While co-management has been around for some time, the field of refractive surgery has brought it to new levels. Co-management may not be essential for you to succeed. But it becomes more important if you want to increase the volume of your procedures.

When co-management succeeds, it’s because a system is in place that provides better and more convenient patient care. Most patients have routinely gone to their optometrists for contacts and glasses and have built up a relationship based on familiarity and trust. Patients find asking optometrists about refractive surgery much easier, because they perceive no bias on the part of O.D.s.

The refractive surgeon knows that, for every procedure he or she performs, at least five postoperative visits will be needed. If a surgeon does 200 procedures per month – and there are many surgeons who double that amount – 1,000 exams are required. Optimal patient care is unlikely in this situation, because no surgeon would have enough time to answer all patient questions adequately. By involving the primary care physician, patients can get more time dedicated to them for questions and exams, without using too much of the surgeon’s time.

As Harvey Mackay suggests in his book "Dig Your Well Before You’re Thirsty," it’s important to have a network in place before you expect to use it to grow your referrals. This network must be built on trust and mutual respect. It must have a consistent value system in place. For example, if your goals are patient care and the co-managing doctor’s goals are to make sizable amounts of money, the relationship will never work. Nurturing an optometric network takes time and energy. Time is required to educate the optometrists, discuss why you should work together and demonstrate the benefits of a relationship.

Optometrists will expect something from the relationship: benefits such as growth of the optometric practice, effective answers to common questions, literature and educational material and help in positioning their practices for success. The surgeon must involve the co-managing doctors in decisions, ask them what they need to succeed and then be prepared to help them achieve their goals.

Once the reasons for co-management are clear, you are ready to create the network.

Many conservative optometrists will only adapt to co-management – particularly in the area of refractive surgery – when it’s so late in the game that they have no other way to survive. You’ll find little benefit in applying your resources to doctors like this. So how do you know who will reward you for building a relationship?

You need to find optometrists who believe in the procedure they’re co-managing, or at least who’re willing to learn more about it. No physician can refer a patient for a procedure he doesn’t believe in without the patient sensing that something is wrong. The doctors who believe in it will mention it to patients or have employees who will mention it. They will have come in to see you perform the procedure and may have observed some postoperative exams. They will have become educated or asked to be educated. They will have staff who have had refractive surgery or, better yet, will have had the procedure themselves.

If you do not already know optometrists who possess these characteristics, then you need to be involved in the process of educating them and their staffs. I suggest an evening class, about 2 hours, including a dinner. If possible, get continuing education credits for the class.

Also, you should spend time at the co-managing doctor’s office. Get to know him in his surroundings and use the opportunity to explain why you believe in refractive surgery.

The best referring practices tend to be group practices. They’re usually progressive; that is, they have up-to-date equipment, computers, use the Internet, etc. You can tell they are motivated because they have full therapeutic licenses. They track their growth and success, and can even tell you how many patients they have referred this year. You are essentially looking for good practitioners with great patient skills and a business sense. Just like putting together any team, you should try to get the best.

Co-managing optometrists are advocates for their patients. They want their patients to go to the expert, so it’s important to establish yourself as that expert.

Besides offering education, you can increase your credibility by publishing in prominent journals – especially optometric journals. Your communication skills should extend to speaking; referring optometrists need to have confidence that you can answer common questions effectively.

Consider creating an optometric advisory board, which could convene with a dinner meeting on a monthly or quarterly basis. Ask this board what you can do to make things better for their practices. You will find the information extremely valuable. And as you help them succeed, you can’t help but succeed along with them.

Begin to think about referring your patients. If you have a patient who lives close to a prospective co-managing optometrist, you might have the patient follow up with that doctor. This is a very effective tactic; you have taken a proactive approach and actually put a patient in the optometrist’s office. After all, the system you put together needs to be a two-way street to succeed. This one step quickly displays your desire to work together.

You should be available to provide refractive surgery to the doctors and their staffs. It’s a lot easier for the co-managing doctor to recommend you to his patients by saying, "This is where I had my surgery done." The co-managing doctor will have a very easy time selling both the procedure and you as the surgeon if you’ve performed his or her own surgery.

One important step to "becoming the expert" is a Catch-22 for new ophthalmologists. Optometrists want to send their patients to someone who is experienced. This might require some creativity on your part in finding the positives that exist. For example, if you’ve completed a fellowship, you can say that you dedicated an entire year to training in the field and that you were involved in X number of procedures. Simply emphasize whatever training and experience you have. If your staff believes in you, it’s amazing how few patients question your experience.

The co-management flow process is the last step to develop. Optometrists who co-manage want a simple and convenient system for sending patients through the process – from open lines of communication when patients are asking questions to simple forms, contact names and numbers, not to mention an easy plan to follow.

The co-managing doctor needs someone to call for quick answers to questions. The system should be as simple as making a single phone call or faxing patient information. Someone from your office should take care of scheduling, contacting the patient and telling the co-managing doctor’s office when the surgery will be and when he should plan to see the patient again.

The forms should be easy to follow. You can even mimic the co-managing doctor’s forms to keep communication of important information consistent. Any creative idea to make the process convenient and easy will assist in enhancing optometric referrals. A well-designed process further establishes you as the expert.

Setting up a good network will create opportunities for the future, as new procedures develop. For example, a well-maintained network will produce new co-management opportunities whether you decide to offer phakic intraocular lenses or oculoplastic or cosmetic procedures.

The key to your success in co-management is to help the co-managing doctor succeed. By directing attention to education, staff involvement, an easy and convenient process, and responsive communication, co-management will enhance their practices, your practice and, most important, the care of your patients.