Perspectives in Vascular Surgery and Endovascular Therapy http://pvs.sagepub.com/ Optimizing Your Vascular Practice: How to Communicate With Referring Doctors, Increase Referrals, and Work With Cardiologists and Interventional Radiologists Krishna M. Jain, John S. Munn, Mark C. Rummel, Dan Johnston, Chris Longton, Tammy Klemens and Lisa Cotten PERSPECT VASC SURG ENDOVASC THER 2010 22: 231 DOI: 10.1177/1531003511400425 The online version of this article can be found at: http://pvs.sagepub.com/content/22/4/231 Published by: http://www.sagepublications.com Additional services and information for Perspectives in Vascular Surgery and Endovascular Therapy can be found at: Email Alerts: http://pvs.sagepub.com/cgi/alerts Subscriptions: http://pvs.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://pvs.sagepub.com/content/22/4/231.refs.html >> Version of Record - Mar 16, 2011 What is This? Downloaded from pvs.sagepub.com by guest on September 27, 2014 Optimizing Your Vascular Practice: How to Communicate With Referring Doctors, Increase Referrals, and Work With Cardiologists and Interventional Radiologists Perspectives in Vascular Surgery and Endovascular Therapy 22(4) 231–234 © The Author(s) 2010 Reprints and permission: http://www. sagepub.com/journalsPermissions.nav DOI: 10.1177/1531003511400425 http://pvs.sagepub.com Krishna M. Jain, MD,1 John S. Munn, MD,1 Mark C. Rummel, MD,1 Dan Johnston, MD,1 Chris Longton, RN,1 Tammy Klemens, NP,1 and Lisa Cotten, PA-C1 Abstract After the fellowship in vascular surgery is completed there is the daunting task of going into practice and succeeding. There are various tools that one can use to succeed in practice and also work closely with other specialists. The key to success is marketing and innovation. Using the two together any vascular surgeon can succeed. Marketing has multiple facets not to be confused with advertising. Total marketing revolves around the surgeon. It involves personal attributes, running of the office, behavior in the hospital, working with other physicians, and using advertising channels. Innovation is required as the art and science of the specialty continues to evolve. Vascular surgeons need to be on the cutting edge of providing latest technology as well as latest methods of delivering care. Keywords vascular surgery practice, marketing, innovation Introduction Over the years, a tremendous amount of work has been carried out in developing various techniques to perform minimally invasive vascular procedures with minimal morbidity and mortality. The science of vascular surgery has grown by leaps and bounds. During the same period, we have failed to develop the science of delivering health care. Part of the answer lies in how we work with our referring physicians, other specialists, and the public at large. This article tries to deal with some of these issues. Vascular practice is no longer limited to evaluation and performance of open surgical procedures. The disci pline of vascular surgery has grown to have increased emphasis on vascular medicine and minimally invasive procedures in addition to the open procedures that we have traditionally performed. There has been an increase in consumer involvement and scrutiny by various agen cies and media. Under these circumstances how do vas cular surgeons build a successful vascular practice? We want to answer that question based on our experiences of the past 30 years. To build your practice you have to mar ket and innovate. Marketing Most physicians hate to market themselves. They believe that they have spent years in training and it should be recognized. They believe that patients should come to them because they are highly trained. But you will not get patients simply because you are there and are qualified to take care of them. You have to let the world know who 1 Michigan State College of Human Medicine, Kalamazoo, MI, USA Corresponding Author: Krishna M. Jain, Kalamazoo Center for Medical Studies, Michigan State College of Human Medicine, 1815 Henson, Kalamazoo, MI 49048, USA Email: kjain@avsurgery.com Downloaded from pvs.sagepub.com by guest on September 27, 2014 232 Perspectives in Vascular Surgery and Endovascular Therapy 22(4) you are. It is no longer about working with referring phy sicians only. Patients are researching and looking for vas cular surgeons on their own because of direct consumer marketing, media, and the Internet. The first thing you have to take to heart is that marketing is fun. Marketing is process of getting communication to your audience, whereas advertising is one method used in marketing. You need to know your strengths and let the world know what you are good at. Even more important is to know your weaknesses and to work on those because your competitors will use those against you. If these weak nesses are not used by other vascular surgeons, other spe cialists competing for the same patients will use them to their advantage. Communication is the key to success. Communication is the single most important part of marketing. You have to communicate at every level; from patients, to referring physicians, to your staff, hospital staff, and to the public in general. Unfortunately, medical schools and residency programs do not train the surgeons in art of communicat ing. If you feel that you are not able to communicate, there are courses and other help available. The old adage of ability, affability and availability has stood the test of time. For the referring physician, if you are not available to answer the phone, they will call some one else. If you are not nice to them, they will call someone else. Ability is expected. You have to have processes in the office to let the referring physician know that you are always available to take care of their patient. In our prac tice we see the patient on the same day if requested by the referring doctor even if there is no doctor scheduled to be in the office. A nurse practitioner or physician assis tant can help with initial contact if the physician is not in the office. Office Marketing has to start with you and the environment you create in your office. It is up to you to determine the kind of image you want to create. The office should be clean. The staff should be friendly and well dressed. If the per son answering the phone is not pleasant you will lose a lot of consults and not even know. Have your friends call and see how they are treated over the phone. Create infor mation brochures specific to your practice that can be given to patients and referring physicians. You need to look professional. Wearing dirty scrubs all day is not what patients expect;a white lab coat continues to evoke the most respect. Hospital Your behavior in the hospital can build your practice or ruin it. If you see physicians who refers to you or could potentially refer to you, talk to them. It does not always have to be about patient care. For future referrals, build a relationship with other physicians. This does not include only the primary care physicians. Almost all physicians in different disciplines can potentially send you patients directly or indirectly. Curb your temper on the floors and in the operating room, even during adverse circum stances. Word gets around that you cannot control your emotions and are not compassionate with regards to respecting other’s feelings. If the staff likes you, they will recommend you to others. The time is gone when surgeons could get away with any attitude in the operat ing room. No one wants to spend time on hospital committees but you must. You meet physicians from different disci plines and it helps you build your credibility as a good doctor. In addition, working with the administrators in these committees helps you build relationships that you can use when you need new equipment or dealing with contentious issues when they develop. The hospital pub lic relations department is a free source of marketing. They are always looking for patient related stories and new developments within a specialty. This gives you free publicity and credibility. Other Avenues You should make contacts with health editors of print media and audiovisual media. These editors are constantly looking for human interest stories and any advances in medicine and surgery. Follow the news for marketing opportunities. When Vice President Cheney had his popli teal aneurysm repaired, our media was looking for a local expert to talk about it. You should write articles for local newspapers and arrange interviews if you bring a new pro cedure to town. You should be available to give interviews if requested by the media. It helps to build your practice and also educates your community. Your personal contacts with the referring physicians are important. If you know them personally they will remem ber you. Ask them how they would like you to contact them if you see one of their patients. Some may want a phone call and others are happy with a timely letter. The letter should leave your office less than 72 hours after you see the patient. If the patient is going to see the primary care doctor before your letter will get to him and there has been a change in patient’s condition a call should be made to the primary care doctor before the patient sees the doctor. Creating a periodical newsletter describing results of prominent articles in literature keeps referring physicians informed of new developments. In some instances, you need to target your newsletter to a particu lar specialty. For example, if you are trying to build a venous practice, write the letter to gynecologists. Downloaded from pvs.sagepub.com by guest on September 27, 2014 233 Jain et al. More and more patients are using the internet to get information. In today’s environment it is absolutely mandatory to have a web site. The site can be linked to information on the Society for Vascular Surgery site so that you do not have to develop all the content yourself. The PAD (peripheral artery disease) coalition is doing a lot of advertising to educate patients all over the country. Consumers now know the term PAD just like they know diabetes. To take advantage of this awareness we have created a Web site, www.padcenterofexcellence.com. Any vascular practice in the country can join this site for free. It is not possible for every surgeon to do basic research. However, everyone should be involved in clinical res earch. If you know and publish your results you can tell the patients. It builds confidence in the patient and refer ring physician if you are able to discuss your own expe rience. It shows that you are practicing evidence based medicine. Outreach Clinics Depending on the geography of the practice, one should have outreach clinics in the hospitals where no vascular surgeon is available. You can take care of preoperative and postdischarge management in the local community where the patient came from. Patients love it because they do not have to travel long distances. Referring phy sicians love it because now you are part of their commu nity. Hospitals love it because many of the ancillary tests get done in their hospital and it helps their bottom line. It gives you more business upfront and much better compli ance with follow up. It is a win-win situation for you, referring physicians, the local hospital, and above all, the patient. Advertising Advertising in the yellow pages is not of much help in building a practice. You need to have a small presence in the yellow pages, because patients are still going to them to find your contact information. It is more beneficial to do event-related advertising. If you are going to have a screening clinic or participate in a health fair, and so on, advertising may be necessary. If you are trying to build a venous practice advertising is crucial. Patients will come directly to you because many patients with venous dis ease do not have a primary care doctor. In advertising you have to avoid aggressive, high-pressure tactics. You have to abide by federal regulatory standards that apply to commercial advertising. Make only objective, factually supportable claims about experience, competence, and quality. Do not use testimonials that do not reflect typical patient outcomes. Innovation We have to innovate continuously. Doctors who do not innovate become dinosaurs. In the eighties, we inno vated by offering high-quality noninvasive studies in the office setting. In the 1990s, as endovascular tech niques became more available and proved to be effica cious, we learned how to perform these procedures. Since 2005, because of favorable conditions in federal regulations we started office-based access centers and showed the benefit of these centers.1 In the coming decade, PAD centers will become the new rage because of multiple specialties joining together to promote awa reness of PAD. That is why we have created a PAD center of excellence. Working With Cardiologists Cardiologists and vascular surgeons take care of the same patient population. Cardiologists have technical expertise with wire and catheter skills but may lack the cognitive skills to manage patients with PAD. In 2004, a consensus statement published in the Journal of the American College of Cardiology2 rec ommended guidelines for training of various special ties in percutaneous peripheral procedures. To develop cognitive skills, the consensus statement recommended that “The year devoted to interventional training should include at least one month on an inpatient vascular medicine consultation service, one month in a non invasive vascular diagnostic laboratory, and onehalf to one full day per week in the longitudinal care of outpatients with vascular disease.” If cardiologists want to take care of patients with PAD, they should have the requisite cognitive skills as well as technical skills. This is the only way to provide compre hensive care to patients. In our experience, for every 20 patients we refer to the cardiologists, we get 1 referral back. Many more patients need cardiac workup than PAD workup. Since there are many more cardiologists than vascular surgeons we have to do a much better job of educating the public and refer ring physicians that we are the specialists in managing PAD. One of the pitches used by the cardiologist is that they can manage their medical conditions. We have prac ticed vascular medicine as an integral part of our practice, yet that is not recognized by the public or primary care physicians. We also do not want to manage conditions that primary care physicians normally manage, such as diabetes, hypertension, and hypercholesterolemia. In some hospitals, vascular centers are being created Downloaded from pvs.sagepub.com by guest on September 27, 2014 234 Perspectives in Vascular Surgery and Endovascular Therapy 22(4) consisting of cardiologists, interventional radiologists, and vascular surgeons. These centers can improve care only if all the team members have comparable cognitive and technical skills or stay within their level of training and work in a collaborative manner. In very few instances cardiologists have total commitment to taking care of patients with PAD. The ones who do, make the necessary effort to acquire the cognitive skills in addition to techni cal skills. Vascular surgeons should be willing to work with these individuals. You may compete and some areas and still be able work together in others. This is a synopsis of our experience and the lessons we have learned. All the suggestions and recommendations will not work in all circumstances. However, we believe that some parts of this article will apply to your practice. Declaration of Conflicting Interests The author(s) declared no conflicts of interest with respect to the authorship and/or publication of this article. Funding Working With Interventional Radiologists The author(s) received no financial support for the research and/or authorship of this article. Interventional radiologists usually do not have a patient base of their own and thus pose less of a threat to the viability of a vascular surgery practice. In many commu nities, there are not enough vascular surgeons to provide care. Interventional radiologists have the skills to per form the procedure when the patient has been evaluated by a vascular surgeon. This can be a good partnership. However, in some communities radiologists are compet ing with vascular surgeons for patients with venous disease. References 1. Jain KM, Munn J, Rummel M, Vaddineni S, Longton C. Future of vascular surgery is in the office. J Vasc Surg. 2010;51:509-514. 2. Creager MA, Goldstone J, Hirshfeld JW Jr, et al. ACC/ACP/ SVMB/SVS clinical competence statement on vascular medicine and catheter-based peripheral vascular interven tions. J Am Coll Card. 2004;44:941-957. Downloaded from pvs.sagepub.com by guest on September 27, 2014