Growing an interventional oncology practice presents challenges and takes deliberate, focused work beyond the medical expertise honed in training. Ezana Azene, MD, PhD, recently offered advice on this topic at the recent Society for Interventional Oncology meeting in Austin, Texas. Dr. Azene, an interventionalist with Gundersen Health System in La Crosse, Wisconsin, answered questions about how best to nurture relationships, identify problem areas, and market effectively.
What are some of your top tips for growing your practice?
It’s absolutely critical to work on yourself before growing your practice, and this includes knowing how to speak the language of oncology. An understanding of the natural course of the disease, how cancer is staged, and first- vs second-line treatment will help you to be taken seriously by other cancer care providers. You must remain aware of new guidelines in the field, especially the NCCN guidelines, as these are updated frequently. Also consider reading the informative discussion sections of the relevant NCCN guidelines.
What are some other areas of practice development that could be improved?
There are some areas of practice development that seem obvious but are often not done well. For example, showing up to tumor board is important but won’t be effective unless you engage in conversation and prepare in advance. Also, some physicians will give presentations to build their practice but don’t put much time into preparing them. A boring presentation can be worse than no presentation. Finally, sometimes the IO clinic is in a procedural setting, which is usually not ideal.
Tell me more about the importance of the clinic setting.
Patients have certain expectations for an office visit. They expect a comfortable waiting room with seating, and a private, quiet area to meet the doctor. Many IRs set up their clinic in the same place where they see their patients for procedures. This is usually an acute care hospital environment where patients may unexpectedly encounter emergency situations and hospitalized patients that can make them feel uncomfortable. Additionally, hospitals tend to be sterile and unwelcoming in terms of décor, with bland colors, no pictures on the wall, etc. The hospital is not a patient-forward area. It's where we work. It's not designed to meet patients and try to develop relationships.
How should IRs approach relationships with referring physicians?
Some IRs don’t have a fully clinically IO practice, so they’ll receive a referral, do a procedure, but leave all the pre- and post-procedural management of medications and similar considerations to the referring physician. This is extra work for the referring physician. When a physician refers to another physician, the new physician should be responsible for the patient care.
This means that you should do the work-up, treat the patient, and manage the patient afterwards. Many of these patients also require long-term follow-up with their interventional oncologist, sometimes for years. The referring physician shouldn't have to do anything more than send you the patient and accompanying clinical documentation. You take care of the rest. If you’re going to have a clinic, then do it well. Go all in on it.
Do you have any other advice about building relationships?
Health care is a relational business. Your success is determined by the relationship you have with your patients, your co-workers, your staff, and referring physicians. If any of those relationships sour, you fail. It’s important to focus on developing good, productive, collegial relationships with referring physicians because a good relationship breaks down barriers. Colleagues trust you and are more likely to refer patients. And if there is a problem, your colleagues will be more likely to give you the benefit of the doubt.
These professional relationships are like any other relationship in life. You build them by focusing on the needs of the other person and putting their needs above yours. As an interventional oncologist you need to go to your referring physicians and say, "How can IR better serve you? Do you feel that the access to port placements is sufficient? Is our quality good enough? Do you feel like you understand the services that we have to offer well enough to explain them to your patients and know when to refer to us? How can we do a better job of helping you take care of your patients?"
When you approach people that way and start to address all those issues first, you will start to see a difference. Keep in mind that many of the areas of need are not going to be glamorous, such as helping referring physicians by obtaining better biopsy samples or scheduling port placements on the same day as surgery or the start of chemotherapy for patient convenience.
These efforts make a big difference to the oncologist and to the patient. Taking a patient-and-referring physician-centered approach will buy you the support of your colleagues when you later approach them about growing your embolization practice or ablation practice. Colleagues will respect you, like you, and know that they can trust you because you’ve been taking good care of both them and their patients. And then you’ll grow from there.
How did this approach play out in your personal experience?
When I finished fellowship, I was all about growing my IO practice. That was my focus. I didn’t start with a focus on developing relationships and serving my colleagues and their patients. I think some of my colleagues interpreted this as an attempt to make them take care of cancer patients according to my priorities and training. That approach was not well received, and I quickly reversed course and focused on the needs of my colleagues first. That's also what I've done in my role as a chair of the Gundersen Cancer Advisory Council. I haven't done any interventional oncology-related projects or initiatives in the year and a half I've been in that position. All my effort has been focused on addressing the needs of the patients, medical oncologists, radiation oncologists, and surgical oncologists. I do this primarily because they see many more cancer patients than I do. However, I also know that by addressing their needs first, they will be more willing to help when the time comes to address my needs. This could be months or years down the line.
What are some marketing strategies that have been effective?
It is easy to lose sight of the need for marketing after coming from a training program where the practice is already built, patients are coming in, and it’s hard to keep up with demand. We aren’t exposed to the marketing that was done to get those patients and maintain those referrals, so we end up thinking, "Well, the patients will come. Why do I need to worry about marketing?" It’s very helpful to have a trained marketing professional to help you develop a strategy and allocate resources to the correct marketing method.
People instinctively market with TV and radio, but I’ve found that brochures given to patients and their families are more effective. If you think about it, that approach makes sense for interventional oncology because most direct-to-patient marketing for IO, in my experience, doesn't work quite as well as it does for other diseases, such as varicose veins. People with cancer look to their oncologist for what to do next, especially in the early stages of the disease.
Interventionalists usually see patients in the beginning of their disease when we are biopsying the cancer to make the diagnosis. If patients take an interventional oncology brochure with them from that encounter, then that brochure might become a conversation-starter with their cancer provider during a discussion about next steps. It’s important to never push interventional oncology services without involving the primary cancer provider, who is usually a medical oncologist. We are making the information available and leaving the conversation and decision to the patients and their oncologists.
What are some simple but effective tips in terms of marketing?
Pay attention to the phone number you have listed on your website and literature. I recommend being your own “mystery shopper” and calling the number yourself to ensure that patients are reaching the proper people and getting accurate information. For example, in our practice, the number we put on our website is the number to our IR schedulers who know everything about our offerings and process. They schedule both our procedures and our clinic. If the patient calls them, they know what to do.
For IRs who are self-assessing their performance, what are some red flags?
A big red flag is if your practice isn't growing. One of the first questions you need to ask is, “Am I doing something wrong? Is there something wrong with the way I'm developing relationships?”
It’s also important to seek patient feedback. All of our patients in IR fill out customer satisfaction surveys, and we take those seriously. After developing a relationship with a patient, it is also worth considering asking the patient directly, "What do you think about the care I've provided for you over this period of time? How can I be better? Are there any shortcomings you think I have or things that you wish were different in our system?"
Honestly, I haven’t incorporated those types of questions into my practice yet because it’s a concept I only recently discovered. Some patients might not say anything, but I think a significant percentage would give an honest answer. To help encourage honest answers, I will likely take the opportunity to point out something that I already know is a problem. I’ll tell them that I know we have a problem in a certain area, ask if they are bothered by it, and tell them we’re working on it. Then I’ll move onto the main question: “Are there any other problem areas similar to the one we just discussed that we could do better with?” With that approach, the patient will see that you truly care about the answer to the question.
Any other key tips?
Identifying personal areas of strength and weakness is often difficult, as many people are not naturally inclined to be introspective and self-critical. That’s where having an honest friend or mentor helps. They can help you identify areas of weakness and opportunities for improvement.