Building Referrals By Marketing To ER Physicians

   This is the time of my professional life when I planned to slow down with fewer clinic hours, less surgery and maybe a few more nursing home visits. It has not worked out that way. Three years ago, I hired an associate who had just completed a quality PSR-24 in a university hospital. The place was an advanced trauma center with a lot of emergency room activity to stimulate young podiatric residents.    He asked about my referral experience from our local emergency room. I received a handful of referrals and consults over the years, and just accepted that trauma cases would go to orthopedic surgeons.    My associate did not buy this and began contacting emergency physicians to stimulate referrals to our practice. I worried that it would irritate the orthopedic guys who had pretty much left me alone for 25 years. It did but this is a new century. Orthopedists can’t stomp on podiatrists like we were little ants. They griped a little but lacked the power to suppress us.    Our initial referrals were somewhat sporadic. Many were uninsured or indigent. Many were pain medication seekers who were “frequent flyers” in the emergency room. We responded to the referring emergency room doctors as if the patients were welcome additions to our practice. Most of them were welcome referrals.    The emergency physicians began noticing something different about referrals to podiatrists. We evaluated and tended to the patients instead of turning them over to physician assistants or nurse practitioners. They frequently express their appreciation for our high level of care. Some ER doctors make direct referrals to us and others let patients choose between our practice and the orthopedic group. The best situation is when patients request our practice.    We have learned to keep marketing this service to ER physicians. When we slack off, referrals drift back to the orthopedists who never let up their marketing effort and assign one of their six well-qualified surgeons to cover the ER each day.    When we approached the orthopedic group about sharing calls for foot and ankle trauma, they declined because we are limited and cannot share all the cases. My associate developed a strategy. Essentially, if they didn’t want to share referrals for these cases, we would take some of their referrals away from them.    It worked. Spring is when we see the most ER foot and ankle activity. When the sun comes out in April, people stop looking at the ground to avoid puddles and bask in the rare sunshine. That is when they start falling or stepping in holes. There is a steady stream of limping wounded in the ER, which is already overwhelmed with other life-threatening ailments. The stream diverts to our clinic, which is on the same block as the hospital.    The ER doctors present the case and ask if we are willing to see the patient. We keep openings in our schedule for ER cases. A person who just stepped out of his RV and missed the step doesn’t want to wait a week for treatment of his Lisfranc’s fracture. We see ER referrals the day the doctor calls.    This change has necessitated establishing an “on-call” schedule so one of us is always available to the ER. It was annoying in the beginning to stay around town all weekend while on call and not getting any requests for referrals. That is no longer the case.    On a typical day, our practice will receive three to five new patients from the ER. Last Friday, an older gentleman fainted and woke up with a red, swollen foot. The X-rays from the ER showed no fracture but they called to arrange a consult. When we took oblique views in our office, they showed a large diagonal/oblique fracture at the base of the second metatarsal. I complimented the ER physician for recognizing a hidden problem.    Be careful what you wish for. I rearranged my schedule to get out early Friday afternoon and enjoy some of the rare sunshine. Just as I was leaving, an ER doctor called with a patient who had a fractured calcaneus. The patient was enjoying the sun and stepped into midair, dropping about four feet and landing on his heel.    An hour later, as I placed a splint and compression dressing on the foot and lower leg, the same ER doctor called with a patient who was descending a ladder and chose to enjoy the blue sky. She missed a step and her left hallux ended up signaling for a right turn. An hour later, I had reduced her dislocation, put her into a splint and left the office. The sun was still shining. Dr. McCord (pictured) is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.