Your clients love you. You have all the necessary degrees and certifications. You have experience with special populations. So why isn't every doctor in your zip code referring you clients every single day? Aren't these physicians aware of the abundance of research studies that support the benefits of exercise in prevention and mitigation of multiple lifestyle-related medical conditions?

You might find yourself asking these questions if you are currently working with special populations or seek to work with this expanding market. And from the perspective of the health and fitness professional, they seem like legitimate questions. As exercise professionals, we believe that everyone should include exercise as part of their lifestyle, and although your local medical community may not be referring patients to you, it's likely they believe it too.

The problem with this approach to working with the medical community is the question we are asking. We should not be asking "why" isn't the doctor referring. We should be asking "what" does the doctor need to feel comfortable referring.

I faced this dilemma myself many years ago. It boggled my mind that physicians in my geographic region didn't request a shuttle bus to pick up all the referrals they had for me. To me, my credentials and experience were stellar, and their referrals should be automatic. That is, until the day I met with one of my client's doctors. In walked this gentleman in his mid-50s, overweight and breathing heavily from his walk down the hall to the examine room we were in. I handed him a card, and he looked at it. Then he asked me what all the letters after my name meant.

After I proudly explained my credentials, it was obvious he was not impressed because all those letters after my name meant nothing to him — he had nothing to compare them to. It was then and there that I realized that getting referrals from the medical community was not about me, it was about meeting the needs of the medical community.

Only after I was able to relate my education and experience to the needs of his patient (my client) was he interested in exercise as a modality. And by further querying the doctor on what he would like to see improve on our mutual customer, he began commenting on other patients that could benefit from the philosophy I was applying to this client.

The Doctor-Trainer Relationship
As an industry, we must keep in mind that we are still only in our adolescence and that we are a fragmented profession. Very few outside of our industry know the difference between certification "A" and certification "B." And to some, our industry still carries the stigma of celebrities-turned-fitness experts and steroid or surgically enhanced role models with no education behind them.

Therefore, some in the medical community may feel the risk of referring to a personal trainer is greater than sending the person home on their own. If that medical professional were to refer to you, he or she would be directly endorsing your services. You now become a continuance of their care. Any good you do looks favorably upon them, but anything you do wrong or harmful comes back to them as well.

After more than 13 years of working with medical referrals, I have observed some characteristics of physicians that refer their patients to exercise programs and have those patients follow through with the referral:
  • These physicians are active themselves and live the benefits of exercise.
  • They provide their patients with detailed instructions on the need to enlist an exercise professional to assist them and provide them with the professional's contact
    information.
  • They take an active role in providing input to the exercise professional on the patients' needs and contraindications.
  • They have an expectation that they will receive timely documentation of an initial assessment, plan and reassessments.
  • They follow up with their patients' progress at subsequent office visits.
  • We have also observed the type of
    physicians who do not refer patients to exercise programs:
  • These physicians may not present a healthy lifestyle themselves.
  • They are not well-versed in the exercise vernacular or exercise prescriptions and are therefore vague in their instruction or recommendations, or their lack of knowledge keeps them from approaching the subject.
  • They are unaware of the level of education and expertise many fitness professionals possess today.
  • They do not fully appreciate that barriers to exercise from the past will continue to be barriers to exercise if not addressed with the help of professionals.

Making the Potential Referral Source Comfortable
Marketing to the medical community is completely different from marketing to the general public. Doctors don't refer based on yellow page ads or brochures that come in the mail. Doctors refer based on relationships. Ideally, these are relationships you personally have with the referral source, but they can also be relationships formed through your clients and their doctors.

One of the first steps leading to referrals is identifying for the physician the type of client with which you excel. Medically referred clients are not healthy people looking for motivation; they are people with special medical needs that require a higher level of care. The referral source will be much more comfortable referring patients to you if you have an area of particular expertise that you understand thoroughly (i.e. hypertension, fibromyalgia, scoliosis, etc.). I work strictly with people with musculoskeletal challenges. If I received a referral from a physician for a client with diabetes, I would forward that physician the information of a colleague much better suited for that patient.

A second step is communicating the "how" versus the "what." A doctor is not concerned with the specific exercises you are going to do or what equipment you will use because these things are specific to a particular patient. If we share with them our procedures (e.g. "how"), they can apply that information to all patients they are considering referring.

For example, a medical referral source will be more comfortable referring to you if they understand:
  • How their patient will be addressed differently than an apparently healthy client. What precautions will you take? What strategies will you use to overcome barriers to exercise?
  • How you will communicate with their office. Will you get permission from the patient/client to share information with the doctor? Will you send regular evaluation and follow-up documentation to the doctor?
  • How your exercise prescriptions are developed. What assessments are used? What is your foundational philosophy?
  • How your progressions will be implemented. What variables are included in your progressions?
  • How you will remain within your professional boundaries. Can you state clearly what your professional boundaries are?

Provide this information before the medical referral source asks for it. Be proactive in addressing any concerns they have or that might arise. Remember that you, and not the doctor, are the expert on exercise prescription, but it is the doctor that is the gatekeeper to this patient's health care. As such, they have an obligation and a right to be comfortable and confident in any resource that they add to their patients' continuum of care.

Anthony Carey, MA, CSCS, CES, is the owner of Function First in San Diego, California, and the author of Relationships and Referrals: A Personal Trainer's Guide to Doing Business with the Medical Community and The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder and Joint Pain. For more information, visit www.functionfirst.com.

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