Spine surgeon referrals are crucial to building their business and patient base. Two surgeons discuss the factors that make or break these connections.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, April 21.
Editor’s note: Responses were lightly edited for clarity.
Question: What does a referral relationship that actually works look like in practice? What kills one?
Gbolahan Okubadejo, MD. The Institute for Comprehensive Spine Care (Englewood, N.J.): A good referring physician trusts you not just with the case, but with their patient, and they’ve seen enough of your outcomes to justify that trust. Communication is fast and direct, meaning they hear back from you before they hear back from the patient. You return patients to them after surgery instead of absorbing them into your own practice. That return matters more than most surgeons realize, it signals that you see yourself as a consultant, not a competitor. The strongest referral relationships also tend to involve a mutual respect for each other’s lane; they don’t second-guess your surgical decisions, and you don’t undermine their ongoing management.
It also helps to understand what the referring physician actually wants from the relationship. Some want detailed clinical updates at every decision point, while others want a clear return plan, and nothing more. Some appreciate a phone call after a complex case, while others would much rather have everything in writing so it lives in the chart. Getting that wrong in either direction creates friction. For example, over-communicating to a physician who finds it patronizing is almost as damaging as under-communicating to one who needs the detail to manage the patient confidently on their end. Figuring this out early, often just by asking directly in the first few interactions, tends to build referral pipelines that are remarkably stable over time. Most of the time, the physicians who send you the most patients aren’t always the ones who like you best or share your training background or run in the same professional circles, they’re the ones who’ve learned, through repeated experience, that working with you makes their own practice easier, not harder. That reputation, once established, tends to travel well.
The relationship breaks down when the surgeon treats the referral as a transaction rather than a partnership. Some surgeons don’t realize that the physician who sent the patient is still watching, still asking that patient how things went, and quietly keeping score. Ego is another common killer; if you’re difficult to reach, dismissive in your notes, or condescending in how you communicate, most referring physicians won’t confront you about it, they’ll just quietly stop sending referrals. The geography of your practice matters too. If you’re hard to access, require excessive paperwork, or make the referral process administratively painful, even a loyal source will eventually take the path of least resistance to someone easier to work with.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The best referral relationships I have are with primary care physicians and physiatrists who trust me to tell their patient the truth including if surgery isn’t the answer.
That’s the foundation: a referring physician has to believe that when their patient comes to see me, I will not manufacture an indication. The moment they sense I’m operating on everyone who walks through the door, the relationship changes. They stop sending the nuanced cases. They start sending only the ones where surgery is obvious, and those cases don’t need me.
In practice, what works is communication and intellectual honesty. I call referring physicians after complex visits. I explain my reasoning when I recommend against surgery. I send them notes that are actually useful, not three-page cut-and-paste templates. I acknowledge uncertainty when it exists.
What kills a referral relationship? A few things, in my experience: operating on a patient the referring physician knew wasn’t a surgical candidate and not having a clear explanation for why. Taking a long time to see urgent referrals. And perhaps most underappreciated — making the referring physician feel irrelevant after the handoff. Patients come back to their PCP. If that physician feels bypassed or kept in the dark, the relationship erodes quietly.
The best referral relationships feel like a team. The worst ones feel transactional. You can tell the difference within a year.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Like all relationships, both socially and professionally, reliance on designated or a group of specialists is based on dependable availability, sound judgement and proven outcomes. Most, if not, all primary care providers are indifferent to surety backgrounds, and patient-disease-focus coupled with referral expedience sets the neurosurgical standard of care delivery. More acute cases rely on responsiveness to urgency and inter-communication in the form of follow-up and aftermath. What stifles any relationship are delays or breaches in these fundamentals of intercommunication or care-refusal based on insurance indiscretions. Choosing payment over disease, especially of late, has become more noticed and deservedly adjusted.
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