Practice in the Real World

Practice in the Real World

Ethics revisited: Lack of specialist referrals often has nothing to do with greed; it’s about pride
Aug 01, 2004

A Friday morning in December... Dr. John Parker sits at his desk in Springfield, USA. John is in his sophomore year of real veterinary medicine after spending the vast majority of his life in school rooms pursuing an education. His formal education ended two years ago when he finished his orthopedic residency at the University of Florida.

The real reason why veterinarians don’t refer more medical cases
John had always been good with his hands and as a teenager had spent several summers helping his uncle build houses in Ohio. During veterinary school this trait came in handy in junior surgery and his senior clinical training. This had ultimately led him to accept an internship at the Animal Medical Center in New York City. This, in turn, led to a residency in Florida and another four years of surgical training. The deferred loan account ballooned along the way and followed his progress in a long and whimsical tether. The balloon of debt followed effortlessly along until it finally came to roost in a nameless bank somewhere on the East Coast.

To John, this silent ghost was now more like a lead anchor.

John has always been a right-brained creative type and was at first daunted and finally left frustrated by the veterinary community around him in Springfield. His private orthopedic practice is simply not as busy and as a profitable as he thought it would be. He had spent the first year in Springfield at an emergency hospital where he and an older veterinary dermatologist worked the day shift. He had thought that referrals would flood in and his dream would materialize.

In his mind, the oral agreement he had made with the emergency clinic director never materialized, and he had left last year embittered by the experience. John's 12-month-old practice is in a good location in a storefront near a busy intersection in a growing section of the city. In fact, he is busy at time but the expenses and the ghost in the eastern bank weigh him down.

John sits at his desk and ponders the local veterinary community. Springfield is now almost 1 million strong and is mostly a white-collar community with lots of government services. Springfield also has developed a strong modern industrial on the north side of town. The veterinarians in the area number almost 300 and there are 90 veterinary hospitals listed in the Yellow Pages—more than enough to support an orthopod.

John had sent a notice to all the hospitals in the area that he was available by referral and would be available and would keep the originating veterinarian in the loop. So, this June, John had noted that only 20 of those hospitals had referred a case to him with about eight hospitals referring the bulk of those. John pondered the other 70 practices and wondered what the problem was.

John sits at his desk and sees in his mind 70 veterinary hospitals doing their own orthopedic work and declares it "unethical". This morning John has "nothing to do". He has some surgeries in the afternoon but this morning he is at his desk.

"This certainly is an unethical situation," John thinks to himself. His musing runs the gamut of emotions from frustration to outright anger.

John sits at his desk.

Springfield, USA Friday night Dr. Newton Rice laughed out loud as Nancy Stowers, DDS related another funny dental client story. Nancy and Newton were gabbing and yakking it up in Dr. Rice's expansive great room along with another 35 dentists and about a dozen more medical doctors from the area.

The kitchen and patio were spread with every morsel and drink that could be found by a favorite local catering service. Newton's wife flitted about serving and making sure that the gathering went smoothly. The house was aglow with the trappings of Christmas was now completely alive with gaiety and a feeling of goodwill.

Dr. Rice had thrown this gala every December for the past seven years as a Christmas party for the local dentists and a few selected medical docs that would or could refer Dr. Rice patients into his referral endodontic practice.

The annual event has grown over the years since Newton left his residency in Milwaukee. Newton is a gregarious and outgoing personality with a tribe of fiends in addition to his long list of referral clients.