Continuing a series of articles about key referral sources and how to reach them...
Physician referrals (Continued)
This first referral source may seem a bit obvious - we all know that primary care physicians refer patients to a specialist when necessary. What is less obvious, however, is how physicians select the surgeons and practices to which they refer. Even less obvious is understanding how physicians decide which patients to refer for surgical assessment, and when. And finally, when a patient is referred to a surgeon, does he or she comply? Why or why not?
Today, we'll answer the second question: how do physicians decide which patients to refer for surgical assessment, and when?
First, a disclaimer. I'm generalizing. Every physician considers different factors when deciding who, when, how and where to refer. Physicians have varying levels of expertise, and differing areas of interest. Some may be well-versed in spinal conditions, others expert knee evaluators, and yet others cardiac specialists.
But that's exactly the point. A primary care physician cannot be expected to be an expert in everything. It's not realistic, and it's not their job. I would argue that it's YOUR job (or my job, as the case may be) to ensure that the referring physicians in your area have a good understanding of surgical indications and other reasons for referral.
In the absence of educational initiatives and valuable references, which patients get referred? Let's take patients who present with back pain as an example. As you all know, back pain is notoriously challenging to diagnose, and a very small percentage of back pain patients will actually benefit from surgery.
Primary care physicians are likely to refer:
A) The squeaky wheel. The patient who has visited and complained about their chronic back pain for 2 years straight. Referral is the only way to appease the patient.
B) No one. Spine surgery has a bad reputation. Many primary care physicians will only refer patients as a last resort.
B) Everyone. New studies show that physicians feel obligated (legally, financially, or otherwise) to treat patients aggressively. Better to be safe than sorry. Hope you like spending ALL your time in clinic, because that's where you're going to be for the next 5 years. Only a handful of these referred patients are surgical candidates...
If you're with me, none of the above options are all that appealing. However, you do have control over your referrals. By partnering with and educating the referring physicians in your area, you can ensure that the appropriate patients are being referred for the appropriate treatment (PT, pain management, surgical assessment) at the appropriate time. Additionally, you can increase the percentage of patients that you see in clinic that are actually surgical candidates - meaning you spend more time in the OR and less time screening patients in clinic. It's a win for the primary care physicians, a win for the patients, and a win for the surgeon.
P.S. Need help developing a strategy to educate the referrers in your area? Drop me a line.