How do doctors select other drs./clinics for referral?

I’m thnking of a large market where there are several choices in most specialties. Is there an up to date listing of schooling and experience to help them? Is there some incentive, cash or otherwise, perhaps from insurance companies/professional organizations/etc? Am I missing the obvious?
I’m putting this in IMHO, but I’d like to hear knowledgable replies.

Advertising. My sweetie is a doctor who practices a sub-specialty. A lot of her job involves going around to the various primary care docs in the area and trying to convince them that she can, for whatever reason, provide better services to the patient than the other sub-specialists can.

The primary docs get no direct financial or other benefit (that kind of thing would probably cross the line into illegal kickbacks), but they have ethical and business reasons to refer their patients to the sub-specialists who will give the best care. The primary doc doesn’t want to refer the patient to a doofus – that hurts the patient and makes the primary doc look like a doofus too. So, the sub-specialists go around to all the primary doc offices saying, “Hey, I’m really awesome. Here are my credentials and here are the extra services I/my practice can offer that the other guys in my field can’t. You should send your patients to me!” In the case of my wife, she arranges a lunchtime [del]dog and pony show[/del] “meet and greet” where she brings food for the doc’s office and chats with the docs and nurses and gives a little stump speech. In her field, the quality of care provided by all the sub-specialists in the area is very comparable, so practices try to distinguish themselves with things like flexible payment plans or especially pleasant customer service. Sub-specialists who aren’t willing to go around and shake hands and talk themselves up get no referrals

Also, when sub-specialists see patients who really need just plain old primary care, they typically refer them to primary docs. The sub-specialists will naturally refer the patient to docs with whom they have a working relationship already. So, the primary docs might get some referrals in return, but the main things driving their referrals to the sub-specialists are the belief that the referral is the best for the patient and just familiarity with the sub-specialist.

Too late to edit…

The stump-speech approach is probably more common among doctors who are new to the area and trying to build up a practice. There are other ways docs advertise to their peers as well. Sub-specialists might give academic presentations to other doctors, send out mailings, attend “social” functions, whatever. Same general idea.

Whenever my doctor has referred me to a specialist it has been on the basis of his regard for the other doctor’s work. When I needed some surgery he referred me to a surgeon many miles away who operated at a smaller hospital further away than the large teaching hospital near where I lived. He said that if I wanted to go to the closer, larger hospital he could refer me to a surgeon who practiced there but he had visited the guy recently and “didn’t like the way he kept his rooms.” He was trying to avoid sending any more patients to him.

There is generally more than one choice available but he is always able to tell me what he likes about the doctor he has chosen.

Thanks for the inside info. It must be very tough trying to establish a new practice. I see to many good docs. who seem to have become ovrcontrolled, by medical. corps., by ins. cos. and by the sheer amt. of time and bucks to set up a new practice.
No matter what a new prez may desire, it’s going to take a huge effort to change the profit driven structure and objectives of our current system… while at the same time establishing a less expensive, more effective one in it’s place. Probably not the best time to be a doc., especially a one new to pratice.

I don’t have much to add to Bayard’s excellent post, other than to say that’s the way I did it, minus the food. Bringing them food feels too much like begging. I am a psychologist, and some of my colleagues have printed pens, but I don’t like that, either. I set up a new practice a few years ago, and got steady business by mailing brochures to internists and family practitioners, then following up with phone calls. I went to see some, and that was pretty productive. I also gave some academic talks at the local hospital, and sent around copies of an article I had written on how physicians should tell patients bad news.