Building Referrals And Relationships With Primary Care Providers

   In the competitive world of medicine, half of the battle for the specialists today is establishing a positive relationship with a primary care physician. It can be initially intimidating to some podiatrists to compete against more established orthopedic foot and ankle specialists in their area. However, if the primary care physician is aware of a DPM’s scope of practice, abilities, strengths, successes and knowledge of limitations, he or she can help the podiatric practice thrive in the local community.    Most podiatrists new to practice are not as busy during the first six months but would certainly like to have more patients coming into the office. It is during this initial time in practice that building a solid foundation of communication with the primary care physicians in your area is particularly vital.    If you are the new practitioner in town, make an effort to meet all primary care doctors in the area. There are numerous ways to do this. Send an introductory letter to all family practice and internal medicine physicians. This letter introduces you, announces your practice, your scope of practice, basic office information and the desire to help referring physicians with their patients. Depending upon the number of primary care physicians in the area, you may choose to send these letters out in batches rather than all at once.

How To Get Some Valuable Face Time With Local Docs

   Three to four days after sending the letters, call each primary care physician to schedule a meeting. While you may find some offices reject an attempt to contact the physician, be persistent. At some primary care offices, the office manager will be the person to schedule this meeting.    Sometimes the physicians themselves will want to control their schedules. Since you are the one calling the primary care physician, you must be flexible with your available time. Offer to meet the doctors in the morning before they see patients, during their lunch hour or at the end of their last patient visit. Assure them that it will not be a lengthy meeting. This face-to-face meeting may be as simple as a two- to five-minute introduction. However, leave your schedule open and available for breakfast, lunch or a short after-work dinner if this is what the primary care physician prefers.    Aside from face-to-face meetings, another possibility is mingling with many primary care physicians by having breakfast or lunch in the hospital’s doctors’ lounge. This provides the opportunity to have a casual conversation and share your name and your talents with several physicians at once. You may also offer to bring lunch to the primary care physicians’ offices for the doctors and their staffs.    When meeting the primary care physician face to face, remember always to speak clearly and with a smile. Keep your language clean and crisp. Be confident but not cocky. Briefly tell the physician about yourself, where your office is and let the physician know what you can do for him or her. Be sure to bring your business cards and office brochure with your phone number prominent on these items.

Educating Primary Care Physicians On Podiatry

   After discussing basic practice information, primary care physicians will want to know about your podiatric skills. In discussing your scope of practice with the primary care physician, remember that in most incidences, they prefer hearing about conservative treatment over surgery. While you may have just recently completed a three-year surgical residency, it is likely not in your best interest to tell the primary care physician that your favorite procedure is a triple arthrodesis for flatfoot reconstruction. This may seem overwhelming to the primary care physician and most would prefer to work with podiatrists who will attempt to alleviate their patient’s pain in a conservative fashion first.    One way to meet and educate a large number of primary care physicians at once is to offer to conduct grand rounds at the hospitals where you are on staff. Contact the medical education department at each hospital and ask to be placed on their scheduled grand rounds to discuss podiatry with primary care physicians. A popular topic of grand rounds may be “The top 10 foot and ankle conditions seen in the primary care physicians’ offices.”    During this educational seminar, discuss ten of the conditions you treat, how to diagnose them and how the primary care physician can initiate treatment. Then educate the primary care physician on the appropriate time to refer patients to a podiatric specialist. However, keep in mind that grand rounds are the time to introduce or emphasize podiatry, not to emphasize your practice specifically.    You can conduct this same presentation in a primary care physician’s office. This is most effective if you present the talk to a large group of primary care physicians in the same office or medical building at the same time. You can arrange these “mini-seminars” through the office manager of a group of primary care physicians.    A mini-seminar is a very effective way to educate the primary care physician about the world of podiatry but there are several other ways to do this. You may set up an in-service in the primary care physicians’ offices, guiding them on simple in-office procedures. When it comes to educating the primary care physician on such procedures, do not feel that you will subsequently lose patients.    In fact, these in-services spark a fair number of referrals. If you educate the primary care physician on in-office procedures, they would more likely feel assured that you know appropriate protocols and will feel more comfortable sending these procedures to you. When it comes to in-office procedures, podiatrists can educate primary care docs about tapings, strappings, proper injection technique, orthotic castings and nail avulsions. During the in-service, be sure to emphasize when it is appropriate to refer patients to a podiatric specialist.

Following Up On Referred Patients

   Be prepared to offer and follow through on seeing referred patients on the same day the other doctor refers them. When the schedule starts to fill, be sure to leave time slots available for such referrals. Remember, you have just asked the primary care physician for referrals so be prepared to receive them.    After seeing a referred patient in the office, be sure to send a copy of your initial treatment note to the primary care doctor. Faxing the note often informs the primary care physician in a more timely fashion. Keep him or her informed of subsequent office visits, follow-up and progress of the patient as well.    In urgent or emergent situations, be sure to call the primary care physician directly. It is not proper phone courtesy for your staff to call his or her office to get that doctor on the phone and then place that doctor on hold while your staff gets you on the phone. Make the phone call yourself and wait for the primary care physician to come to the phone.    Also make sure the primary care doctor knows you will be referring the patient back to him or her for follow-up and any testing that needs to be done. Let primary care physicians know you will be referring the patient back to them for any additional referrals or specialty consultations you are considering.

Seven Ways To Maintain Relationships With Primary Care Doctors

   Once you have established a rapport with primary care physicians, there are several things you can do to build on the relationship and keep your name in the doctors’ minds.    1. Send thank you notes for referrals to primary care physicians’ offices. This thank you may be as simple as a form letter, a handwritten note or a personal phone call. When the primary care physician regularly sends referrals to your office, you may choose to send an appropriate gift such as a plant, flowers, box of candy or an annual thank-you such as a holiday gift or sending a catered lunch to the physician’s office. It may also be appropriate at this time for your staff members to build a relationship with the referral staff at the primary care physician’s office.    2. Keep the primary care physician abreast of your office, your scope of practice and your areas of specialization. When you become familiar with a new podiatry treatment or become skilled in a new technique, be sure to send an appropriate letter to the primary care physicians telling them about this new information. Sending pertinent journal articles to medical professionals will also keep them informed of treatments offered by podiatrists. When sending a journal article, consider highlighting the important parts of the article in case the primary care physician does not feel compelled to read the entire article.    3. Keep primary care physicians informed of the insurance panels with which you participate. Every six months, consider sending the primary care physician a laminated list of the insurance plans on which you are included. Be sure to include your name and office phone number at the top of this list.    4. Contact the medical education department at the hospitals you work at and offer to write an article for the hospital newsletter. You may write this article on a new technique you have learned or a common foot/ankle condition that you see during a certain time of the year. For example, you may choose to write about winter foot care or summer sports injuries.    5. Regularly attend hospital staff meetings. This is an excellent opportunity to maintain face-to-face contact with referring physicians. This will also provide a casual opportunity to discuss any difficulties or concerns you have regarding their patients.    6. Ask your patients to tell their primary care physicians about the treatments they received at your office and the progress that they are making. Your many satisfied patients will be happy to relay this information. Consider digital photographs of “before and after” surgical corrections of significant pedal deformities. Patients may share these digital photos with the primary care physician as they can leave a striking impression.    7. Send a “care package” on an annual basis. Assemble this care package in a professional manner and include a pocketed folder stuffed with professional cards, office brochures, a referral pad to your office, the current list of participating insurance plans and a couple of Rolodex cards from your practice. You may also choose to include a calendar highlighted with your name and phone number or a fun magnet with the same information.

In Conclusion

   While a new podiatrist may appropriately feel the urgency of meeting primary care physicians in the area and the building upon these established relationships, it is equally important for seasoned podiatrists to maintain these relationships and build relationships with new primary care physicians as they come into town. Start this whole process over each time a new primary care physician announces his or her practice. You will likely be the only podiatrist in your area who takes the time to meet a new primary care physician in town and you will be the specialist the primary care physician remembers as his or her practice grows.    With these tried and tested successful techniques, you can build and maintain relationships with primary care physicians in your area that keep your practice thriving in this competitive world of medicine. Dr. Titko is the Vice President of the American Academy of Podiatric Practice Management. She is a Fellow of the American College of Foot and Ankle Surgeons and is board certified by the American Board of Podiatric Surgery. Dr. Titko is certified by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine in podiatric surgery, orthopedics, primary podiatric medicine and diabetic wound care.