Too often professional practices dwell on the technical aspects of their specialty niche and ignore who their primary and secondary customers are.

From a business perspective, specialists have two levels of “customers”: their patients (primary customer) and those who refer patients to them (secondary customer). Primary care doctors are important secondary customers for specialists.

Strong specialty practices are built by repetitively and automatically accomplishing the three objectives stated above. These methods become part of your daily office procedure; a proprietary way of operating.

A one-week seminar on these three topics would barely scratch the surface. The purpose of this article is to talk about aspects of the referral process that are germane to specialists.

Since I am by training a family physician, I’m going to talk about key aspects of the referral relationship between specialists and family doctors.

A light, breezy discussion of referral generation systems does no good. You have to drill down deep on each step to get it right, as I do with my consulting clients. It is like Colonel Sanders’ secret recipe (pardon the dated reference). Unless the right ingredients are used the right way, there is no deliberate way to produce the desired results.

The answer to this question is deceptively simple: The first one that pops into their brain. True, being paneled on managed care plans can be a factor as well. And to be fair, one of the keys to being busy is to be on all the plans. But just ask a busy veteran practitioner what they think of being on all the managed care plans available, including Medicaid, and you might choose to reconsider the choice to participate in every plan.

The subject of payor mix is one that deserves its own column and I will not go into that here. One last thing about payor mix before we leave the subject: Being on every known managed care plan doesn’t guarantee you will be busy either. If that is your only strategy to build patient volume, it is probably a major strategic flaw in your growth plan.

So how do you become the obvious choice? The preferred expert? Let’s consider some basic consumer psychology and see how it applies to your practice.

When the average consumer needs to buy goods or services, be it a new set of tires for their Minivan or a pool cleaning service or medical services, there is a built in hierarchy of choice of provider:

This confirms an objection I sometimes hear from my coaching clients: “The busiest primary care physicians already have preferred specialists that they use.” These doctors are simply conditioned to keep using their existing referral relationships.

My answer to their objection is this: “What are you willing to do, and how much time and money are you willing to spend to ethically form a relationship with these doctors?”

Many specialists are too busy with their own practices to develop these all-important new business relationships. This activity is definitely an investment in your practice. And it doesn’t always pay off immediately.

Face to face contact. I refer a good volume of patients to several specialists that I have never even met face to face. And these specialists have never bothered to say ‘Thank You’ for the referrals.

There are limitations on gifts that can be paid to referral sources on a federal and a state level. It is very unwise to ignore these limitations – that could land you in jail. But there is no law against picking up the phone and saying, “Thanks for sending over Mr. Jones, we’re going to take great care of him.”

By the way, this doesn’t have to be executed by you personally. You can outsource this to members of your staff or take turns with them.

When we design these referral systems for our clients, we script the entire encounter.  Then we get the presenter to practice multiple times before visiting each referral source.  Although you may think a scripted presentation will sound canned and inauthentic, it actually has the opposite effect.  It will allow the presenter’s voice to come out and make a real connection with the prospective referring doctor.

The frequency for contact varies between weekly to monthly. This correspondence is an offer of free information, not a sales pitch. Physicians are very sensitive to being “sold” and will not read your offering if it lacks relevance to their life or appears to be a manipulative attempt to sell them.

Information on affinity subjects works very well but is time consuming to discover and it must be a real passion of the referring physician.  This is very difficult to automate.

My preference is for the printed newsletter and the preprogrammed automated email formats.These are outsourceable, automatic and they work. The content should not be dry clinical information only.  It should be a mixed content in an easily readable format. 

The delete key and the trash bin are an ever-present threat to your message and they should be respected as such.  There is an art to getting the content right and most specialists are best served by getting someone else to assemble this content, unless they have an innate flair for copywriting.

The newsletter and email formats keep you in front of your prospective referral sources in an unobtrusive and interesting way. They also provide a topic of conversation when you or your representative is visiting in person with the physician.

Business studies show that you are most likely to make a second purchase immediately after your original purchase.  According to the theory, we have an unconscious need to validate our decision to purchase, and we can do so by making another similar decision.  It is a paradox of consumer psychology.

Have you ever ordered anything from a television infomercial?  You are immediately offered extra units of whatever you ordered, an insurance policy on what you ordered and several related products.  They call this “upsell”.  The merchant knows that you have a 30% chance of buying the upsell at the time of the initial purchase; but if they called you back in a week for an upsell, you probably wouldn’t buy.

Let’s apply this concept to referrals made from a primary care doctor to a podiatrist.  Dr. Smith, a busy family physician, sends patient Mary Jo Hammertoe to Dr. Goodfoot for a consult.  Dr. Smith never hears back from Dr. Goodfoot – no clinical notes, no call acknowledging the referral or treatment process, no referral back to Dr. Smith for related care.  The next time Dr. Smith sees Mary Jo, he completely forgets about her foot pain.  What are the odds that Dr. Smith will refer to Dr. Goodfoot again, given the fact that he has multiple specialists to choose from?

Now imagine that same scenario in a different way.

These are the first steps in a sequence I use to help specialists that want to grow their practice via referrals.  It works very well.

There are specialists in my area that will take the time with me on the phone to teach me if I call on them. They give me clinical pearls that make my work easier. Information on the best tests to order, or new drugs or procedures. They offer that information in a friendly cooperative manner. And I trust them as a natural result of this process – and I refer my patients to them.

I offer my practice development book at cost to specialists who want to share it with their referral sources. It is priced so as not to conflict with Medicare’s guidelines for gifting to referral sources. There is also an abundance of free information available on this subject as well as other publishers who are willing to offer their textbooks at a discount for bulk purchases Expert positioning is a big success key for specialists. When you are perceived to be the most knowledgeable specialist, your practice can’t help but benefit.

A well-known example is the practice of Hare Krishnas in the 1970s to give flowers as gifts in airports as an incentive for donation to their church.  The majority of their donations came form people who did not believe in or practice the Hare Krishna religion.  They simply felt an obligation to repay the gift of the flower by giving a dollar.

If you were referred a patient who had no insurance and you treated them for free, do you think that would say something special about you to the patient and the referring doctor? If you provide timely useful information to your referring sources, do you think they are likely to trust you more?

A physician friend of mine plays guitar, as I do. He mentioned it to me in passing and we started a discussion that led to him inviting me over to his house to meet several of his friends that were also doctors who played an instrument. He is to this day, the gynecologist that I refer to the most. And it has very little to do with anything other than the fact that I relate to him.

By the way, affinity marketing is a very lucrative business. Credit card companies are especially adept at using this technique. Have you ever been offered a special credit card linked to your state medical association? Or linked to the school you attended? Or the airline you fly the most? The means to develop affinity relationships is to mingle with primary care doctors. Attend mixers, drug dinners, and county medical society functions. Make this part of your schedule. Attend at least one function per month. When you do attend these functions, collect business cards and follow up personally with those you meet.

One of the most effective ways to develop affinity is to become involved on a committee at your local hospital. It gives a reason for you to communicate with all the medical staff, and start the process of relationship building. It generates better visibility within your local community.

There are numerous ways to build joint ventures into your practice, so let me give you one simple one to try out. After seeing a patient referred by a primary doctor, call back and say something like, “I saw Mrs. Jones today. Thanks for the referral. She has mild diabetic neuropathy and a Grade 1 ulcer. I will follow her weekly until the ulcer resolves. When do you want to see her back?”

Then have your receptionist call the patient and have the patient schedule back with their primary doctor. It shows an appreciation for the relationship the patient has with their primary doctor and a need for continuity of care.

Joint venture relationships can be a lot more complicated than that, but they don’t have to be. I am a strong proponent of using endorsed mailings to build a practice, which is an excellent use of joint venture relationships.

That is a brief introduction the strategies behind generating referrals to your Specialty practice. Large practices are often built on referrals alone. Once you understand how to build referral relationships with primary care doctors, the next question is how can you automate and outsource the process? How quickly can you scale it up to build your practice to the size you desire? How can you build your practice to the point you can bring on associates and earn passive income from their activity? The process of doing this is easier than you think if you will invest a little time and thought into the process.