Perspectives in Vascular Surgery and Endovascular Therapy

Perspectives in Vascular Surgery and
Endovascular
Therapy
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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
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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
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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.
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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
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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.
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