Hospital Consults: A Satisfying Practice Builder

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
Mountain View Medical &
Surgical Associates,
Madras, Oregon

When building a practice, many new physicians may think first of mailing advertisements and meeting referring doctors, or perhaps word of mouth. As important as these sources may be, an unconsidered referral source for many is the hospital consultation. For those of you who enjoy office practice I’d like to recommend expanding your practice to include hospital consultations. The benefits are manifold and more than outweigh the disadvantages.

Practice building. Performing consultations in the hospital exposes you to a potentially large source of patients for your office practice. These are the nurses, students, orderlies, techs, assistants, and other members of the hospital staff that often suffer from foot and ankle problems. Every person you meet while performing a consultation is a potential patient. Keep in mind they have children, parents, and friends who also may require your services. Additionally, the physicians you perform the consult for has – in most cases – an outside practice with a large number of potential referrals. Performing a comprehensive consultation displaying your clinical acumen will lead to more office referrals. Finally, many consultations may lead to surgical procedures and the fees that come with them.

Intellectual interest. Many hospitalized patients will have a range of complex medical illnesses and lower extremity pathology. I’ve been lucky enough to treat a variety of pathologies from nail fungus and gout to severe diabetic limb salvage cases to emergent trauma patients. By simply reviewing orders you can stay current with treatments of other disorders. When time permits I’ll read through other consults simply to see how other specialists treat pathology. The opportunities to interact with other specialists and continue learning abound.

Chance to significantly affect your patients’ lives. These are often very sick people who will benefit greatly from your interventions. The satisfaction that comes with salvaging a limb, repairing a fracture, or treating a limb or life-threatening infection is a great benefit of practicing hospital medicine.

The disadvantages. When I was a student, one of my trainers said, “Pus doesn’t take holidays.” That’s absolutely true. I’ve spent many nights in the OR treating patients when I could have been home with the family. Consults are not part of the 9-5 office schedule. If you can’t live with this fact then don’t do hospital consults. I would guess, though, that the majority of us understand this and became physicians in spite of the hours. It’s also possible to receive consultations on patients with poor or no insurance. I accept all consults that are requested of me whether the patients are insured or not. I present it as a courtesy to my attending physicians, though I try to keep this as much to a minimum as possible.

Recommendations. Here are some suggestions to build the hospital side of your practice.

If you’re not already, get on staff at your local hospital.
Visit the hospital, focusing on patient floors and nursing. In many hospitals the charge nurse is responsible for calling on the consults, and they choose who gets called. When I practiced in Michigan, the attendings would order “consult podiatry,” and the charge nurses would call me since they knew me well.
Bring a brochure about your practice to educate the nursing staff. Include convenient contact information and your pager.
As part of your marketing plan, inform your physician referral sources that you are available for hospital consultations.
Take the bad with the good. You may receive toenail consultations, but do them in the same comprehensive manner you would any other consult and with a positive attitude. Don’t come across as arrogant by taking only the “cream.” Your referring physicians will appreciate the help. Consider it also as another opportunity to gather more patients. Remember, that toenail patient has a family.
Respond as rapidly as possible to a consult request. For example, I tell my docs that I’ll do same day consultations on emergent in-house issues (diabetic wounds, etc) and within 24 hours for nonemergent issues (onychomycosis). I’ll respond quicker when time permits.
When you see a patient in the hospital, educate them on their problem. Show them you are the best at what you do, and they will follow-up with you after they’re discharged.
Consider carrying a medical bag with basic supplies and instruments. You’ll save time by not having to search out supplies on the floor.
Call ahead to the floor when you’re coming to see a patient. They may be unavailable at other tests or procedures.

For those of you who spend time in the hospital, what tried and true methods work for you? For those who stay away from the hospital, what concerns or issues keep you away?