Building and Maintaining a Successful Practice

A guide to the many ways community involvement and interaction may help your practice grow.

By Colleen Moore

Before the ink dries on your contract, the work of building a practice should begin. By learn- ing the local landscape, introducing yourself to and becoming part of the community, and maintaining a professional and welcoming appearance, you can start and build a highly successful practice.


Before your first day in the office, it is imperative to identify local physicians and determine their interactions with one another. This investigative process is important whether you have joined a group practice or are setting out on your own. Ignorance of the political landscape can lead to any number of faux pas that can take years to overcome.

This process begins with the medical staff offices of hospitals where you are seeking privileges. Deciphering inpatient consult patterns and the proper involvement of primary care physicians before admitting the first patient are paramount to your success. Understand that local practices may not be the custom where you trained, and early adaptability can lead to more outpatient referrals. In addition to identifying local customs, the medical staff office should be able to provide you with a list of physician contact information for the physicians practicing at that hospital.

Information from local and state medical societies will help you expand your list of potential referring physicians. Much of the information from local medical societies will overlap with the hospital medical staff office. When contacting a state medical society, it is helpful to provide a geographic radius or the zip codes of surrounding areas for a more focused search. If your practice will be in a larger city, it may be wise to chose a smaller radius than if you are moving to a primarily rural or tertiary care environment.

The Internet can also be a resource when compiling a list of potential referring physicians. The American Medical Association Web site can be searched to identify physicians within a geographic area.1 It is wise to register with the American Medical Association and state and local medical societies because patients and physicians often look to these organizations for information. The final listing can be referenced with the local phone book to ensure that no physician is overlooked.

The final list can be culled and sorted according to specialty. It is impractical to think that you will contact every physician on the list, so identifying potential referral specialties is important. Primary care physicians, internists, family medical physicians, and nephrologists are logical choices. However, limiting the search to these primary care specialties excludes some potentially fruitful relationships. Neurologists are often the first physicians to evaluate and formulate a treatment plan for acute stroke patients. Early interactions with neurologists can result in multiple referrals for the evaluation and treatment of carotid disease. In addition, fibromuscular dysplasia and many of the more uncommon arteritides have cerebral manifestations. Early interactions with neurologists can ensure that you remain in the forefront of their consciousness when they encounter these patients. Rheumatologists can potentially refer patients for temporal artery biopsies and for complications of Takayasu's and giant-cell arteritis.

Podiatrists and nurse practitioners are often overlooked as potential referral sources. Many are practicing independently in the hospital setting or within a large primary care group. Acknowledging their role in patient care and offering to evaluate their patients can go a long way to garner referrals. It also offers you an outlet to arrange diabetic foot care or set up patients with a new primary care provider.

Gynecologic contacts can be a source of very pleasant, healthy young patients, a demographic not often seen in vascular surgery practices. These women use their gynecologists as primary care providers and are often seeking information about treatment options for varicose veins that develop with pregnancies. Some women desire to preserve their uterus and so ask for uterine fibroid embolization procedures. Postpartum bleeding can be treated with embolization. Nonsurgical specialties that perform these last two procedures can not offer the understanding of post-procedure pain control or resuscitation that comes with the involvement of a surgeon interventionist. This results in better patient care, and the gynecologists are happy to refer to another surgeon.

Much of the focus when young physicians embark on the process of building a new practice is directed toward developing an arterial practice. Venous disease is overlooked and not felt to carry the prestige that an arterial practice brings. In addition to the gynecologists, dermatologists see a lot of venous disease that can be referred on. Women make the overwhelming majority of medical decisions for families, and each family has at least two parents that are aging and may likely require vascular care. A positive experience in the vein clinic can translate into many new arterial referrals.


Industry representatives are a valuable resource for gathering information about the community you are joining. Ask the local medical device representatives which physicians perform the majority of vascular sur- gery and the bulk of the endovascular interventions. It is important to gain an understanding of the role you are expected to play and the specific skill set that you were hired to provide. By identifying this early, you can establish a referral toehold.

As your role becomes more defined, it is time to make yourself known to local physicians. This is where your local medical society can provide additional assistance. These societies are designed to assist local physicians and can give you tips on local marketing practices that have been successful and those that do not work with your desired referral base or patient population.

Letters of introduction sent a few months prior to your anticipated arrival are nice. But, most practicing physicians do not take the time to read the letters and they often find the trash can before anyone reads them. If you decide to send out letters of introduction, keep it short and state your educational background and train- ing. Briefly discuss procedures or new skills you bring the community. It is important to be humble in this initial communication. Speak in generalities and do not claim to perform procedures you hope to add to your arma- mentarium in the future.

Once your start date has been set, it is important that someone is always available to answer the phone. Your office staff will start interacting with referring offices before that first clinic. It is vitally important to educate your office staff on how you would like the phone answered and what information you would like from the referring physicians office. At this time, writing scripts for your office staff is helpful. This way no matter who answers the phone, the answers are always the same. It avoids conflicting information. Also ask for the mini- mum necessary information from the referring physician at that initial phone call. If they have to work too hard to get the patient seen, they are unlikely to call back. A pleasant interaction during the initial phone call goes a long way toward continued referrals. Office staffs have a large say in directing patient referrals. If the process to refer a patient is too cumbersome or the person on the other end of the phone is unpleasant, it is unlikely that more patients will find their way to your door.

An effective way to introduce yourself to both physicians and the community alike is through the local newspapers. A small advertisement with a photo, a statement of your clinical interests, the office location, and phone number can be lucrative. Newspaper advertising can be slightly more expensive, but the return on your investment is excellent. This is especially so for more competitive markets such as the cosmetic vein market.

The days of driving to each referring physician’s office, introducing yourself, and having a cup of coffee are gone. Although it may be reasonable to visit a few physicians who are likely to refer a large volume of patients, it may be easier to have them come to you. A cocktail party or open house at your home or office provides an excellent opportunity to shake hands and let physicians interact with you socially. This event shouldn’t require professional party planners or rival a Hollywood red carpet event. A simple, informal affair is sufficient to allow you and your future partners to discuss the role within the community that you expect to fill and how you can evaluate and treat their patients.

Another professional venue to meet a variety of physicians is in the physicians lounge at the hospital. Although the fare may leave a lot to be desired, the opportunity to socialize can be unparalleled. Attending hospital staff meetings, department meetings or even faculty meetings, for those entering and academic practice, can prove fruitful.


Because appointments are easy to schedule when your office is just opening, and local physicians are apt to try and help you out, referrals will come in at the beginning. To keep new patients coming through the door, however, it is important to stay in the forefront of the local consciousness.

Local medical societies meet regularly and are frequently looking for speakers. Take the initiative and approach some of these groups and ask to speak. These forums provide you with a venue in which to explain your approach to common problems. When selecting a topic, it is important to speak about diseases you are comfortable and able to treat in the community where you now practice. It is important to establish a reputation as a competent surgeon and interventionist before pushing the envelope on the local landscape.

It is also important to acknowledge the local competition. If someone else provides similar services, do not expect to come in and dominate the market. Rather, explain what additional services you may offer or how your approach may differ. In addition, be humble. Presenting an arrogant façade does not endear you to physicians that have been practicing in that community for years. Their methods may be antiquated, but by presenting a distinctive approach in a collegial manner, it is possible that you may be able to alter the local landscape and get people to come around to your way of thinking

An additional speaking venue is hospital departmental meetings. Approaching various departmental chairs and asking for 5 minutes to introduce yourself to these small groups provides access to small groups of physicians. These opportunities show your commitment to establishing a successful practice and your desire to form a cordial working relationship with them. It also allows for frank and open discussion about the referral process and what you can do for them.

An additional speaking venue is hospital departmental meetings. Approaching various departmental chairs and asking for 5 minutes to introduce yourself to these small groups provides access to small groups of physicians. These opportunities show your commitment to establishing a successful practice and your desire to form a cordial working relationship with them. It also allows for frank and open discussion about the referral process and what you can do for them.

Establishing a relationship with local health reporters either in the print media or television is a great way to expose your practice to a large variety of people. Coordinating a patient education series during Heart Health Month ties in nicely with your practice. In addition, if you decide to provide free venous screenings, a short press release or piece on the local news establishes you as an expert in the field. The American Venous Forum provides a toolkit that allows you to provide free community screenings to assess deep vein thrombosis risk as well as to assess for the signs and symptoms of chronic venous insufficiency and venous obstruction.2

Another speaking opportunity that can result in a variety of referrals and establishes you as a local expert is the infamous “rubber chicken” dinner. These are often sponsored by local philanthropic organizations. Although the venue may not be glamorous, the attendees are interested and grateful for the time you have spent with them. Make sure your presentation is appropriate for the layman. At the conclusion of your talk, leave plenty of time for questions. Attempt to answer all of the questions that are asked no matter how bizarre or seemingly unrelated. If you establish that you are genuinely concerned, they are likely to self-refer or send a friend or family member.


Community involvement is mandatory for any physician starting a new practice. Becoming involved with various community organizations gives an impression that you are there to improve the community and not just to make money. By giving back to the community, you will get more in return that you ever imagined. This does not need to be a daunting task. By simply reading the paper or watching the local news, you can identify organizations that will benefit from your expertise. Social clubs and country clubs are often viewed as elitist; however, these organizations provide an opportunity to interact with a wide variety of people outside the community and can provide access to a variety of organizations with varied political and social agendas.

Often the easiest way to become involved is through children’s activities such as sports, dancing, and music. These provide excellent networking opportunities. Becoming a head coach may not be feasible due to the unpredictability of your work schedule, but you can volunteer to assist. Attend games and practices. Learning names of players and cheering from the stands is a great way to be involved and recognized.

Through active community involvement, potential patients see you as more human and much more like them. Referring physicians recognize that you are there to stay and to improve the local environment. The perception becomes that you are there to stay and not just passing through on your way to bigger and better things. It is important to remember that signing up is not sufficient—it is imperative that you project a sense of commitment and dependability. Keep the commitments you have made. Be more than a name on the roster.


Just as you continue to upgrade your computer, you must continue to upgrade your practice. Things such as keeping up with dictations and maintaining a relatively flexible schedule early on put referring physicians at ease. They can be assured you have seen their patients and developed a plan of care. In addition, a flexible schedule means they can get patients seen in a timely manner. If you identify patient- or physician- access problems to your practice, acknowledge these with a personal phone call and provide a solution to the problem.

Once your practice has been up and running for a few months, ask someone to be a “secret shopper.” This can be any random person that you trust to give you an honest assessment of your practice. Have them call to schedule an appointment and come in as a new patient. This can provide you with invaluable feedback as to what works well and what needs to be fixed with-in your practice. Continuous upgrades of your office processes will only make you more efficient and keep your patients very happy.


It is easy to sign a contract, but it is much more difficult to establish a practice that encourages patient referrals. By taking the initiative to step to the front of the local medical community and the community at large, you will encourage patient referrals. Once the patient flow begins, it is important to provide patients and referring physicians with the service and care you would expect for your family. Keeping the waiting room full requires constant care and maintenance.

Colleen Moore, MD, is Assistant Professor at Southern Illinois University School of Medicine, Division of Vascular Surgery in Springfield, Illinois. Dr. Moore may be reached at (217) 545-8444;

  1. American Medical Association Website. Available at: Accessed August 20, 2009.
  2. American Venous Forum Website. Available at: Accessed August 20, 2009.

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