Health care is a unique industry for many reasons. One interesting element in health care is just who is the customer? The answer to that question resides in the actual perspective. For most primary care physicians, the customer is the patient. But then, moving down the referral chain, things get a little tricky. For the specialist and the hospital, the customer is the referring physician and the patient.

Specialists do have the dual customer responsibility but in most cases, the patient will return to the primary care physician to resume their long-term relationship. While many primary care physicians report that they jointly decide with the patient where to refer patients, the bulk of referrals still remain the responsibility of the primary care physician. Because patients are both accustomed to the advice of their primary physician and his/her knowledge of the medical community, their main concerns are how long before they can obtain an appointment and will the specialist take their insurance?

In terms of outreach and practice growth, knowing how the referral process works between patient and primary care physician informs us that the specialist should be paying very careful attention to the primary care physician as the customer. In our work in network and referral development, we repeatedly hear from primary care physicians that the things they care most about when referring is access and communication.

Access and communication sound simple enough but in practice they are apparently difficult. Often primary care physicians will indicate that if they did not receive appropriate feedback, they will drop the specialist from their referral list. One area that causes significant frustration is when a secondary referral occurs without discussion with the primary care physician. Physicians refer to those who send the patients back, don’t refer the patient elsewhere and communicate promptly and directly with the referring physician.

Developing a relationship with your referral sources takes time. If you practice in a personal community hospital environment, it is easier to get to know your referral sources through less formal connections. With more hospitalist programs, however, those informal interactions are less likely to occur in the hospital. Efforts have to be more systematized in an academic medical center to understand the needs and expectations of the referring physician.

Consider keeping a database contact list of your referral and potential referral sources. Specifically ask them about their expectations and communication preferences. Note the names of their office manager/practice assistant who typically will be charged with facilitating the referral. If you provide more customer service to your referral sources, they will continue to refer patients to you and they will share their positive results with their primary care colleagues.

Your customer is always your patient but the way to more patients is through the referring physician.