Oncologists Need to Reach Out to GPs

WASHINGTON--In today's evolving health care system, on-cologists andoncology centers must reach out to primary care physicians as never before.And unaccustomed as oncology is to such marketing efforts, the ways toa primary care practitioner's trust and allegiance provoke more than alittle puzzlement within the specialty, according to Sara Sprague, RN,EdD, director of cancer services, Phoenix Memorial Hospital. She summedup the important issues of oncologist/primary care physician relationshipsat a roundtable discussion during the Association of Community Cancer Centersmeeting.

Noting what she termed a "huge gap" between primary care physiciansand specialists, she asked: "How do you bridge that gap? How do youset up alliances? How do you nurture those relationships? How do you buildbridges 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. "Whatit really takes is face-to-face communication," Dr. Sprague said."Fliers and newsletters are great, but, really, nothing takes theplace of developing a relationship with a primary care physician."

Recently, she has visited all primary care providers whose practicesPhoenix Memorial has purchased. "I've surveyed them, asked them whattheir needs are, and introduced the cancer program to them," she said."Obviously, I'll have to continue doing that to nurture the relationshipand the referrals."

One of her biggest challenges, she acknowledged, was breaking old referralpatterns and encouraging the hospital's primary care physicians to continueto 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 patientsget the best care in the age of managed care.

"A major job is to work with primary care physicians and with patientsto advocate for those patients," she said. "As managed care movesinto Medicare and Medicaid, you have a very vulnerable population. It isso 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 specialtywas always depicted as old men in a room drawing pictures on x-rays, andwe still have a lot of people who think that is radiation oncology,"said Kathryn L. Kepes, MD, of the Brandon, Fla-based Center for RadiationOncology. "We have to emphasize the word oncologist and that radiationis just part of what we do."

For oncologists in private practice, a key to success is often how welltheir 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 seminarfor primary care physicians on breast cancer screening and examination.

"I don't think the majority of those primary care providers hadever seen a radiation oncologist," Dr. Hunter said. He also notedthat military medicine "is going to an HMO-like system."

Old-Fashioned Civility

Thomas A. Paivanas, director of integrated delivery systems, ELM Services,Inc., Rockville, Md, stressed that regardless of the degree of managedcare penetration in a region, strong personal and professional relationshipsbetween 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 referringphysician's confidence in the specialist's professional competence. "Physicians,like any other group of busy professionals, tend to gravitate toward certaincomfortable patterns," he said.

In this increasingly impersonal world, a little old-fashioned civilitycan make all the difference, he said. An oncologist's availability, forexample, is often a key to referrals. "If I can get you on the phoneevery time, I'm going to refer patients to you," Mr. Paivanas said.He offered a list of things oncologists should consider to help them becomethe primary care physician's oncologist of choice:

How to Improve Your Relationships With Referring Physicians

From a presentation by Thomas Paivanas.