; they are happy to send them to a physician who will appreciate the referral and be sure to send the patient back to the chiropractor.

Interest in alternative methods of healing and complementary medicine is on the rise. An ever-growing percentage of patients are choosing alternative methods of healing or doctors and practitioners of complementary medicine. This reality has not been lost on the mainstream medical community, and many allopathic physicians now collaborate with chiropractors and acupuncturists, among others. Large cancer centers have established departments of integrative medicine, seeking to take advantage of the large sums of health care dollars being spent on alternative remedies and herbal medicines.(1)

The smart physician would be wise to develop contacts with reputable alternative practitioners.

The smart physician would be wise to develop contacts with reputable alternative practitioners, because millions of Americans now seek healthcare from a full range of such practitioners. If you are able to intelligently inform your patients about complementary remedies and their reasonable use, instead of discounting alternative remedies altogether, you are more likely to retain that patient. You become a resource instead of an adversary.

An article in the New England Journal of Medicine pointed out that Americans made an estimated 425 million visits to providers of nonconventional therapy in 1990. This number exceeds the number of visits during that year to all U.S. primary care physicians (388 million). Expenditures associated with use of nonconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket.(2) The number of patients relying on alternative therapies has increased even more in the last 15 years. In 2002, a report in the Journal of Integrative Medicine stated that 62% of adults used some form of complementary and alternative medicine therapy during the past 12 months when the definition of complementary and alternative medicine therapy included prayer specifically for health reasons. When prayer specifically for health reasons was excluded from the definition, 36% of adults were found to have used some form of complementary and alternative medicine therapy during the past 12 months.(3)

The evidence continues to mount that an increasing number of our patients are seeing nontraditional healthcare providers. We must make an effort to communicate with these providers in a professional manner, and, as a result, we can achieve additional referrals to our practices.

Target Your Market

For years, orthopedists have had a symbiotic relationship with the legal profession, particularly the personal injury (PI) attorneys. Many orthopedists now communicate directly with PI attorneys and insurance companies to generate referrals. An orthopedic clinic in New Orleans has escalated its outreach efforts to include insurance claims adjusters. Ancillary income can be obtained when orthopedists identify attorneys and insurance adjusters as important targets for potential patients. The following anecdote gives an example of an orthopedist who marketed to nontraditional referral sources.

An orthopedic practice invited local attorneys and insurance adjusters to attend a seminar on “Common Orthopedic Injuries and Their Symptoms,” “Determination of Disability,” and “Role of Diagnostic Testing” conducted by the doctors, nurses, and insurance billing/coding experts in the practice.

The practice identified two more important authorizers of payment: risk managers and insurance rehabilitation specialists. The clinic’s mailings extend to thousands of attorneys, insurance claims adjusters, rehabilitation counselors, and risk managers all over the southeastern United States. The clinic offers continuing medical, legal, and nursing education credits for its seminars.

The clinic has tracked its referrals and has found that marketing has attracted a substantial number of new patients. The clinic reports that tracking the number of referrals from third-party guarantors (i.e., attorneys and insurance adjusters) for the period following inception of the clinic’s seminars until four years later revealed that referrals had increased to an average of 15% more than previous levels.

Other Referral Sources

Nurses

Nurses and hospital employees are other important sources of referrals. It is common for consumers looking for healthcare providers to ask nurses for recommendations. Doctors who are kind, considerate, and attentive to their patients are frequently the ones who are suggested by nurses.

Several times one of us (NB) has been asked to speak at meetings of the American Operating Room Nurses Association, and a number of referrals are generated after each presentation. If you are a surgeon, consider giving an in-service instruction. Whenever you are going to perform a new procedure, go to the hospital and give a talk to the operating room nurses. This accomplishes several goals:

• It makes the nurses knowledgeable assistants when you do the procedure;

• It reduces the anxiety they usually feel when assisting with a new procedure or operation; and

• It lets them know that this doctor is on the cutting edge, performing the newest procedures.

Whenever you have an opportunity to speak to nurses, always leave handouts. Just as with other speaking engagements, provide additional information to anyone who requests it. As a result, you can expect additional referrals from the nurses.

Pharmacists

Pharmacists are another group from whom patients frequently seek advice. Therefore, it is important to become an ally of the pharmacists in your community. For example, before you start prescribing a new medication, call (or have your office call) the local pharmacists and make sure they have the medication available.

Send articles to local pharmacists about your areas of interest and expertise.

You can also protect your patients from receiving confusing advice if you stay in touch with your pharmacists about nontraditional uses of established medications. For example, in the past one of us (NB) prescribed the mild antidepressant imipramine for mild stress and urge incontinence. In one case, the pharmacist told the patient that the medication was not used for incontinence but for depression. That meant there was a need for some explaining—to both the patient and the pharmacist. The problem was solved by photocopying the journal study showing the efficacy of imipramine for both urge and stress incontinence. By sending along the information about the medication with each patient, the pharmacist became educated, and several phone calls to explain the rationale for prescribing it were avoided.

You can also send articles to local pharmacists about your areas of interest and expertise. For example, one of us (NB) wrote an article on the use of transdermal scopolamine to treat bladder instability, which was an off-label use for that anti-nausea medication. The pharmacists in my community were thus knowledgeable about this new use. (Transdermal scopolamine is still not approved for use for that purpose.)

Pharmaceutical Representatives

Don’t forget pharmaceutical representatives as another source of referrals. Not only are these men and women able to provide you with educational materials and sample medications, but they are also capable of generating good public relations for your practice. If you have a well-run practice, they will often mention it to other physicians and potential patients. If you want to endear yourself to the drug representatives, see them in a timely fashion. That is their “hot” button, and they really appreciate it if you do not ignore them or keep them waiting.

Other Referral Sources

Other possible sources for referrals include oral surgeons, dentists, and orthodontists. Neurologists interested in treating headache can communicate with dentists who have patients with temporomandibular joint syndrome. Psychiatrists can communicate with psychologists, sex therapists, social workers, and the clergy.

Ophthalmologists can work with optometrists. Orthopedists can look for referrals from chiropractors. Rheumatologists can connect with manicurists as women who visit a manicurist often have problems with the joints in their hands. And dermatologists can solicit referrals from barbers and beauticians. Once you do a little “out of the box” thinking about referrals, you can see a wider range of possibilities for your marketing.

From Alternative to Complementary

Not too many years ago most medical doctors scoffed at the mention of patients visiting chiropractors, acupuncture specialists, or homeopaths. Now that patients are seeking out these practitioners, medical science is taking a second look at these practice patterns. If physicians can overcome old notions of what constitutes the healing arts, there may be some fruitful collaboration in store for both types of practicing professionals. Not only are consumers willing to pay out of pocket for alternative medicines and treatments, but insurance companies are agreeing to pay for certain kinds of alternative medicine.(4)

Cast Your Referral Net Using the Internet

Have you Googled yourself or your practice lately? With pandemic fears and social distancing mandates in place, more people are utilizing the Internet for information. Are your online reviews positive or negative? Have you responded, within HIPAA guidelines, to your reviewers? The vast majority of patient complaints are related not to medical care, but customer service. When patients are frustrated because of rudeness, inattention, or long waiting times, today’s response is to vent frustrations online with the click of a mouse. Even with the best intentions and actions by the best staff, a bad review of your practice is inevitable. However, responding to those reviews in a timely and courteous manner can demonstrate that your practice is making every attempt to rectify a patient’s negative experience. Most patients will recognize that no one is perfect, not even medical doctors!

Your online presence must be constantly monitored, either by yourself or by someone within your practice.

Replying positively and promptly to a negative review is often the best way to overcome the repercussions of a less-than-stellar review. In many cases, frustrated and angry patients just want to be heard. Acknowledging the patient’s experience and responding in a positive manner not only will reflect well on your practice, it may even save the loss of a patient. In a best-case scenario, the reviewer may even remove the negative post or amend their review.

Keep in mind that simply searching for directions in Google Maps will reveal your Google ratings. If you have no stars or a low number of stars, patients may think twice about calling your office for an appointment.

Your online presence must be constantly monitored, either by yourself or by someone within your practice. Furthermore, always ensure the online responses to reviews are HIPAA compliant. Google Reviews are the most commonly used platform for those actively seeking reviews, but do not neglect to monitor other sites such as Yelp, Healthgrades, Vitals, and other online review sites.

Approaching Potential Referral Sources

Some suggested ways to approach nontraditional sources for referrals include the following:

• Agree to meet “on their turf,” at least the first time.

• Find common areas of interest and emphasize them.

• Show respect for the professions of nonmedical colleagues, even if you do not completely agree with their approach. In the past, this was much more of a problem, with physicians discriminating against osteopaths, orthopedists against chiropractors, and ophthalmologists against optometrists. In today’s world of decreasing reimbursements and shrinking patient bases, we cannot afford to be provincial. It is time to expand our worlds—and expand our practices by doing so.

• Demonstrate the benefit of sharing patients and referrals. Not only will you increase your network of potential referral sources, but so will your nonmedical colleagues.

• Provide your referral sources with something new, interesting, and educational. You have an opportunity to increase your awareness and understanding of their professions, and vice versa.

• Promise to provide written documentation on a regular basis.

• Make every effort to refer patients to the specialties or professions of your nonmedical colleagues.

• If all else fails . . . feed them!

Bottom Line: By moving “outside the box” of traditional referral patterns, you can garner additional patients. All it takes is a little innovation and a little time. Whatever your niche, there are professionals who can feed you referrals—ophthalmologists with optometrists, orthopedists with chiropractors, rheumatologists with manicurists, dermatologists with cosmetologists and massage therapists—the range of possibilities for marketing is vast. Take the time to consider nonmedical professionals who could potentially make referrals to your practice and build a plan to connect with them.

References

1. MD Anderson’s integrative medicine. www.mdanderson.org/documents/patients-and-family/diagnosis-and-treatment/care-centers-and-clinics/Integrative%20Medicine%20Center/IMC-nutrition-WTE.pdf

2. Puchalski L. The use of alternative and complementary medicine in radiology today. Radiol Manage. 2000;22(1):51-55.

3. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Seminars in Integrative Medicine. 2004;2(2):54-71.

4. Overbay A, Hall M. Insurance regulation of providers that bear risk. Am J Law Med. 1996;22:361-387.