Some of the more common things I hear when talking with colleagues about referrals to ophthalmology are these:

I have a great relationship with Dr. OMD. They send me letters back and they send the patient back for post-op care.

My OMD is great to work with…they are good about sending my patient back.

I only use OMD’s who send patients back and who don’t have a dispensary.

Of course, there are various iterations thereof, but let’s talk about what is a true referral relationship, and how all too often, OD’s sell themselves way too short in this regard.

Before I get into my thoughts on this, let’s get one thing straight. The goal here and the one thing that trumps all other discussions is the patient…the care they get, the care they need…that is what should always be at the top of the importance list. We are all interested in offering our patients great care, and if that care is something that we don’t offer, it’s incumbent upon us to direct the patient to the best provider of that care. But the second, and almost, but not quite, as important issue is the health of our practice. Referrals out of our practice have business repercussions.

OD’s who refer out too many cases, will, in my opinion, wake up one day with a practice with fewer and fewer patients. If one has a detect and refer (DNR as I like to call it) practice, it won’t take too long before patients realize they can cut out the middleman and circumvent your practice. You should have a practice directive of DNR…do not resuscitate.

I’m not talking here about detect and refer practices. I get it that some practice environments are not set up for medical management; those docs should be sending the majority of their patients to fellow OD’s. What I want to talk about is referrals to ophthalmology.

Yes, there are things that ophthalmology does that we don’t do, such as cataract surgery, retinal surgery etc. But think about it…there are things that they don’t do. My guess is that most of you will say, right! They don’t do contact lenses, or VT, or maybe even glasses.  I’m not talking about this either.

Some ophthalmologists just do cataract surgery, they don’t evaluate retinae for diabetic disease, they don’t do glaucoma, they don’t do dry eye. They chose to concentrate on certain aspects of eye care, and refer out other areas. But who do they refer them to? We do the same thing. I personally don’t do vision therapy or contact lenses…it’s mostly glaucoma, retinal disease, and acute care. I refer those things out to colleagues who are better at those areas than I am.

With all that said, I began this column with the comment about a real two way street. What do I mean by that? Well, when you refer a patient to an ophthalmologist for, say, cataract surgery, and they refer them back to you, that is NOT a two-way street. That is simple patient management. For example, an endocrinologist and a retinal surgeon who just don’t like each other (imagine that)…the patient may go to retina for a look-see, but they go back to the endo. The retina doc just had a patient added to their practice whom otherwise would not have made it there had it not been for the referral of the endocrinologist, who got their patient back. While the patient was cared for, would the docs involved consider this a great relationship? Heck no…its one of necessity. So the ophthal that sends you your cataract post-op patient back…are they doing you any big favors?  They’d do that with someone they don’t like. But of course, they do like you, because you send them so many patients right? You put a new patient into their office. Have they put a new patient into your office? No. They just returned your patient. That my friends is not a two-way street. That is a one way street with a dead end.

What does a two-way street look like? Well, has that same ophthal put a new patient into my office that otherwise wouldn’t have come in had it not been for their referral??? Not someone I sent them…but an entirely new patient. Most likely one who needs services that they don’t provide. And for the record, I’m not talking about glasses and contact lenses here. I’m talking about medical care patients. Too many of us are happy with just getting an eyeglass patient or a contact lens patient referred in. But what about the retinologist who doesn’t do glaucoma…where do they send those patients? Most likely to a fellow ophthalmologist. But who can and who should they be sending those patients to? You got it! You! That is a two-way street. Think about it. And think about it long and hard. If they are bringing about the same volume of new patients into your office as you are bringing in to theirs, that is a two-way street.

I’ll share with you one of my favorite stories that I share with my interns about just this. A large ophthalmology practice in our area says they are our friends (again, imagine that).  And of course a new ophthal will join their practice, and make the rounds to the local OD’s to introduce themselves and perhaps garner a few referrals out of the meeting. When I get the note that Dr. New OMD wants to visit, I smile to myself, because I know what’s coming. 

It goes like this, Hi Dr. Fanelli, I’m Dr. New OMD and I’m well trained in the latest cataract surgery techniques from XYZ Medical School where I did my residency. I’ll take great care of your patients that you send over, and I’ll make sure you get them back after surgery.  I’m limiting my practice only to cataract surgery to provide the best possible care for your patients, and I won’t hold on to them after surgery. I promise.” 

Me: I smile, and listen, and confirm an important point: “So, you are limiting your care to only cataract patients, correct?” 

“Yes, sir, I am. No glasses, no contacts, no glaucoma, no retina…just cataracts.”

Me: “Perfect! Since I do mostly glaucoma, and I don’t do cataract surgery, how about you send me all your glaucoma patients and I’ll do the same with my cataract patients?” Deer in headlights stare sent my way.

Folks, there ARE ophthals out there who get it. Most don’t get that concept. And I would guess that most don’t get that concept because most OD’s don’t ask for that two-way street. We too often settle for the one way dead end street.