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    Christian Green, MA

    One of the most important components in growing a practice is referral development, particularly relationship building between primary care physicians (PCPs) and specialists.

    Illustrating how frequently these interactions take place, more than one out of three patients are referred to a specialist each year.1 According to another study, medical referral rates in family medicine — referrals placed to physician specialists, rather than referrals for ancillary services — were as high as 13.4%.2

    Referral relationships start by focusing on communication, which can help separate your practice from the competition. In talking to PCPs in hospitals and health systems, “it’s one of their No. 1 complaints,” says Susan Boydell, partner, Barlow/McCarthy, Dallas, about the need to clearly communicate with specialists and patients alike. “If you’re doing it very well right now, then pat yourself on the back and continue to make sure that you do that,” she emphasizes.

    Next to clinical expertise and quality, the ability to communicate well is the most important criteria to physicians when referring patients to specialists.3 Similarly, communication is essential between patients and their PCPs when detailing their experience with a referred specialist. If patients aren’t satisfied, their PCP won’t soon forget their patients’ experience.

    Boydell suggests that a PCP may need to step in if he or she hears about negative patient experiences. “If a patient comes back to your office and says, ‘Yeah, that didn’t go so well; I really didn’t like his bedside manner,’ or ‘I sat in his waiting room for way too long,’ or ‘I tried to get an appointment, but it was going to take me six months to get in,’” intervention may be necessary, as a negative patient experience reflects poorly on the PCP. This should influence whether he or she refers additional patients to that specialist.

    Referral action plan

    To make sure patients have a good experience with referred physicians, primary care practices should develop an action plan, prioritizing the following:

    • Clarify expectations for referring physicians — PCPs need to clearly communicate expectations to specialists to ensure delivery of those expectations.
    • Emphasize the importance of the patient — Likewise, when making referrals, patients are the No. 1 priority for PCPs, so their needs should be met.
    • Develop a consistent approach to communication — Consistency can ensure that patient and physician expectations are met. For PCPs, the preferred means of communication with specialists concerning referrals is via face-to-face meetings (45%).4
    • Engage staff in new business success — Staff should play a vital role in referral development to help produce favorable results.
    • Track, trend and monitor — A critical part of engaging staff is to keep tabs on referrals to determine patterns, interaction with patients, and connections and loyalties with healthcare systems. Much of this data can be tracked in your EHR.
    • Take advantage of hospital-sponsored programs — This can be an alternative to hiring field reps, especially for smaller practices.

    As Boydell points out, hospital-sponsored programs are often an untapped resource that should be used. “Almost every hospital and health system has some sort of physician liaison team/physician relations team that call on physicians to earn their referrals,” she says for practices that may not have the wherewithal to hire dedicated salespeople to target referrals.

    Physician expectations about communication

    Expectations vary by physician type regarding communication after referral. As seen in Figure 1, patient discharge summaries and hospital admission notices are extremely important to PCPs, while specialists place an emphasis on being notified once a patient is seen. According to Boydell, expectations should be customized based on the needs of referring physicians.

    Referral targets 

    To help grow their business, primary care practices need to understand which specialists to single out. To help with this, referral targets can be broken down into three categories: loyals, splitters and nevers.

    • Loyals — Physicians you can’t afford to lose. They will give you the benefit of the doubt when referring, and it’s vital to nurture these relationships and communicate often. “Loyal physicians trust you … but they are also probably going to complain more than anybody else, because they have that special relationship with you,” Boydell conveys.  
    • Splitters — Physicians who give some referrals to your practice and some to others. They give you less attention than loyals, but they are vital to your practice’s success. “From a growth perspective in referral development, those are your No. 1 opportunities,” Boydell contends. “Because they are already giving you something.” Assessing splitters may help determine the need for a sales team or a physician liaison to call on those physicians, Boydell adds.
      This is where data tracking really becomes important, according to Boydell. “If I have a salesperson or I’m thinking about getting one, that’s an expensive marketing proposition,” Boydell expresses. “If you are calling on referral sources to earn additional referrals … you have to know whether the investment you are making is actually working for you.”
    • Nevers — Physicians with whom you have little or no contact. Over time, they have shown that they prefer to work with other PCPs. Unless they are one of the leading specialists in your area, they are probably not worth the effort.

    Best practices for hiring a dedicated salesperson

    If you have the means to hire a dedicated salesperson, there are several best practices to employ to get the most bang for your practice’s buck.

    1. Targeted/data driven — Track referrals to determine ROI and to reconnect with referrals who aren’t actively working with you.
    2. Consistent field visits — When hiring a dedicated salesperson, he or she has to be in the field to build and nurture relationships with referrals.
    3. Clear difference — A business can’t grow by being as good as its competitors; it must differentiate itself in some fashion.
    4. Measurement — Beyond differentiating your practice, you must be able to use data to assess what makes you better.
    5. Communicate clinical depth — For a field rep or physician liaison to be successful, he or she must be able to help change referral patterns. That individual should know what makes the practice different and be able to take a deep clinical dive on a particular type of patient.
    6. Effective field talent — You can’t teach someone how to sell, so make sure you hire talented salespeople.
    7. Internal role clarity — Finally, every stakeholder should know his or her role in the pursuit of physician referrals.

    As Boydell maintains, face-to-face conversations are the key to physician referrals for PCPs, with or without a dedicated sales person. “They want to build a relationship. They don’t send to buildings; they don’t send to institutions,” Boydell says. “Most of the time, they are sending to a physician whom they have a relationship with, because they have to trust them with their patient.”


    1. Mehrotra A, Forrest CB, Lin CY. “Dropping the Baton: Specialty Referrals in the United States.” The Milbank Quarterly. March 2011; 89(1), 39-68.
    2. Porter M, Malaty J, Michaudet C, Blanc P, Shuster JJ, Carek PJ. “Outpatient Referral Rates in Family Medicine.” The American Journal of Accountable Care. March 2018; 6(1), 25-28.
    3. Barlow K. The complete guide to physician relationships: Strategies for the accountable care era. 2011. Middleton, MA: HCPro.
    4. Ibid.

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