Rules of attraction

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The art of drawing in physicians-led referrals to your practice.

Suzanne Al Houby likens the referral process to a turf war over patients. As CEO of the Dubai Bone & Joint Centre, she has seen first-hand the reluctance of primary care physicians (PCPs) to release their patients for specialist care.

After three years of practice, the facility has still yet to make a real indent into physician referrals. "Most of our patients, the majority are self referrals," she admits, describing physician referrals as "a continuous challenge".

"The whole community here historically does not like to work together."

It's no exaggeration to say that a solid referral base is a rare achievement in the Middle East. Specialist centres complain that extracting patients from first-line providers is a near-impossible task. "The whole dynamic is very different," explains Dr Chris Canning, CEO of Moorfields Eye Hospital Dubai (MEHD).

It used to be that being available, amiable and accommodating was enough to guarantee a steady stream of patients. Now, heated competition means specialists must do more to make a mark with referrers. Medical Times has polled the experts to learn how best to corner a share of the market and convert one-time referrals into long-term supporters.

Formal flirtation

The route to increased referrals is equal parts courtship and confidence building, insists Dr Neil Baum, a New Orleans-based urologist and author of the book Marketing your Clinical Practice; Ethically, Effectively, Economically.

"PCPs want to hold on to their patients," he says. "Specialists need to convince them that they are going to participate alongside them, and reassure them that they are going to get their patients back."

The main strategy is to have your name cross the mind of the referring physician frequently, and with positive associations, a technique that requires less time in the practice and more time on the social circuit. Baum advises visiting each potential referral source personally to tell them about your area of expertise, taking along a copy of your CV.

"Think outside the box with the healthcare professionals you target," Baum recommends. "There are multiple sources of referrals that are available, not just primary care practitioners. Podiatrists, dieticians, chiropractors - these people can all send you patients."

Ward staff can also be a key source of referral. Position yourself as an expert in your field by offering seminars to nurses, or holding grand rounds at local hospitals. Cultivate these employees effectively, reports Baum, and you can secure a virtual sales team.

Moorfields has targeted local ophthalmologists by offering lectures covering the latest updates in their field. "It lets them know who we are, wrapped up in an educational programme," Canning says. "These have been a good source of tertiary referrals."

As an ambulatory facility, MEHD has also pooled resources with the American Hospital Dubai, to offer overnight beds to patients that require an inpatient stay. The quid pro quo, said Canning, is that the hospital refers on the patients it is unable to treat.

Baum has found some of his most lucrative referral sources in physicians he should outwardly be competing against. "You can get referrals from surgeons in your specialty, if you can offer skills they do not have," he says. "It's a value-added service for their patients."

As important as raising your profile, is ensuring your availability. Practice consultant Susan Baker, author of Managing Patient Expectations; The Art of Finding and Keeping Loyal Patients, advocates establishing a direct dial number solely for use by referring physicians.

Answering that phone should be a top priority for everyone in the practice. "Make it easy for physicians to refer to you," she says. "Provide cards with your contact information and a map to your practice."

Small gestures can spark lucrative results, so Baker advises doctors to keep it personal. "Never ask another person to return referring physician's phone calls. Place the call yourself."

Handle with care

As important as securing referrals is knowing how to keep them. The fastest way to be struck off a physician's referral list is by failing to observe good referral etiquette, and top of the list is communication.

When you receive patients, get diagnostic information back to the referral source speedily. A timely succinct report, says Baum, trumps a delayed, detailed one, and physicians give high marks for effective communication.

"There are three things that are important to a physician; diagnosis, medication and your treatment plan," he says. "If you have a template, and you can enter those three things, you can get the report back to the referring physician's office before the patient leaves yours."

By keeping the doctor in the loop, Baum says, you're deferring to their claim on the patient and building a reputation for efficiency. "The objective is to make that PCP feel that they are the captain of the patient's healthcare ship," he stresses.

Specialists should also be alert to the fact that primary care physicians are logistically unable to stay ahead of advances in every sub-specialty. If Baum is using a new technique on a patient, he sends educational material along with the referral note and flags up the text relevant to the treatment plan.

"If you can highlight the one or two sentences you want him or her to read, you'll be educating the doctor and they will certainly appreciate it," he insists.

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