With all the recent studies and reports on consumerism in healthcare, direct-to-consumer advertising and the impact of the Internet on consumer health decision-making, it's no wonder so many healthcare organizations have focused their marketing efforts on reaching consumer audiences.

In the last 10 years, we've seen a significant shift away from many of the traditional physician marketing (business-to-business) activities that sustained hospitals, health systems and other healthcare organizations to the business-to-consumer activities that are so popular today. It's time for the pendulum to swing back in the direction of the physicians and the critical role they play in where patients receive medical care.

Depending on what studies you believe, physicians still control 70% to 80% of where patients go for outpatient procedures, where they're admitted for in-patient hospital care and what specialists they see. With the exception of some healthcare services, which have always been more consumer-driven (drug and alcohol treatment, psychiatric care, women's health and maternity care, for example) the majority of medical services and healthcare decisions are still heavily physician influenced. The physician has never been more important, but you wouldn't think so listening in on many management retreats and consultant presentations.

There's no question the tide is changing. In everything from nutrition to treatment of chronic diseases, we are seeing a very real shift in Americans' attitudes toward medicine and how they interact with the healthcare industry. Consumers are much more likely to report that they make healthcare decisions jointly with their physicians than they did 10 years ago. And they also report taking a more active role in understanding their healthcare conditions better, researching treatment options and asking more questions during diagnosis and treatment regimes. Even the number of patients seeking second opinions is increasing. Once considered only in very serious clinical cases, more and more patients are routinely seeking second opinions for routine medical treatments.

However, despite the growing interest among many consumers in directing their medical care, these are slow-moving trends, and we are still far from replacing the physician as chief caregiver and primary gatekeeper to the healthcare system. Hospitals, in particular, have jumped on the consumer marketing bandwagon, driven by a number of factors including the rush to brand their facilities and systems, the desire to attract more patients, faster and more directly without relying on a loose network of "middle men or brokers" and the appeal of having more control over the healthcare dollar. It's the same reason many healthcare providers bought networks of physician practices and went into the health insurance business with their own health plans and managed care operations-albeit only moderately successfully.

The typical health system and its medical staff are still strategic partners and depend heavily on one another for success. But recent studies reflect the growing challenge these partners have in working together. The Future Vision 2000 study conducted by VHA (www.vha.com) and Deloitte & Touche (www.deloitte.com) suggests many physicians don't feel empowered in the strategic decision-making processes of their organizations and are contemplating ventures where they have a larger role and more control. It doesn't take much study to realize that these ventures may be at odds with the health system and other providers in the market. Cooperative efforts - especially in marketing - will be increasingly important for both groups.

What then can healthcare marketers do to ensure they're not excluding physicians in their drive to build community loyalty and capture retail healthcare dollars? Below is a list of some of the more popular physician marketing activities that healthcare providers have employed for years. Many providers are revisiting these strategies in search of more balanced marketing programs. Not every market is the same, so reviewing this list with an understanding of what your strengths, weaknesses, opportunities and threats are is important. The key is to find the most important and beneficial strategies for your organization to focus on and then invest the time and effort into making them unique to your marketplace.

Physician-to-physician referral programs. A basic element of any successful healthcare provider network is the relationships that exist between primary care physicians and specialists in the market. But it is surprising how little time administrators and many marketers spend studying where patients come from and the relationships between local and regional medical practices. Sure it is difficult to track specific referral patterns, but the more that marketers know, the easier it will be to address challenges or barriers to access and build stronger, mutually beneficial relationships between physician groups. To do this, marketers will need to spend time with finance and information systems experts to find the best ways to collect and maintain the right data. The investment in time and systems is a marketing investment and well worth it.

Call centers and physician referral. At one time, healthcare providers invested heavily in building and promoting referral programs designed to drive patients into area physician practices. Although many referral programs morphed into clinical nurse triage programs and specialty call centers, there is still a need for basic physician referral efforts in most markets. Call centers will continue to play an important role in healthcare systems, especially as physicians and consumers continue to use other technology, like the Internet, to access and manage activities remotely. Understanding basic issues of access, whether it's a lack of physicians, a lack of providers who accept certain types of health insurance or physical barriers to access, is critical for marketers to know their market.

Physician-hospital and physician-patient communications initiatives. From computerized medical records and clinical data repositories to intranet and Internet communication systems, providers should be exploring every opportunity to build and enhance communication among providers and between providers and patients. IS investments in physician-hospital communication are key, and marketers should be driving these initiatives and convincing management that these decisions aren't just operational in nature, but mission-critical business opportunities that will probably have a larger ROI short-term than any branding campaign. It's not that branding and other consumer marketing efforts aren't important - because they are - it's that successful health systems know how important other issues like information exchange are to the healthcare system of the future.

Physician liaison teams. Sometimes called physician representatives, clinical liaisons or simply physician advocates, many health systems are bringing back these popular programs because they work. Referral specialists serve many functions from collecting input and feedback, solving problems, promoting services and keeping lines of communication between providers open and productive. While some organizations like to use clinical staff, the most successful models seem to be professionally trained representatives with clear objectives and focus.

Management involvement. Having a good liaison team in the field for day-to-day communication and marketing isn't a substitute for management involvement. If anything, it's even more important today for senior managers to be highly visible within their organizations, as well the marketplace. The typical hospital administrator probably spends 70% of her time with operational, financial or human resource issues. What if that same leader delegated those responsibilities to her lieutenants and spent 70% of her time with her key referral sources - strengthening the active relationships and addressing the weaker ones?

Physician research. From market feasibility studies to physician attitude research, providers should be conducting regular and ongoing research to better understand the needs of physician practices in the market. A recent study conducted by Nashville-based Data Management & Research (www.dmr-inc.com) finds that the five key predictors of physician satisfaction of hospitals in order of importance are: administrative staff quality, nursing staff quality, overall hospital quality, access to information and hospital efficiency. These findings underline the importance of knowing how your organization rates and tracking changes in attitudes over time.

Physician recruitment programs. Aggressive recruitment efforts are critical for most providers, but it's surprising how many organizations have informal or unstructured recruitment efforts. Recruitment campaigns are thrown together, responses to inquiries are slow or disorganized, scripted tours for site-visits are non-existent and Web sites lack sufficient and compelling recruitment messages. Marketers must see physician recruitment and retention as part of their role - especially when those responsibilities might be spread between outside recruitment firms, medical staff administrative staff and human resources.

Physician-centered marketing and communications campaigns. There are numerous ways for marketers to promote specific physicians, service lines or physicians in general through ongoing communications efforts. Some of these include:

• Highlighting physicians in publications like community newsletters, mailers and magazines
• Online physician directories and referral services
• Online interviews and articles written by or about area physicians
• Medical features and physician interviews in local television, radio and newspaper programs
• Educational seminars and workshops featuring physician presenters
• Including physicians in community advertising efforts
• Promoting specific service lines that are physician-driven

Practice management and marketing. Despite legitimate concerns over Stark and Safe Harbor regulations, there are many things providers can be doing to bring practice management and marketing support to physicians in the market. Marketers should outline strategies and resources for sustained practice marketing efforts, review those with counsel and implement them as part of the organization's marketing, advertising and public relations program. Since many healthcare organizations have limited experience in this area, finding outside experts and highly rated practice management companies may be the best way to get started.

To summarize, marketers should develop a three-fold approach to physician marketing and relationship building: 1) promoting your products and services to physicians, 2) helping physicians to promote their services in the community and 3) partnering with physicians to jointly promote services that attract and retain patients and in the region.

Healthcare marketers don't need to abandon their investments in consumer marketing. Building strong regional brands and promoting specific services lines are still important marketing strategies. But in the rush to speak to consumers and appeal to the masses, marketers can't allow their organizations to lose sight of the important role physicians play in driving patient volume and revenue.

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Daniel Fell, an innovative marketing planner and strategic thinker, spearheads client service and marketing communications efforts for Daniel+Douglas+Norcross, a Chattanooga-based marketing firm. He is also a former partner and senior vice-president with a national healthcare marketing firm and former hospital marketing executive.

Danny's experience and expertise uniquely aligns ddN to meet and exceed the goals of clients such as Hewlett-Packard Medical Products (now Agilent Technologies), Health Management Associates, Geisinger Health System, University of Tennessee Medical Center and HospitalHub. He has authored numerous articles on healthcare marketing and frequently speaks on the process of developing marketing and communications strategies.

Danny is a member of the Society for Healthcare Strategy and Market Development's board of directors and is a past president of the Tennessee Society for Healthcare Marketing and Public Relations. He is a contributing author of the 1997 Guide to Health Care Resources on the Internet and co-authors marketing and technology columns for Marketing Health Services magazine and HealthLeaders.com. He is also on the advisory board for eHealthcare Strategy & Trends newsletter.

He can be reached by phone at (423) 752-4687 or by e-mail at dfell@ddngroup.com.