Obviously, there are many ways to upset a referring doctor.   But some hot buttons will kill a referral pipeline faster than others.  Over the last 15 years of practicing dentistry, I have experienced each of these 5 referral killers.  I know there are plenty of things that we, the general dentists do that are just as upsetting to specialists, but I will address those in another article.  

Here are the top 5 referral killers.

1.  PERFORMING MORE THAN WHAT WAS ASKED FOR (WITHOUT DISCUSSING IT FIRST)

(A Real Situation)

A patient was referred to an Oral Surgeon's office for the extraction and bone grafting of #19.  There was no mention of providing an implant.  While talking with the patient, the patient mentioned to the specialist that she desired to have an implant in that area eventually.  The Oral Surgeon was confident that he would be able to provide an immediate implant in the same visit.  In his mind, he was just providing a service to the patient by doing it all in one appointment.  The Surgeon placed the implant without discussing it first with the referring doctor.  The referring doctor had planned to place the implant at a later date.  Unfortunately, the Oral Surgeon traded 1 implant for a lifetime of referrals. 

IF YOU FIND YOURSELF IN THIS SITUATION, PLEASE WAIT!

BEFORE YOU START ON THE IMPLANT:  1st, pick up the phone and call the referring doctor.  If the doctor indicates that he would like to do the implant himself, kindly thank him for the referral and just do the bone graft.  DO NOT make the referring doctor feel bad about wanting to do the implant himself.

I'm sure there are many reasons why you believe that your placing of the implant is the better choice, but you need to respect the wishes of the referring dentist if you want his ongoing referrals.    

(Real Story)

John (a patient) was referred to an endodontist for a re-treat.   John never made it back to the referring doctor.  The referring dentist called John, only to find out that John had decided to switch to another dentist.   The patient explained that the endodontist said that "General Dentists" should never perform molar endo and that if the referring doctor would have referred the patient to him in the first place, the tooth never would have given him problems.

The general dentist wanted to give the specialist the benefit of the doubt, so he called up the endodontist to hear for himself.  Unfortunately, the endodontist went on a 5 min rant telling the general dentist that generals had no right performing molar endo.

Bottom Line:  Even if the feelings of the endodontist were warranted, unloading on the patient ruined a referral pipeline for that doctor.   The General Dentist still performs molar endo and will absolutely never refer another patient to that specialist again.  

Certainly, if a General Dentist is continuing to perform below a minimal standard, a nice phone call would be helpful.  "Hey Doctor Smith, I want to first thank you for your confidence in me by sending me referrals.  My hopes in calling was to not only thank you but to also let you know that I am here for you if you ever need any help.  I have noticed a few cases come through where the fourth canals were missed.  That happens to all of us, for sure.  If you would like to go out to lunch, I could show you some techniques that I like to use to help locate that canal."

Do you see the difference?  The specialist is acting like he is a part of the general's team and has the attitude of helping the general succeed.  

(This happened to me)

I had a patient with an extensive treatment plan.  The patient needed scale and root, a root canal, multiple extractions and a ton of restorative work.  Of course, getting  him out of pain was the first priority.  I referred him to an Oral Surgeon for some extractions.  One month later, I was wondering what ever happened to that patient.  After calling the patient, my secretary was told that he thought that he was all done with everything.  Shocked with the response, I called the Oral Surgeon and found out that while he was there, the Oral Surgeon noticed another tooth that needed an endo, so he sent the patient next door to the endodontist without calling me first.  The endodontist performed the endo and sent the patient across the street to the periodontist for 4 quads of scale and root.  

After talking with a few other generals in town, who had had a similar experience, we came to find out that these specialists were intentionally feeding each other referrals and bypassing the general dentist.   

Most can easily identify many unethical issues with this scenario, but the biggest issue was the fact that no one was really overseeing the entire patient treatment.  The patient thought that everything had been completed when he still had a ton of work left.  

Many of the dentists in our area stopped referring to those specialists.

There was an endodontist in our area who flat out announced that he was no longer working on teeth that had been started by a general.  

Ok, first off, I completely get it.  There are many issues that arise when trying to fix others mistakes.  Finding and negotiating canals after they have been messed with already, is horrible.  But you need to understand what an announcement like that will do to your practice.   

The better choice is to put on a lunch-and-learn for the generals in the area where you suggest optimal times to refer a patient.  (e.g. when you can't locate the 4th canal or have tried and failed to negotiate the canal with a #6 or at most an #8 file.)

The Cold Hard Truth of the matter is that if you will only except the easiest cases, you will always struggle to stay busy.

A specialist may perform exceptional work, but if referring doctors do not hear back from the the specialist with a detailed report, including radiographs, the general dentist will go to someone who will provide good communication. 

If you think that a final report in the mail is adequate, you will soon be passed up by other forward thinking specialists that realize there is much more to reporting than just the final letter.

There are other things to consider such as whether or not the patient scheduled an appointment at all or if the patient refused treatment.   

Specialists need a good system that helps keep the referring doctors always in the loop.  ReferralWeb is one of those systems that greatly improves doctor to doctor communication. ReferralWeb

In closing remember, there’s no fanfare when people stop referring. You will not get a telegram or fireworks ending a referral relationship. They just quietly stop referring. You may not even know what happened (or failed to happen). And worse, if a practice stops referring, they probably will NOT tell you, but they may tell their friends. Your reputation is damaged and you may quietly lose other referral sources. It is difficult to fix a referral relationship gone sour. Even when the cause was unintentional or an oversight.  That is why referral analytics are so important.  You can catch those doctors who are slowing their referrals and reach out to them before it is too late.  

by:  Robert L. Barrick DDS

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