A Fact of Life Discussion—A Tough Love Conversation With a Referring Physician

Neil Baum, MD


Neil Baum, MD, is Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, LA, and author of Marketing Your Clinical Practice: Ethically, Effectively, and Economically, Jones Bartlett Publishers.


All of us would like, whenever possible, to have a bilateral referral arrangement with our colleagues. Have you ever experienced a situation in which you are sending patients to another physician and receiving no reverse referrals? Of course, you can change your referral source, hoping that the other physician will notice that there is a decrease in referrals and will call you to ask what happened, but do not hold your breath. Chances are that physicians are busy enough and will not notice a decrease.
A better alternative is to have a discussion about the facts of life with a physician. During your meeting, recall for the physician the number and the names of patients you have sent him or her in the last 6 to 12 months. Ask whether the quality of patients was satisfactory and whether the physician would like to continue receiving your referrals.
If the physician answers yes to both questions, ask how he or she feels about your quality of medical care: “Do I enjoy a good reputation in our community? Have the patients I have sent you, as well as any others that we may both be treating, been satisfied with my medical services?”
If the answers are again yes, then it is time to initiate a facts of life discussion. At this time you should suggest that you want to see some patients in return if you are to continue referring patients to that physician. If he or she does not agree, it is time to find another referral source.
I had a facts of life discussion with a physician when I had been in practice for only 3 years. I had been receiving calls from an internist from the intensive care unit on a regular basis late at night to insert urethral catheters for patients in urinary retention. I did this for several years, hoping to demonstrate that I was available to provide care for all of his patients. However, when this internist had patients with non-emergency urologic problems, he referred them to another urologist. After many months of being inconvenienced in this way, I decided to ask for a meeting with the physician. I said, “I am capable of seeing patients not only in the middle of the night but also between 8:00 AM and 5:00 PM as well!” I did not request all of his urologic referrals, but I did ask for a few. If that was not acceptable, then he could get someone else to come in the evening hours to insert catheters. “What was the worst that could happen?” I asked myself. That I could get a good night sleep!
As it happened, this discussion brought about a change in that physicians referral pattern. I was satisfied to notice that I began receiving a few daytime referrals as well.
Bottom line: I am not recommending this approach for everyone and in every circumstance, but whenever you feel exploited or that referrals are a one-way street, consider having a tactical discussion before abandoning the potential referral source.