Pulling together

Persuading general dental practitioners to pass over patients can be a tough sell. MED learns the rules of the referral game.

Dr Mohammed Afsahi has become accustomed to dealing with rebuttals from possessive general dental practitioners (GDPs).

Afsahi, himself a general dentist, works at the Bin Belaila Specialist Dental Clinic in Dubai.

The clinic is one of a few in the emirate to have a CT scanner for implantology and orthodontal applications, and had invested on the premise that rival clinics would be keen to make use of the technology.

However, Afsahi says, he has found local dentists are so afraid of losing their patients and their revenue that they are reluctant to release them - even for a scan.

"AED1.2 million we have spent on a CT scanner and no-one will refer to us," he says, exasperatedly.

In Europe, if you do implantology without using a CT scanner, you can leave yourself open to legal action. But here dentists say to me, ‘You have an implantologist at your practice, so how can we be sure that you will return our patient?

As any specialist in the region will tell you, this reluctance to refer patients for secondary care is a widespread problem. As more GDPs branch out and offer a wider range of services to patients, specialist referrals are becoming harder to come by.

And, suggests Afashi, without a major shift in perception, this situation is unlikely to change soon.

So what role can specialists play in encouraging better referral habits? MED spoke to the experts to learn the rules of play in the referral market and how a little networking expertise can pay dividends in the success of your practice.

It's good to talk

Communication is the backbone of most business dealings, and referral relationships are no different. To persuade any GDP to send a patient to your practice, first there must be a dialogue. Where many specialists stumble is by not knowing how to make that first contact.

Simply knocking on the door of a general practitioner's office, handing over a business card and telling them you would welcome any patients they could throw your way, is rarely the best way to start.

Dr David Hoexter, a New York-based periodonist and implantologist, rates good communication as the first rule of referral etiquette. He estimates that around 65% of his business comes courtesy of other dentists - a clear indication that specialists cannot afford to ignore this source of revenue.

Having spent 12 years as a GDP himself, Hoexter is well placed to spot the strategies specialists can use to encourage referrals.

"I am grateful I have the background in general practice, so I know how they think and what they expect.

Hoexter, formerly a clinical professor at Temple University in Philadelphia, invites general dentists to study groups to help raise his profile and cultivate new referral sources. "As a specialist you have to make contacts," he says.

"You have to expose yourself a bit and raise a general practitioner's level of awareness of what you do.

It's an approach endorsed by consultant and dentist Dr Lee Ostler, whose marketing company trains dentists to boost their referrals from physicians.

"What are required are things like professional marketing materials, newsletters and a referral strategy," says Dr Lee Ostler.

He advises sending ring binders with articles and information on the latest techniques in your field, coupled with suggestions about how these techniques could benefit the dentist and their clients.

"While the general practitioner may know the overall picture [about a speciality] I have found that they appreciate being filled in on the details.

Continuing this strategy pays off, even when GDPs start sending patients your way. Hoexter is careful to involve referring dentists in treatment planning, and to defer to their claim on the patient.

He holds regular consultations with general dentists to discuss diagnoses, and to keep them informed of his progress.

"I consult with up to 25 general dentists a month," he reveals. "It's a team effort."

This has the added bonus, explains Hoexter, of making it clear he intends to return the patient. And, just to reaffirm, he has a policy of scheduling follow-up appointments with the original practice, to smooth the handover.

When I'm finished with a treatment, I call up the referring dentist's office for an appointment while the patient is with me," he says, "to make sure that they return to their dentist."

Try a different door

Looking outside normal routes of referral can prove beneficial to a specialist practice.

Where banging on the front door fails, finding another way into a dentist's referral network can succeed.