Build Stronger Doctor Referral Networks for Your Multilocation Specialty Practice

Stewart Gandolf (Healthcare Success)

Hi, everyone. Stewart Gandolf here. Welcome to another podcast. Today we have Susan Boydell, whom you may have heard about.

We had her one about two months ago, and we are bringing her back today for some special work. Susan is a principal with Barlow McCarthy, and she does a whole lot in the world of building doctor referrals.

Susan Boydell (BarlowMcCarthy)

Welcome, Susan. Thank you, Stewart. It's good to be back. I'm going to enjoy our conversation today.

Stewart Gandolf (Healthcare Success)

We always do. So, today, what we're going to be talking about is how to build doctor referrals to multi-location practices, and there's been a lot of changes today.

A lot of times when we think about the world of building doctor referrals, particularly for providers like hospitals and health systems, it's really where people are thinking.

So, first of all, let's actually, why don't we go back to step and Susan, tell us about your business, maybe what you've done, and then how it's kind of evolving today.

Susan Boydell (BarlowMcCarthy)

Well, just like you said. And this is our topic. It's one of our favorite topics. But we specialize in this space of referral growth. And, like you said, we do a lot of work.

Likely you would understand that in the hospital health system space. But this space of large multi-location groups, practices. We'll talk about that here in a second. But there's a lot more going on in that space which says a lot about what's happening in the market. So, our piece in referral development is, if you just think about how you help organizations, whether it's a hospital health system, large practices, sustained growth and what that means to their bottom line, and what they can do and how we do that. So, if you just take the word referral linking physicians and their patients to the care that they need. And sometimes that's the simple part of this, because we all get referrals. But sometimes it's like, you know, you gotta link them up. You got to make that piece happen. And this is the piece that connects it to that sustainability. So that's a good idea for a background.

Stewart Gandolf (Healthcare Success)

Very good. And so one of the things that caught my ears when we were speaking recently, because again, this world of, and just for some of you that maybe knew to this topic with my blog or podcast, I remember about 10 years ago, somebody from the Wall Street Journal reached out to me and said, I can't believe that there's these people out there that go out and build dock referrals for hospitals.

I’m like, yeah, it's called position liaisons. like, we're covering this because we just had no idea that hospitals were spending money on this kind of thing.

And I flew out and met her at a conference. And it was just the most amazement they had. And it showed up in Smart Money magazine within the Wall Street Journal.

And it's like, they just had no idea. And you and Chris and others really pioneered this world of building, you know, the term we use for them could be a lot of things.

addiction, they talk about business development, sometimes we'll call them practice reps. I think I set it on the same term that you guys use, which is physician liaisons, but somebody who goes out and builds doctor referrals on a face-to-face basis, and typically it was for hospitals.

And oh, by the way, just as we were getting started here for those of you that are new to this topic, I don't know of any other world where business is done where you just drop by, like still, it's like only I'm sure there's others, but I can only think of healthcare, where doctors actively discourage setting appointments and encourage stopping by.

So it's kind of like the way this has evolved over the years. so everybody's familiar with drug reps, dropping by to build referrals or sell doctors on how they're going to prescribe.

But you know, hospitals, this was nascent, you guys sort of helped build that category. But today's topic is not such about hospitals and health systems, it's about private practices, but larger ones.

And so, I would multi-location, typically, specialty practices, but tell me more. like what kinds of calls are you getting these days and from and what about?

Susan Boydell (BarlowMcCarthy)

Yeah well you know it's a little bit of a change of the market because even your piece where you say and I think I remember that Wall Street Journal article probably as well but even when you think about the just dropping by that's changing that is really changing because boy everybody wants a piece of a primary care’s business.

Everybody does. Hospitals do, specialists do, everybody knows that well it all starts right there but that's only one piece of it but this whole space and this multi-location piece it's an interesting one that I would say you know we've been talking a long time about the I'm going to say consolidation of hospitals and health systems okay merging you know they're getting bigger you just hear you don't maybe hear quite as many of them because there's been so much of it but you know for a long time that's really what it was. Now let's think about it. Well, now it's in the space of these specialty practices and you sort of get it because why did health systems do it?

Well, I can save a lot of money if I take all of my expenses and I try to make that happen across consistently across multiple locations versus an individual hospital.

I can negotiate better rates because I have a bigger marketplace than otherwise. So you can take the same thing and sort of put it in this multi-location practice.

And so we've actually seen the same thing where, and it's mostly like whether it's very large orthopedic groups that have gotten together, there are multi-location doesn't, it can mean multi-location within a geographic area, but a lot of times it's like, okay, we have offices in, know, Georgia and Denver and other places.

So, it's all of that and you sort of get it. So then when you think about that piece, So how do you grow business and how do you do that when there are not all in the same geographic or marketplace, there are multiple marketplaces, but you're delivering a service across the board.

So, and it's all about lifting how well that organization does as a whole, no matter where their locations are. So a little bit.

Stewart Gandolf (Healthcare Success)

Alright, so let's talk about that little bit more. So when we were talking offline prior to the podcast today, we were talking about, you know, who's reaching out these days and in my experience working with private equity and of course, you know, we have healthcare success, we're an agency, but and also, if we get people who might be newer to us, you know, when we talk about marketing, we're not just talking about consumer direct.

A lot of what we do is consumer direct, but we're also always thinking about things like patient experience and doctor referrals, which most agencies just doesn't make their radar.

And that's why, you know, I refer to Susan and her team for the you know fairly often have a lot of referral time so we get prospective clients that aren't really applicable what we do or in conjunction with what we do we you know bring in Susan and Chris and other people on the team over there but to help you understand if you're or what we're seeing these days on our end as well as Susan is seeing is you know oftentimes is private equity behind these multi-location businesses sometimes their doctor or more frequently private equity the person who makes these decisions at this level usually not doing the work the CEO could be driving us CFO COO sometimes marketing a lot of times it's different executives that are really looking to boost revenue and I often speak at you know private equity conferences or you know other kinds of venues I talk about marketing as a misunderstood lever it could really grow a business and like yesterday's isn't talking to an urgent chain about how much the paid search is driving growth for their business most people don't think about that when talks that, you know, private equity takes over, you know, business, they're looking at cost cutting and they're looking at revenue cycle management, a lot of smart things.

But they often underestimate marketing. And I think this is another category,  doctor referral building is such a driver. So many of these businesses might be, you know, 50%, 75%, 80% or more doctor referall driven. And the idea of, geez, can we grow our doctor referrals purposefully? Seems like a good idea. So I'd love to hear more about that from you.

I'm doing all the talking right now, intentionally. But what kinds of things are people telling when they reach out to you and that you're helping with?

Susan Boydell (BarlowMcCarthy)

Well, it's exactly what you said. They need to grow their business. And they know to grow to get there.

I'm going to say these are specialists, okay, to get them busier. It means I need to give them more referrals.

Absolutely the consumer plays into this. I love your patient experience piece because we will tell you that referring physician

If they hear from their patients that they did not have a good experience with that specialist, they will think twice before making that referral again.

So that piece even plays into all of it. But growing business of referral level, it's exactly that. I need them to think when they have that patient with a specific need that they need to then refer them on to a specialist to take care of that.

That where that special where that referral is going to go and what's not any different than it ever has been before.

It's just harder today is that everybody wants that same referral. Okay, they didn't like if you said what you got no competition, you're great.

But there's probably not hardly anybody. They can say there's no competition in this. So the whole piece even in your world Stewart about what's different, why them?

Why should I send here when I've been sending over there forever and I'm happy about that. Why would I switch and you know one of the things we see that you probably see similar in your space too but I'm gonna guess that a lot of like you were talking about the you know the CEOs and these large practices and all of this when they think about growth they know their market and I will tell you one thing that this happened over the last 12 months I'm gonna say 24 months for sure is highly aligned markets so it used to be that primary care physicians or those referring physicians because in the specialty world it's not just primary care because there are other specialty practices that can also send you referrals depending on what it is you're looking to grow but when you think about that piece of it they would sometimes send to multiple different like depending on what the need was and who was available the relationship they had well that's all very tightened up and so when you think about how hard it is now to change a referral pattern. It's not as simple as like, well, let me just go in and have a stop by and go in and have a conversation with you.

It is much harder and much deeper. And it also tells us about the talent that you need in the field to be able to do that.

Because what was done even five years ago probably won't work today. And that's the biggest thing that I would say we're seeing is different, is that the strategy still works.

But how we look at it and how we deploy it, there's a lot of different levers to that than what there were before.

Stewart Gandolf (Healthcare Success)

So we were talking to a large specialty practice that just had a health system change. And so now a lot of the referring doctors that they were able to get before have just stopped.

And so, and there's, you know, they may be sort of legally allowed to refer outside of their system, but it's really highly discouraged.

So I'm assuming that's what you're referring to here, because this health system kind of becomes tribes now. It used to be everybody for themselves, everybody was independent, but now, you know, so often they're here and, you know, affiliate of the hospital system, maybe an IPA or whatever.

What are you finding there? Like, is that the challenge? And if it is, like, what are some of the ways to, you know, try to start penetrating that?

Susan Boydell (BarlowMcCarthy)

Yeah, I would say that's exactly the challenge. So yes, everybody wants to keep everything in-network. So, if you think about it from, you know, oftentimes we've used the word leakage, okay, so I had that patient in my hand that they needed to go have different things done.

It could be as simple as imaging. It could be as simple as if it's like, let's say it's for a, you know, breast cancer diagnosis, you know, they're going for a biopsy, depending on where all those things happen, I could lose the patient.

Okay. I usually want them from a hospital and health system perspective. I want the procedure. Okay, because that's where that that's what helps their bottom line. let's go to the multi-specialty practice side of this. Depending on how you're aligned with those hospitals and health systems, they can direct to you or direct away from you.

The same thing can happen in the insurance world. If you're if you are considered high-cost, maybe your outcomes aren't at the level that you want.

Perhaps there are some other outcomes that you don't deliver at the level that they want. Guess what? They bypass you.

They influence where those referrals are going to be made. You know, we hear so much about, this could be a whole not a blog on itself or podcasts on itself in this whole world of value-based care.

All of that sits in there. So the strategy from a multi-location specialty practice is I got to understand how all of that ecosystem works.

And I better make sure that what I've got is differentiated and meets those needs, because otherwise I won't get

at those referrals, because they're going to automatically go somewhere else. So, it's understanding that ecosystem, which is where data comes in, all of it that just makes the whole thing so much more sophisticated than just, do I have really good talent in the field to go have these conversations?

I got to know a lot beforehand to be able to say, okay, let me direct my talent to these practices where I know I can earn something and make sure that they have the skill set and the knowledge to be able to influence where that referral goes when the time is right.

Stewart Gandolf (Healthcare Success)

So, when you have, you know, health systems, you know, employed host, employed positions within a health system, aren't going to probably refer to employed system and another health system.

But when you have a practice group, I'm guessing a lot of the people you're talking to are trying to be Switzerland to be able to work with both health systems or, you know, all three health systems in an area.

Or are you finding even then some of the health systems are really trying to refer to doctors or captive, you know, either directly employed or heavily affiliated.

Is that what's going on? And is that, and I also like to know, is that a doctor by doctor basis or is it like the whole practice? Like how does that work in the real world in your experience?

Susan Boydell (BarlowMcCarthy)

again, it depends on how these large groups are organized.

But there are affiliations and partnerships with health systems that can then drive that volume. They have to do, let's just take an orthopod, for example, okay, let's just use that because it's like they need, they have to have somewhere to do their surgeries.

So either they have their own facility that they do their surgeries in and you're after those referrals to drive that business to your own surgery center, or you are partnering for maybe maybe that's outpatient and all you're inpatient for those things that need to be done inpatient.

Well, where am I doing those? Who am I partnering with? Those relationships can drive sometimes where those referrals go.

So, if you look at the ecosystem again, you can see, oftentimes through data, who's aligned with whom and where do I have an opportunity to earn away?

Sometimes anymore, it can be, well, I'm not going to get all of their, I'm going to say, you know, all their orthopedic referrals from this group of primary cares, okay, but I can niche this because I'm differentiated.

I shouldn't get all of these because they don't do that as well, they don't have access as much, whatever it might be, access is a big thing right now. That’s just an example.

Stewart Gandolf (Healthcare Success)

I want to come back to that in a moment. The other question that occurs to me as, and it's fun, you know, I've been doing this for a long time.

So, hearing the side of it more in detail is just fun for me to, you know, learn and catch up with what's going on for you guys.

The other question I have is traditionally, you know, physician liaison was somebody, and we'll talk about what makes a good physician liaison in a minute.

We'll talk about that before, but we should come back to that again in minute. But it really was somebody who could generate relationships with referring doctors on sort of a doctor by doctor basis.

And back in the old days, you know, you had a bunch of individual doctors, even though they group of three or four doctors, each doctor was their own prospect, right?

Like they had their own relationship. So, one doctor within the same group may refer to a different doctor than somebody else within the same group, right?

So, it was a very one-on-one basis. I'm assuming there's still an element of that, but what about like sort of on a partnership level with a multi-location business in the hospital?

That's a different kind of thing. And, you know, as a physician liaison, helping set those meetings with the CEO, or how does that work?

If you're trying to go less on a one-to-one, you know, one-to-one basis, this doctor with that doctor, but more system-wide, do you get involved with that?

And how does that work? Or is it the same thing like you're kind of doing both at the same time?

Susan Boydell (BarlowMcCarthy)

Well, so it depends on what I want on the back end of it. Just using your example. So, if I'm trying to earn referrals from, let's say, a large primary care practice, yes, I'm probably going to start at the data side to say, okay, let me see who we might have an opportunity to earn referrals from.

Like I'll give you an example that happens, this still happens a lot today, okay, is in a large primary care practice, they might, they might play Switzerland.

Okay, let's say they're independent of some sort, there's not very many of those, but let's just say it.

Stewart Gandolf (Healthcare Success)

Right next to the Sasquatch and the Loch Ness Monster, talked about a lot but hard to find.

Susan Boydell (BarlowMcCarthy)

Yeah, but in terms of where their alliances are and where their business goes. Because there might be some physicians that that are, I'm gonna say, assigned to—you work with this this health system or these providers. I mean, you just got to kind of know that piece and where they go. So, there is some individuality to it today. But you kind of almost have to step back to be able to see. Well, where? Where is my opportunity to grow? Like, if I'm thinking about a multi-location practice. And I'm trying to grow my specialists. Okay, where my specialists do business is going to help drive some of that. So, if I'm doing my business at a competitor. My likelihood of getting referrals from their primary care physicians is going to need to be. I'm going to need to be differentiated. I'm going to have to create. Figure out what's the what's in it for them to make that referral?

It might mean, well, do I need to do some of my procedures at their facility. I don't know. I'm being general now. But all of that, it's like, who's getting what out of it? That sort of drives it. Does that make sense.

Stewart Gandolf (Healthcare Success)

Yeah, I think that what it sounds to me is this is super custom by business you're working with, right? Like, you have to think through and you said something a couple times that I haven't emphasized enough is data. It's funny, lot of even recently sophisticated business aren't familiar with just how good the data is and how much you can get data to see, you know, what their procedures are doing, what they're diagnosing, what drugs are giving out.

So, this data is out there. And so, you can certainly figure out the 80-20 rule, which doctors are referring most of the orthopedic surgeries, for example, which groups or which individuals or whatever.

So, starting there is a lot better than just knocking on doors randomly. You know, it's like not like there is a yellow page anymore, at least I don't think there is, but it's like, you know, you're not going at the beginning of the yellow page is starting with A and going down to Z, you're focused more on, okay, understanding the marketplace is a really important thing, like where might the opportunities be, and I'm assuming when you're consulting with people that's probably where you start.

So, with the data-based analysis approach, and looking at the opportunities like who's out there, who's referring, where they were affiliated with, trying to decide who was the right prospect at the sort of larger business level versus the individual doctor level.

But let's talk about, yeah, who's doing this, okay? So, this is my former roommate and I just have a joke about our lazier, messier roommate, where like, hey, elves don't clean up after you, you clean up after you.

So, in this case, it's been a while since I’ve had a roommate, but the elves don't go out and get doctor referrals. So, those are typically people who are paid to do that, solely that, we've commiserated. for years about like, you know, then they give them brochures to do and fill out this paperwork and all this other stuff that's in the middle, but a true physician liaison on, goes out and builds relationships.

So, in this much harder world today, what is, you know, what are the qualifications, salary level you see, like the temptation I see over and over again is to send somebody out of drops off bagels.

So, you know, like, what works in terms of the kinds of people you're find for, you know, to actually do this kind of work.

Susan Boydell (BarlowMcCarthy)

Yeah, it's a really good question because it's, I would say it's an evolution that we're still in because, yep, the taking donuts doesn't work.

And that's been around for a while, okay? But just like we were talking about before, everybody wants the time of the primary care physician, everybody wants their time, including research people who say, oh, I need to understand what primary care physicians think.

Stewart Gandolf (Healthcare Success)

Oh, it works or not. It's yeah, real estate salespeople, jewelers, car dealers, you know, insurance sales guys, financial planners…

Susan Boydell (BarlowMcCarthy)

Everybody wants their time. So, so let's just think about the, like what it used to look like and data drove this too. Okay, so when, when teams would look at, okay, where does my team need to focus? Who are my targets that I have the greatest opportunity to earn referrals from?

And majority of the time when you looked at data, the bucket that I love the most was the, was the group of splitters, well, as we call them, okay, it's like that meant they gave some to me, but they gave some to the competition too.

So, if I could just move a little bit more my way, because they already used me, I should grow business and they did. Okay, that's how that works. When you look at the data today, that bucket has gotten really small for all the reasons I just told you. The alignment is so much tighter. They're either highly aligned with the competitor, highly aligned with you, and then there's this bucket in the middle that you go.

If I just focused on that, I'm probably not going to hit my goals, which means now I have to go after that business that is aligned more with the competitor, which means my conversations are very pinpointed on what business, what referral can I earn away?

So, I have to understand better what we're differentiated in, what makes, why that would be much better. I almost have to have from a talent perspective, a little more clinical insight.

You know, was just having a conversation a couple weeks ago, this was with the health system leader, and her last couple hires had been clinical.

Now, we will tell you, you don't need to be clinical. You don't need to be a nurse. Because I'll tell you, most nurses don't really of selling skills. So, that's a fine and that's a tough one to find that can do both. But they have hired people with more clinical background and have seen a considerable shift in effectiveness because of that.

I get it because what we're asking them to do is have a far clinical more clinical conversation about what a patient would present with when would be the right time that that referral needs to happen and why your specialist versus somebody else's. So that that to me is the big thing from a talent perspective and because I said data, I'm going to tell you there's most sales people are not data gurus and not that we need them to be data gurus but when I think about large practice and multi-location practices in these larger groups, something like they got data people all over the organization, they do not.

Which means as a salesperson, that person that's going to go out and grow some business, I got to have some insight in how I look at that data to determine where's my greatest opportunity, because that your time is precious, because it costs, they cost more.

So, everything I'm telling you right now, you're going to have to pay more, which is the tough part in most organizations is switching that and finding the talent they can do it.

Stewart Gandolf (Healthcare Success)

So, you know, in terms of numbers, I know every city's, you know, going to be very different in Topeka, Kansas versus Los Angeles, but you're talking probably, what, $80,000-$100, 000 plus for a lot of these markets, for sure, right? You're not going to find somebody for minimum wage to go out and be effective at this.

Susan Boydell (BarlowMcCarthy)

No, here's a lot more conversation about it's like you said, they build relationships. Well there’s relationships with intent. So I'm, I'm looking for when your patient needs something, I want to make the connection to my specialist for the services that your patient needs.

So, these are sales skills. So incentive plays into it. We talk a lot with a lot of teams, mostly health system teams, I would tell you, but it more and more in this multi-specialty space. That true, if they, if there's true opportunity to grow business, incentivize them. Have a portion of that, but it's got to be enough to incentivize, not enough for them to go. That was nice, thank you. It's got incentivize. So, there's a lot of work still in that space. That's in addition to what maybe that base salary might be.

Stewart Gandolf (Healthcare Success)

Yeah, and that's again one of the key issues that, you know, we talk about a lot. Like if I will come back, well, I'll do it now. So, we don't answer everything right now, but some of the questions is, you know, with your business, you guys consult with people and hop them and figure all this stuff out. But there's a lot of issues. If you first of all, if I were looking at this as top of mind, and I was thinking, like, I really want to build doctor referrals, Susan. Okay. So, okay, first of all, who leads the effort? Like, that's different than the person on the ground.

Do I do a beta test with that person? Is the person that's good at doing this good at managing people? I'm not sure I know that answer, probably not usually. Um, how do I compensate? Well, first of all, how do I recruit people? How do I write a job description? How do I compensate them? How do I manage them day to day? How do I hold them accountable to results? Um, how do I make sure they're doing what they're supposed to be doing?

Like, that's a lot, right? Management on a day to day basis. So, I'm assuming these are the things that come up for you every day, right? Like when you're out consulting with folks?

Susan Boydell (BarlowMcCarthy)

Yeah, every day. And I will tell you, though, especially in this multi-location, multi-specialty space, because I'm going to say it's newer. Most hospitals and health systems have some form of a referral development field team.

Stewart Gandolf (Healthcare Success)

Yeah, it's a long way. It's been going on for what? 20 years, probably. Yes. It's pretty, pretty saturated now. Yes

Susan Boydell (BarlowMcCarthy)

Yes. Yes, they might come to us and say, oh, I need, you know, I need to make sure we're performing at the top of our level. But when it comes to these others, sometimes they have some people, but it's not a really strategic approach to how they put that together. And then when they start to expand and grow by bringing on more practices, which is what drives the growth need is, okay, now I'm bringing on more, I need to make sure that they're getting busy.

Um, and so that whole piece of like sometimes we've done pilots, it's like, okay, let's go, let's go look, because sometimes they don't even have the data to be able to tell you, well, what's the opportunity, which is what drives the resource count.

Like, well, do I need a liaison? Well, data would tell you if you need liaison, because you got to know how much referral opportunity you've got in a market. And there's ways to do that, even when there's not data. But we do do a lot of pilots. Not a ton, but it's a good way to start to say, let's put somebody out, let's put a strategy, best practice strategy together, and let's see what results we get.

Based on that, we always in our minds say, how can we scale? So, as they grow, can we scale it?

Can we expand it up even if it means I'm going completely into a different state into a different geographic area?

How do I expand that same thing as I bring on practices? Because usually the first time you do it, it takes longer. When you start to then move, yeah, you get it. But it's like, okay, now I can move quickly. When I move into new market, I have a plan for how I move into a market, how I determine what resources I need, who am I going after, what's the, what do I, do I have my tracking and reporting in place? I mean, you mentioned that, like how do I even know they made a difference? Well, it's kind of foundational, like you want to be able to do that, like I want to be able to see, are we getting the referrals based on this strategy and the money we're spending for that resource because the resources, like you said, they're not cheap.

So, I gotta deliver. Yeah.

Stewart Gandolf (Healthcare Success)

Well, also, like, you know, at least if it's private equity owned, they may have five to seven years from the time they buy this business, so they want to sell it again.

So that's not a very long time if you've got 150 locations and you're just getting starting, right? that's a lot of scaling, a lot of people, a lot of coordination.

And, you know, we've talked about this in other calls, but even when you start putting people, you know, like in a marketplace and, you know, as you get bigger it gets more complex obviously but like if you think about, all right in some marketplaces you may have enough locations that you know two or three you need two or three reps just to cover Atlanta for example whatever maybe you have 10 or 15 locations I don't what numbers are how that breaks up but it's you're going to see you know regional other times you may have somebody for a whole state or you may have like lots of people it's all clustered so that even that is figuring out how many people you need to cover well just to scale it to manage it you know these are all decisions you have to make but at the end the day the, well, let's talk about results like so how much can this really move the needle like let's say have somebody's listening patiently like yeah but is this anything really matter like what kinds of you know increases are possible when you start getting ll of this does can you double a business this way can you grow by 5% like you know what are some fun maybe you have a fun success or I don't know but just like what are the results what are we trying to get?

Susan Boydell (BarlowMcCarthy)

Yeah, it's there's a lot of variables that come into that. But I'm going back to data again, because data drives the front end of this. It tells you what the possibility it is. It tells you what you can earn. It also sometimes can tell you how quickly you're going to be able to move that.

So, I'll just use my example. When I was remember, I was talking about splitting things if I'm going after business that's highly aligned with a competitor that will take longer. Then perhaps those that give me some, and I want to get more like, like. So, it's looking at. That's it's my best example is like it's looking at. Well, how? Where, what business can I earn? How easy is it going to be for me to get it, because, like, you know, we've all said that we all know it. There's not usually in many markets anymore any low hanging fruit. It's all been picked. So, it's that's a piece of how you determine how quickly you can do something.

But you know sometimes the best way of looking at this is, and you know I'll just use our orthopedic example. You know, if I get if I can get 5 new XYZ surgeries, what are those worth to the organization. And how does that pay the salary like, what pays for this? It's very easy to calculate that. How many do I need to bring in in order to be able to pay for this. And, of course, it's got to do more than pay for it. So that's usually where that looks like. The reason pilots come in is when we're unsure. It's like we're really unsure of what the true potential is. How hard is it going to be to move it? So, before you invest in a lot of talent, hiring talent, which is not easy. Okay, which we already talked about. But before you invest in that, put somebody out there, for where your greatest opportunity is, get the right talent, and let's see what can happen. So, there are ways to ease into this without making a big investment, to be able to see what your results will be over a shorter period of time. Does that make sense?

Stewart Gandolf (Healthcare Success)

Sure, the pilot thing certainly is gonna go well with a lot of people that I work with. They like the idea of pilots, right? Because they're not putting their reputation on the line and millions of dollars on the line. It's like, let's try this. Although you're the expert on this, but I'm broadly speaking, and it's gonna get into something like this. I prefer two salespeople because the variation and ability of salespeople varies a lot. And it's really hard to tell. Even the best sales managers, it's hard for them to spot talent and motivation, right?

It's 50-50. So, to me, I'd probably spend my risk out by maybe a couple people if I can, I got the budget for it.

So, backing up to big picture, like we talked about a lot of things here, but what strategies broadly being the greatest result? Like what are the... really key variables that really matter to being the best results?

Susan Boydell (BarlowMcCarthy)

Well, okay, so from, um, there's probably we have, we have what we call nine best practices in this referral development space.

I won't give you all nine of them right now, but I'm going to pull out the ones that to me make the biggest difference, okay?

Um, data-driven, which we've already talked about, like anything that can drive who you're targeting, what's your opportunity to get, all of like I said, how easy is it going to be able to get it?

Like what can I earn, okay? So that's one, okay? The other is we've also talked about and that is differentiation, okay?

I think we've been talking about differentiation and, you know, I'm a marketer, okay? We know differentiation in this space of referral development.

I think we've sort of, oh yeah, yeah, yeah, I get that. Um, and anymore, if I want to change your referral pattern, I got to get pretty niche-y on why me versus somebody else, including when somebody even wants to recruit a specialist or something. What do they do that's different? How is that going to help me compete in my marketplace?

All of that plays into it. So differentiation. Talent we talked about it. Okay, this take this is an expensive Strategy because it is talent a hundred percent talent driven If I don't have the right person in the field I can have the best data I can have the best surgeons, but if I don't have the right person in the field I won't get the return on investment.

So that talent piece is an important one and then I'm gonna just grab the last one I might even throw one little one here at the end, but the last one is am I tracking and and keeping track of all of that?

because I Will tell you in these larger multi-specialty type practices. It's the piece that challenges them the most Like hospitals and health systems exact same thing.

They have no idea where the where the referral comes from and that's very challenging. I will tell you a multi-specialty practice, you can do it.

You can see exactly where that referral came from and connect that referral to the activity that that person had in the field, that field rep had in the field and you can begin to make correlations between how many visits it takes, what those conversations need to be like, how long it takes before I actually see the first referral, what is it worth in the long run in terms of ROI, down the road, that relationship as you build it, I mean they're all full of it.

So it's to me, it's vital that you put that in place because it tells you what works and it tells you what doesn't, which doesn't mean that the program didn't work or that the strategy didn't work, it just usually means you need to tweak.

Stewart Gandolf (Healthcare Success)

That makes sense. That was great. As we were not quite at the end as we began to start circling towards the end, just a comment or two about access. I mean, first of all, doctors were overwhelmed before COVID. COVID gave a lot of groups, the convenient excuse, we just don't see people any more ever. So that's going to be more challenging, but any other special insights besides, yeah, it's brutal. I mean for getting access?

Susan Boydell (BarlowMcCarthy)

Yes, you're right. It's real. And I don't think we have talked to a hospital health system or anybody that doesn't have an access issue. In fact, you can differentiate if you don't. Most of the access though are on all those areas that we just know, like if you want to try to get an appointment with a neurologist, it's going to be rough for an endocrinologist, it's going to be rough. So, access is real. Here's the other side of access that goes to my niche piece of it. I'm getting really niche-y. It's like what procedures, what am I looking for? What is the patient that I will have access for? So in other words, so I'm not growing cardiology or I'm not growing orthopedics. I'm getting pretty niche-y on the ones that I absolutely want.

And that's where this talent piece comes in because I'm going to have a conversation in the office about that patient need versus all of your orthopedic needs.

Stewart Gandolf (Healthcare Success)

Yeah, it's also a compelling way to get in the door. So there's access in two ways here, right? There's access in terms of we have access to take care of the patient.

The other way of looking at is access to get him to meet the doctor. Two different, very different concepts, having something specific helps really with both, right?

Like you've got on your side, your doctors have, you know, will make room on their schedule for a big surgery, for example.

And the getting in is something special to talk to the primary care doctor or whomever about is really important. You know, the, I guess the last thing we can talk about today, because we covered the other questions we've prepped here would be you know, steps in creating the referral development program. We talked about data, we've talked about a pilot, any other things that you think are like really critical things for them to think about as they begin thinking about creating a program like this.

Susan Boydell (BarlowMcCarthy)

So the other one we probably really didn't talk about is what I would call internal buy-in, so that you've got specialists that are hungry for the volume. You've got processes in place that make it easier for a referral to happen. What's the relationship your specialists have with the referring physician? Like we didn't talk about how important, like what do we're referring physicians want? I mean, I think we know the basics, take good care of my patient, and make it easy for me to make the referral. But the whole other piece that's in the relationship with that specialist is what's that communication like? How do I want to be continued to be involved in the relationship while I've made the referral with my patient? When do I expect you to communicate and what to back to me. All of that can make and build really strong relationships. When I think about the specialist, boy, that's a differentiator from a referring physician standpoint. So, those are the ones we haven’t talked about that can really make a difference in growing some business.

So, when I think of large groups, I'm like, so what's your strategy for how you're going to, what's your experience going to be for the referring physician when they work with you or any of your specialist?

Stewart Gandolf (Healthcare Success)

So fun talking about this because back in the days when I used to fly around the country leading seminars on growing practices. It’s been a long time now, but the, you know, we would do it, teach a section on doctor referrals, and those exact same things 20 years ago we would talk about, but back then we were talking to the individual providers on how they could do this themselves, right. And so now it's like, well, you know, doctors would say, well, first of all, don't have time, but number two, I became a doctor so I don’t have to be a salesperson. But it is funny, know, like what I have found is in any group of say 10 or 20 doctors, one or two are just naturally good at all this.

And some of them like are really busy with the best cases because they make time, they actually stop by and meet referring doctors once in a while in the way into the office.

And they do all these things well, either purposefully or they sort of stumble into it. And it's a decided difference in results.

One doctor could stand up far above everybody else because it is do this stuff. But that doesn't scale, right? So you can't, because in the old days, the method is teach all your doctors how to do this. And yeah, how many of them will actually to do it?

So, that's where the idea of scaling, which is so important and is, as you know, deeper than we have time to go in the day.

But for sure, anybody that we work with would want to know how do I scale? How do I do this across only a 50, 100, 200, whatever number of locations?

So last two questions. One is, okay, obviously you're a consultant in this and that's what you do, know, if somebody wanted to, I'll give you a sort of a 30-second message here of like, you know, do you usually recommend like an assessment as a first step? How does that look? You know, like how does that work if we want to, you know, talk to Susan and her team?

Susan Boydell (BarlowMcCarthy)

Yeah, if somebody, we do a lot of assessments, mostly when there are organizations that say, okay, I have some people doing this. We're going to, here's the line usually, we will be expanding over the next two to three years and I need to get this team performing at the upper level or all of that. So that's where a lot of assessment comes in. When they have something in place, the second part of assessment is they don't have anything in place or maybe they've got one person who's kind of doing it part time and they know they need it or they think it's an opportunity, like they want to grow their business and how do they do that? The assessment comes on on the other side that says, what's the potential in the market to grow?

So that's sometimes where pilots come in, where it's like, okay, it takes a lot of listening, a lot of reviewing of understanding their market, understanding where referrals are coming from today, the competition in their market, everything from, like I said, what's it going to take to earn the referrals? And that sometimes in those cases is where that pilot comes in. It's like, okay, let's put a person out there before you hire somebody, because there's ways to do this.

We have ways in which we've done this with teams. And that's where you start. And then based on those results, then you figure out how to scale and take it from there.

Stewart Gandolf (Healthcare Success)

Right. So the last thing we can talk about is, you and I have been talking a lot about lately, how our agency will do digital marketing to reach HCPs, healthcare professionals, doctors, know, PAs, MPs, or whomever on a one-on-one bases online. You know, as I hope you're likely excited about that, tell me about how helpful would that be to, you know, physician liaisons in the field trying to, you know, establish relationships when they're already much more familiar with your based upon other marketing directly to the doctor as that ewer to support the ground So to speak.

Susan Boydell (BarlowMcCarthy)

I am a firm believer that you got to do both because just like we've talked about today, all on the sale side of this and having that having that field rep have responsibility for conversations with referral sources and data is driving who I have an opportunity to earn from.

There's usually a whole bunch more that I want to go, well, that's expensive for me to go after them. So, what can I do on the digital side to create awareness to create interest to create a relationship digitally that just begins to move them from like I'm going to nurture them.

Into okay, now let's have conversation with them. I most do one or the other, but not both. And to me, they work really well when both go together, because there's a whole market usually out there that doesn't make sense to have a field rep calling on, because it's expensive.

But can I get them, can I move them into where now it's time for them to have that conversation?

Stewart Gandolf (Healthcare Success)

Very good.

Susan Boydell (BarlowMcCarthy)

Yeah.

Stewart Gandolf (Healthcare Success)

So, we're going to post your contact info on the web page for the people that are listening audio on just audio on a podcast.

How do they reach you, Susan? What's the best way to reach you?

Susan Boydell (BarlowMcCarthy)

Easiest way. Easiest way is email, and that is sboydell-b-o-y-d-e-l-l because I think you can see my name on the thing at barlowmccarthy.com or you can just go to [email protected] and they'll get it right to me. So, either one, they work out.

Stewart Gandolf (Healthcare Success)

Great. All right, awesome. that was fun today. Thank you, Susan, for attending. This area we're talking about is something our agency does a lot in and will probably be working together on assignments ongoing into the future. So good seeing you again

Susan Boydell (BarlowMcCarthy)

Same here. Thank you.