WASHINGTON--In today's evolving health care system, on-cologists and
oncology centers must reach out to primary care physicians as never before.
And unaccustomed as oncology is to such marketing efforts, the ways to
a primary care practitioner's trust and allegiance provoke more than a
little puzzlement within the specialty, according to Sara Sprague, RN,
EdD, director of cancer services, Phoenix Memorial Hospital. She summed
up the important issues of oncologist/primary care physician relationships
at a roundtable discussion during the Association of Community Cancer Centers
Noting what she termed a "huge gap" between primary care physicians
and specialists, she asked: "How do you bridge that gap? How do you
set up alliances? How do you nurture those relationships? How do you build
bridges between primary care physicians, hospitals, and managed care organizations?"
She and several other participants offered some specific suggestions,
and most of them involved communication as a major element. "What
it really takes is face-to-face communication," Dr. Sprague said.
"Fliers and newsletters are great, but, really, nothing takes the
place of developing a relationship with a primary care physician."
Recently, she has visited all primary care providers whose practices
Phoenix Memorial has purchased. "I've surveyed them, asked them what
their needs are, and introduced the cancer program to them," she said.
"Obviously, I'll have to continue doing that to nurture the relationship
and the referrals."
One of her biggest challenges, she acknowledged, was breaking old referral
patterns and encouraging the hospital's primary care physicians to continue
to send their cancer patients to Phoenix Memorial Hospital.
Gail Amalia B. Katz, director of Managed Care, EquiMed, Inc., Towson,
Md, suggested that oncologists could forge a partnership to help patients
get the best care in the age of managed care.
"A major job is to work with primary care physicians and with patients
to advocate for those patients," she said. "As managed care moves
into Medicare and Medicaid, you have a very vulnerable population. It is
so easy for those people to get crushed. They are not used to being assertive.
They don't know how the system works."
For radiation oncologists, image isn't everything. "Our specialty
was always depicted as old men in a room drawing pictures on x-rays, and
we still have a lot of people who think that is radiation oncology,"
said Kathryn L. Kepes, MD, of the Brandon, Fla-based Center for Radiation
Oncology. "We have to emphasize the word oncologist and that radiation
is just part of what we do."
For oncologists in private practice, a key to success is often how well
their staffs know and work with the staffs of primary care physicians,
Dr. Kepes said. "It's not just physician to physician any more."
Serving as an education resource can help, several participants noted.
Major Darryl Hunter, MD, a radiation oncologist at Travis Air Force Base,
Calif, said that he and his colleagues recently held a two-hour seminar
for primary care physicians on breast cancer screening and examination.
"I don't think the majority of those primary care providers had
ever seen a radiation oncologist," Dr. Hunter said. He also noted
that military medicine "is going to an HMO-like system."
Thomas A. Paivanas, director of integrated delivery systems, ELM Services,
Inc., Rockville, Md, stressed that regardless of the degree of managed
care penetration in a region, strong personal and professional relationships
between oncol-ogists and primary care physicians will remain essential.
He believes that about 80% of routine referrals are made based, in part,
on the "my good friend" approach, as well as on the referring
physician's confidence in the specialist's professional competence. "Physicians,
like any other group of busy professionals, tend to gravitate toward certain
comfortable patterns," he said.
In this increasingly impersonal world, a little old-fashioned civility
can make all the difference, he said. An oncologist's availability, for
example, is often a key to referrals. "If I can get you on the phone
every time, I'm going to refer patients to you," Mr. Paivanas said.
He offered a list of things oncologists should consider to help them become
the primary care physician's oncologist of choice:
How to Improve Your Relationships With Referring Physicians
From a presentation by Thomas Paivanas.