Referrals are crucial for any podiatric practice and particularly valuable when it comes to pediatric patients. This author discusses methods of spreading the word about the expertise you can offer via visits with physicians at hospitals, sending consultation reports to primary care physicians and maximizing use of the Internet.
In today’s murky medical climate with all of the challenges of a difficult economy, referrals are more important than ever as a source of new patients who are the lifeblood of any healthy practice. We all depend on referrals from medical colleagues and a host of others to suggest us to patients who may be in need of quality foot care.
When it comes to pediatrics, the referral is perhaps more critical as a source of patients than it is in other patient populations. Many parents are particularly thorough and cautious about selecting a specialist to evaluate their child’s foot or leg concern. In many cases, they will pursue a specialist for their children with a diligence and doggedness even greater than they would in choosing their own doctor. There are many reasons for this. Chief among them is that most parents want the best possible doctor available to them to offer advice on the health and well-being of their children.
How can you be that “best possible doctor” in your community? One of the most important gateways to more referrals of children to your practice is through the pediatricians in your area. Parents understandably place a great deal of faith in the opinion of the pediatrician regarding which specialist would be best to consult with for their child. Parents rightly conclude that their child’s primary care doctor will know the reputation, skill and overall excellence of any doctor that gets his or her endorsement.
Parents are also inclined to use the pediatrician’s office as a resource to get the names of top people to help with a particular issue. After all, with everyone being so busy, parents especially, it is convenient to seek the doctor’s opinion on specialists. While some parents may explore further on their own, speaking to friends, other doctors and searching the Internet, the recommendation of a particular specialist from the pediatrician will often trump all other sources.
It is important to remember that many members of the medical community still associate podiatric medicine primarily with the treatment of adults, particularly senior citizens. It often does not even register to primary care physicians that podiatrists are trained in and have special expertise in the evaluation and care of the child’s foot.
This knowledge deficit often manifests in a particular way in pediatrics. The pediatrician has a ready supply of names of pediatric orthopedists to whom they refer children with lower extremity concerns but is often not even aware that a local podiatrist can be an option for their patients with these concerns. By raising awareness of your interest and expertise in the child’s foot, you open the door to many possible referrals.
When presenting yourself to a pediatric practice, be sure to emphasize your training and expertise in the evaluation and care of the child’s foot. Use this opportunity to educate the pediatricians about the myriad of problems that a podiatrist can help treat in children. Many pediatricians will be familiar with a podiatrist as a resource for warts, ingrown toenails and trauma, but some are unaware of the wide variety of biomechanical imbalances that can contribute to lower extremity dysfunction.
This is particularly true in young athletes and there has been an explosion in youth sports participation in the past decade. Every pediatrician frequently sees patients who complain of discomfort or worse during or after playing a sport. Helping pediatricians understand that someone’s chronic shin, calf, knee, thigh or hip pain may be coming from an imbalance at the distal end of the kinetic chain can be a eye-opening experience, and should lead to many referrals for evaluation and care from those doctors. You need to be creative about getting this information to the pediatric practices in your community.
What can you do as the specialist to increase referrals from neighborhood pediatricians? Begin by making sure that these practices know of your interest in treating children and of any special expertise and skills you may have in this area. Introduce yourself by scheduling a visit with the doctors and staff. Ensuring the staff in a pediatrician’s office know you and your availability as a referral resource can be as important as the doctor having your name handy to offer to parents. Patients and parents often seek out office staff members for insight on who is the “best” or “right” specialist for them to see.
You can take the “get acquainted” visit to another level by sponsoring an in-service lunch for the doctors. Doctors love sponsored lunches. In a busy practice, they often only have time for a quick bite. If someone is providing the food, they are more than happy to sit and listen to what you have to tell them while they eat lunch. You can plan your presentation to be anything from a simple fact sheet about what kind of conditions they could send you accompanied by a short biography to a PowerPoint presentation with visuals and handouts.
Whatever approach you decide to take, have plenty of handouts about you and your practice to leave behind along with an ample supply of your business cards. Once you have prepared one of these overview talks, you can easily reuse the talks for visits to other practices to grow your referral base.
If you are on a hospital staff in your community, use the medical staff office and services to acquaint yourself with area pediatricians admitting to the same hospital. Attend medical staff meetings and become active among the doctors at your hospital. This is an easy way to get to know the pediatricians who might refer to you. Take every opportunity to chat with these other doctors in a casual, relaxed setting away from the demands of patient care. Let them know of your interest and expertise in working with children. Many hospitals offer grand rounds or monthly lectures to attendings on staff and to residents training at that hospital.
Attempt to contact the hospital pediatrics department and find out what regular meetings of attendings and residents they hold. Offer to present at one of them. If it is a grand rounds format, choose an interesting case that highlights your skill set and prepare a short PowerPoint presentation to deliver. If it is a lecture that the department requests, put together a simple talk on common foot and lower extremity problems in children, and emphasize how the pediatrician might recognize which children should be referred. Use the opportunity to raise their awareness. Always have handouts, flyers and/or cards with you to enhance retention and recognition. Referrals will follow if you do it well.
In addition to visits to offices, you might try mailings with cover letters and practice brochures that include thorough descriptions of the pediatric services you offer. While mailings can save the time and effort of a visit to an office, there is no substitute for meeting the doctors. Doctors are far more likely to refer to someone they know and having a face to put with a name can go a long way to making sure you are the first name they think of when they need a pediatric podiatrist.
Another excellent method of gaining more exposure to pediatricians is to develop a Web site for your practice and make sure to include aspects of pediatrics in the information you provide on the site. If you already have a Web site, take a look at how much pediatrics you highlight. If that is an aspect of your practice that you want to grow, increase the amount of content on your site about the care of children’s feet.
Search engines will find your practice quicker and rank it higher in browsers if there are more references to pediatrics and/or pediatric conditions. As many patients who are using the Internet today to help them find medical information and to choose doctors, almost as many physicians use search engines to find resources for their patients when they may not have someone readily available.
With Web site development, you get multiple audiences for your effort. Once you and your practice are a presence on the Web, you will benefit from all those who search and find your practice. This may be patients searching on their own or doctors searching on behalf of their patients.
Perhaps the most powerful way to increase referrals from pediatricians and the one that I have found most effective in my practices is to write and send consultation reports to pediatricians and other practitioners who refer patients to you.
Each time a doctor refers you a patient, send him or her a report of your findings and recommendations for that child. There are many ways to produce these reports, whether you use dictation systems, word processing templates or handwritten letters. The important thing is to do the reports and not get too behind in completing them or having your staff complete them. If you are backed up and have too many to complete, you will never catch up. Part of the value of these reports is that you send them in a timely fashion so the referring doctor has the benefit of your specialist evaluation and recommendations.
Develop simple forms and templates you can complete in small amounts of free time. Then designate a staff member to produce the finished document on a computer. You can then read it over and sign at the end of the day or week, and get it out to the referring doctor. Sometimes for practices I work with frequently, I will save a stamp and fax the consultation report or e-mail it as an attachment to the office. Your content reaches them even sooner this way.
I have found that the enemy of doing these reports successfully is to make them too complicated. It will take too much of your time to produce and it is likely more information than the referring pediatrician needs or wants. If you are concise and focused, the doctor is more likely to read it, absorb the information and remember it the next time he or she sees a similar patient. Work to find user-friendly methods to stay on top of these reports and get them out to the referring doctors. I have found this a very successful way to continue to receive referrals from these practices.
These reports also give you the opportunity to thank the doctor for the referral and invite feedback, which may start a dialogue that can lead to future referrals. I always try to send a copy of the report to other practitioners who may also be treating this child. For example, if a physical therapist sends me a child, I will write my consultation report to the referring therapist and I will also send a copy to their pediatrician. This allows me to inform the pediatrician about my care and also affords me the opportunity to introduce myself and my practice.
Finally, happy patients and happy parents will spread the word to others about the good work you have done. This includes them telling the pediatrician about your work, even if the referral to you did not come from that doctor. If another parent refers a child to you and the parents are pleased with how you were able to help that child, they can be a valuable and credible endorsement of you to the pediatrician. Do not hesitate to let a parent know that you appreciate his or her letting the pediatrician know of the service you provided and that you are available to other families in that practice.
Some parents will even offer to take some of your business cards back to the pediatrician’s office to facilitate those referrals. Thank them for doing that on your behalf. Networking is a major resource to parents of young children and encouraging parents to network on your behalf can help you raise your profile with families in your community.
In the end, pediatric specialty care is all about referrals. The vast majority of children I see are referrals. Increasing the number of referral sources by raising awareness and knowledge about what you do and what services you can provide is the ideal way to grow this aspect of your practice. Some of the most satisfying work I do is in helping children with foot problems get better. Every time I get another referral of a youngster is another opportunity I have to make a positive influence on the growth, development and the quality of life of a child. As the saying goes, “As the twig is bent, so the tree is inclined.”
Dr. Volpe is a Professor in the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine in New York City. He is in private practice in New York City and Farmingdale, N.Y.