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Fam Pract Manag. 2012;19(4):33

Stop providing secretarial services for referrals

When we refer patients for more specialized services, our offices are often expected to work with these patients to schedule their referral appointments and answer questions. We are not paid for this work; however, it does generate income for the referral specialist. Recently, our office decided to put a stop to this practice. When one of the physicians objected, I sent the following reply:

“Thank you for your note regarding referrals and your expectation that we make all arrangements for the patients. There are many reasons why we request that your office call the patient after we have made the referral. Many times the initial appointment will not work for the patient, and then we have to call your office back. Many times the patient may have questions regarding where you’re located, what insurances you accept, what they should expect at the visit, etc. It makes little sense for our office to sit between the two parties that need to communicate directly with one another. We have found that we are serving as a free secretarial service for specialists’ offices whose staff members do not wish to make the telephone calls necessary to bring them business. We refuse to do this any longer.

“I have monitored this situation, and it is taking on average five telephone calls per referral and almost one hour of staff time. We receive no reimbursement for these services. Thus, we are expending almost $20 for every referral we make. This is often 25 percent of the fee we receive to see the patient. I am not aware of any other industry where the party providing referral customers for a business is expected to expend revenues for that business.

“As health care dollars shrink, we can no longer provide our services for specialist practices free of charge and are developing referral patterns to allow us to reduce these expenditures. If this will not work for your practice, please let us know.”

Use technology to store all your notes, tasks, and ideas

I have found Evernote (, a software program designed for notetaking and archiving, to be a great tool to allow me to focus on the task at hand and mentally shelve other important but not urgent tasks. I try to make a habit of coming back to those items at several “refocus times” during the day. Evernote is accessible on my PC, tablet, or smartphone, and is also a great collaboration tool.

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