February 1998 Bulletin

We go out in rural america and talk to family doctors in town about their concerns. It really helps with referrals."


Orthopaedists share savvy marketing strategies to get referrals from community and primary care physicians

By Sandra Lee Breisch

Steve Willey, left co-host of Ask the Doctor program on HCTV-CHannel 19 in Nobleville, Ind., fields questions from callers to Stephen B. Sexson, MD.

Have you noticed things have changed?" asks physician consultant Robert O. Graves, of Graves & Co., Glendora, Calif.

"It used to be easier to get referrals," says Graves. "We had more patients than doctors. Today, a lot of the primary care doctors are hanging onto these patients until they have to send them to an orthopaedic surgeon. And, the other orthopaedic surgeon on the panel is now your team competitor. Your colleagues are always asking, 'How are you doing, how are you doing,' but often wondering, 'How can I get your patients?'"

Physicians need to get savvy with their marketing strategies - no matter where they’re located, points out Graves. "Like it or not, it’s going to be a corporate world of medicine."

The following is a roundup of orthopaedic surgeons who have devoted a lot of time, hard work and creativity in their marketing plan:

When Stephen B. Sexson, MD, left a practice in Indianapolis six years ago to join Hamilton Orthopaedics and Sports Medicine, a small general orthopaedic group in Noblesville, Ind., he took advantage of his fellowship in sports medicine to market himself and his three partners.

Within two years, he took the lead in the practice by being at the sidelines of team sporting events covering five local high schools. His three partners rotate medical coverage at the games. Gradually, their patient base began to increase in this town of 23,000.

Dr. Sexson gets "free" local television air time to do "live" play-by-play television coverage at the games. He also hosts Ask the Doctor, a half-hour telephone call-in segment of a TV show that reaches 100,000 viewers within a 20-mile radius. He receives 200 calls each show, fielding questions such as, "My son is 10 years old and wants to lift weights, should he?"

Dr. Sexson uses his recreational time to network when he attends his children’s sporting events; often he is the coach at their games. "You have to be recognizable, be out there," explains Dr. Sexon. "If they see you out there coaching not only their kids, but your kids, it builds an instant rapport."

Yet, this 40-year-old knows that his marketing "energy" and "sideline tactics" are atypical for other practitioners whose time limitations and interests vary. He advises senior colleagues to get on the boards of local organizations, chambers of commerce, the Lions Club, or take a senior position in an organization that is totally unrelated to medicine. "This exposes them to a lot of people," Dr. Sexson emphasizes.

Being aligned with your local hospital’s sport center also is key, Dr. Sexson says, because the marketing department "plays an important role in getting your name out." Advertisements are placed in newspapers, collateral material, health fairs, physician directories and the physician referral hot line.

Out-of-pocket advertising expenses include: local newspaper ads, phone book listings and donations to the community’s annual fund-raising events. "Don’t underestimate the value of referrals from getting known at your local 4-H Club, YMCA or Boys and Girls Clubs," stresses Dr. Sexson.

"One of the few advantages of being a little guy that lives and works in the community is that people in a small community want to know you’re one of them," says Dr. Sexson. "It’s good word-of-mouth advertising and it doesn’t cost a dime."

Surgeons at Butte Orthopaedic and Fracture Clinic, a general orthopaedic group in Butte, Mont., also positioned themselves as team physicians for community high schools, one college football team and a minor league hockey team. They also make emergency calls to six small hospitals (with less than 20 beds) in nearby rural areas.

Yet, to increase their patient base in this town of 50,000, they dole out sponsorship dollars and time to promote fund-raising events, health fairs, substance abuse and crisis centers, local missions, the police association and the YMCA. Inexpensive radio and television commercials, running about 30 seconds, also help promote the practice.

Building a rapport with family practitioners within a 100-mile radius also was key for getting referrals, explains Michael Gallagher, MD, who has been in practice 1 ½ years with the five-man orthopaedic group. Time permitting, all five members of the group routinely travel to outlying towns (within a 100-mile radius) to build a rapport with other physicians. "We go out in rural America and talk to family doctors in town about their concerns," says Dr. Gallagher. "It really helps with referrals. This way, the outlying doctors can put a face with a name when they send people here."

In any small town, Dr. Gallagher says, a lot of your marketing is word-of-mouth. "You just need to show your time, financial support, and good will - rather than any aggressive marketing." Plus, it also helps to be in practice with senior partners who’ve lived and worked in the community for 25 years," he notes.

Example: Cave Run Clinic, a three-person orthopaedic practice specializing in sports medicine in rural Morehead, Ky., population 11,000. Affiliation with just one hospital, on-call status for emergencies, team doctors for one high school and college, and visits to outlying towns are not enough to satisfy dwindling referrals or cover overhead.

A plus for them, however, was their teaching rotation program at Morehead State University which was good for a number of "one-on-one referrals," because family practice residents, emergency room rotation students, physician assistants and nurses would eventually send patients to the Cave Run Clinic orthopaedists. Cynthia Ann Schneider, MD, explains, "By marketing ourselves from the front line up, we let them know how to refer and when to refer patients to orthopaedists. It has really put us in a good position, because the people we’ve trained now refer patients back to us."

Yet, "marketing quandaries" spurred Dr. Schneider into a creative mode. Taking her cue from Dr. Doolittle, she rounded up her pets and joined St. Claire Medical Center’s Pet Therapy Program in Morehead, Ky. Her marketing team is Vanilla, a poodle-mix; Bosco, a shepherd mix; Leslie, a very large gray cat; and Hope, a half-grown black and white cat. They accompany her on visits to patients at the hospital, nursing homes, hospitals and other clinics.

According to Dr. Schneider, these animals "have done miracles" for everyone, including people with Alzheimer’s and Parkinson’s disease. "People who haven’t said a word, now talk," she explains.

Her pets are a "wonder marketing tool," Dr. Schneider says. "Many patients who would otherwise shy away from seeing an orthopaedist, now come in." Many of her patients and colleagues’ patients often inquire about the pets. For the asking, Dr. Scheinder sends those patients a personalized note from the pets with a paw print signature. The pets also have their own business cards. Dr. Schneider’s patients "especially like" Vanilla. "She’s a truly personable health worker," she notes.

Dr. Schneider says her partners don’t emulate her marketing techniques, but are "tolerant" of her. "They (her partners) look at me with bemusement," she says.

One and one-half years ago, before changing the name of her solo practice to the Hand and Shoulder Specialists, in the senior retirement town of Sebring, Fla., Diana Deane Carr, MD, did an "unscientific market survey" to see why someone local would drive more than two hours to seek orthopaedic care in Orlando, Fla.

One of the reasons: "The old boy network tends to refer to the old boys," she explains. Feedback from a random sweep of family practitioners and patients made it clear: Dr. Carr advertised herself as a general orthopaedist. Being one of four in the county, she competed for patients. Although her specialty was hand and shoulder, she never promoted her specialization.

Dr. Carr renamed her practice, designed a new logo, complete with hands, and put up signage in front of her office, which is located around the bend of the hospital. "Basically, a lot of people were self-referred," says Dr. Carr.

She also bought ads in telephone yellow pages, newspapers and directories handed out at trailer parks where the seniors live and at golf courses, whose patrons often suffer upper extremity injuries. It cost $55 to $100 to buy small half-page ads that run for a year. "If I get one patient from the advertising, it pays for the cost of the advertising," explains Dr. Carr. "A lot of people think we need to spend a lot of money to market, but there’s a lot of networking you can do that doesn’t cost anything."

To eliminate "stingy" referrals from her alignment with two large managed care networks, she routinely sends out letters stating that she is the "only orthopaedist in the county on a specific health plan" and "available for telephone consults" if the physician is not sure about the need to refer.

Dr. Carr also uses Academy collateral material and slide presentations for group lectures, community health fairs and displays them in her office. She keeps lectures short to get the audience involved. "They like a lot of information, but really want the chance to ask a lot of questions," she says. Giveaways such as pens and refrigerator magnets with her practice name and phone number on it are very important, she lecture with nothing wrong with them. Later on, they’ll fall down and break a bone, or their friends might need an orthopaedic surgeon. The pens and magnets come in handy when they’re looking for someone to give them medical care."

According to Dr. Carr, it often "doesn’t matter" what you speak about. "The real trick is to get out there. People like to see doctors they know who are personable with them; patients then perceive you as wanting to give." She also hosts some local radio and cable shows on various health topics.

If Dr. Carr’s patient is referred by another physician, she makes it a point to follow through with a copy of the chart notes, even if the doctor didn’t refer the patient. "Then their physician gets an idea of what we’re doing for the patient and the patient gives them feedback," she notes. "This will sometimes change your referral pattern."

In any case, knowing how to market your practice still goes back to your old-fashioned bedside manner. Consultant Robert Graves, advises, "Remember, people still talk about you, the decor of your office and if you have a good staff."

And if you’re locked out of referrals or a panel, "You’ve got to fight and scratch for every patient you can get," stresses Graves.

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