At some point, most hospitals have had a physician relations program.  It operated either within the marketing department, the medical staff office, or reported directly to the CEO.  The Physician Liaison had the responsibility for maintaining contact with the members of the medical staff and their office employees.  Few programs were designed to produce measurable results, the representatives were hired for their PR skills, and physician practices had few, if any, complex needs or issues.  The programs made the physicians feel “special” and, at the time, this was enough. 

Times changed.  The emphasis of hospitals shifted to the primary care gatekeeper, and most of the available financial resources were shifted to acquiring physician practices or recruiting new primary care physicians to the service area.  Many hospitals terminated their physician liaison programs as a result of “accountability mentality”.  The programs produced few measurable benefits and were, therefore, expendable.  There were a few national consulting/management firms that specialized in the design and operation of physician relation programs in the early part of the 90s.  They had failed by the end of the decade, as interest waned.  A recent internet search, conducted by our staff, did not find any firms that offered technical assistance in the development or management of these programs. 

Our impression is that the loyalty of physicians will become something that must be continually earned.  It was once enough for hospitals to sponsor an annual golf outing or banquet.  Today, declining physician incomes result in loyalty bonds that are tied to efficiency, excellent patient satisfaction/care, and business partnerships.  “Physicians go where they are invited, stay where they are well treated, and grow where they are cultivated”.[1]  This statement reflects the reality of the hospital-physician relationship.  It is truly a two way street.  Frustrated physicians fully understand that the hospital receives the benefits of their referred work and they recognize the power of their referral recommendations on patients.  Few patients will go against the suggestion of their trusted physician. 

How, then, should a physician relations program be structured to achieve the intended results; increased loyalty and patient referral volume?  We suggest the following: 

Regular Contact 

A hospital representative should visit each physician/practice monthly.  Typically this role falls to the Physician Liaison.  The encounter should be documented in a contact management computer program and routine activity reports should be generated.  Liaisons often find that it is easiest to visit with the office staff, rather than the physician.  While this encounter is valuable it must not be allowed to replace the face-to-face visit with the physician.  Representatives of drug manufacturers must obtain signed encounter cards to “prove” that the visit took place.  Use of such a tool should not be discounted. 

Bring a Message 

A simple “Hello” is not sufficient.  The hospital representative should bring news of a new program, staff education opportunity, practice support initiative, or an answer to a previously asked question (or the resolution of a problem).  This content creates a reason for the physician to anticipate the visit and meet with the representative.  It is also appropriate to bring a representative of a clinical department to meet with appropriate physicians.  The chief radiologist or department manager, the Director of Surgery or the Vice President, the VP for Nursing, and the Medical Staff Secretary are all good candidates for periodic “rounds”. 

Categorize Physicians 

“Loyalists”, “Splitters”, and “Phantoms” describe the three key physician categories.  Loyalists admit or refer a substantial percentage of their patients to you, they must be coddled and kept excited about the relationship (watch out, they eventually grow old).  Splitters divide their business between you and others.  These “base coverers” are seeking to maximize their practice market and earn the maximum possible.  These physicians need to understand why working with you can result in a more efficient (or profitable) practice.  Increase their income, or lower their hassle, and you’ll get more business.  “Phantoms” use you only when the patient requests, or insists.   You’ll either need to make these physicians a business partner or convince their patients, or even their staff, that you are the facility of choice.  Converting these physicians to splitters is a key focus of the program and the progress should be monitored. 

Monitor Data 

Track referrals, by dollars and by numbers, on a regular basis.  Increases in business from splitters or phantoms should be met with an immediate “thank you” from senior management.  Rewards for staff performance, and continued employment, should be tied to “conversions”. 

Any program success will depend on the ability of the liaison program to assess the needs and wants of the medical staff.  These should be identified, quantified, and summarized on a regular basis.  The source of the data is the periodic physician meetings and regular (annual) surveys and focus groups.  Senior management should remember that their middle managers will minimize the importance of problems and will resist change, especially if it is physician initiated.  Management should also be sensitive to their true “customer”, the physician. 

Popular product offerings include assistance with annoying procedures such as credentialing with health plans, assistance in marketing practices [2] [3], buying groups, and information resources. 

Staff chosen for the position of Physician Liaison should have specific qualities.  Our firm utilizes a personality profiling system based on Mouton’s DISC program.  This assumes that personalities are influenced by the following traits: Dominance (how we respond to problems and challenges), Influence (how we bring others to our point of view), Steadiness (how we respond to the changing environment), and Compliance (how we deal with rules set by others).  These factors can be used to identify those personality traits that can help or hinder the individual in the development of positive relationships with physicians and others. 

There is no one best type of individual for the role.  The “sales” approach is often annoying to the private physicians while the “relationship builder” may often take too long to deliver the message or develop a connection.  Our suggestion?  Identify a candidate that is loyal, bright, and motivated and work with them to understand how to be successful.  It works!  

It is critical to know as much as possible about the individual members of the medical staff and their referral patterns.  A program, to be successful, will need to document physician practice location, other physicians in the same group, physician specialty, and age.  Admissions need to be identified by physician and then rolled into groups.  An age-weighted admissions profile should be developed, by specialty.  This will highlight the risk exposure to pending retirements and practice slowdowns.  Finally, the number and total dollar volume of admissions should be attached to the top 25% of admitters, the middle 50% and the bottom 25%. 

Each physician visit should be planned and the outcome documented.  Information should be obtained about problems, needs, and requests.  Critical information about office operations, such as the role of key staff, will be helpful in targeting marketing efforts. 

Each week an activity report should be submitted documenting the number of visits, those visited, and the outcomes.  A summary report should be prepared, each month, which tracks referrals by physician and highlights increases or decreases in volume.  The reasons should be included. 

Trends in office needs and requests should be identified and used in the development of new programs and initiatives. 

The critical component of this entire process is the ability to tie Physician Liaison behaviors to changes in referral patterns.  The ultimate value of the program is its ability to bring business to the hospital that, without its existence, may go elsewhere. 

 Senior management should utilize the monthly input from the Liaison program to target certain physicians for personal attention, develop new programs that will support the needs of the medical staff, and identify geographic and specialty areas for future development. 

 The ultimate outcome of any physician relations effort is the generation of new business for the hospital or, at least, to counter the proactive efforts of competitors.  The most critical aspect of a successful program is the interaction between key hospital personnel and the physicians.  The relationship cannot be one sided.  If the hospital wants the loyalty and business of the members of the medical staff, they need to be prepared to understand the needs and wants of the physicians and to develop meaningful programs that address these.  The most damaging behavior is to survey the physician, obtain their input, and then do nothing.  This will, initially, create frustration, which will lead to apathy, and result in anger.

 An effective program requires time and skilled staff.  It also requires the allocation of resources and the empowerment of Liaison staff to impact the issues identified.  Within reason, the Liaison needs to have the influence and support of the CEO behind them as they interact with other hospital staff in their problem solving activities.  The routine reports should be sufficient to keep the CEO abreast of the issues and actions and allow him/her to intervene if the program begins to stray from its mission.

Finally, and we believe most critically, the staff of the Liaison effort needs to understand and appreciate the challenges faced by their physician customers.  Physicians and their key staff do not have the time or the desire to teach hospital staff about their business.