San Diego—When a veteran gastroenterologist summarized his principles of success, one of the main points he made sounded remarkably like the golden rule—that gastroenterologists should not only treat their referring physicians with respect, but that the same degree of respect should be conferred to nurses, physician assistants and anyone else who can play a role in marketing the physician’s good will.

“Here is a key question: What is the most important quality for a physician to thrive? Is it ability, availability or affability?” asked Mark Fleisher, MD, a gastroenterologist at the Borland-Grover Clinic in Jacksonville, Fla. “This is not on the Boards, but it is crucial to a successful practice,” he said.

After giving his audience a chance to ponder the issue, he revealed, “The most important is affability. The least important is ability. Success is not correlated with your SAT score. Referring physicians don’t ask for your CV. What you will learn is friends like to work with friends.”

Don’t Sell Yourself Short

While acknowledging his advice may be “seemingly trite and hackneyed,” Dr. Fleisher stressed that physicians need to recognize that their job, like the majority of jobs, requires selling at some level.

“Basically, you are selling yourself. You don’t have to sell out, but you are selling yourself,” he said at a symposium on developing a successful private practice at the 2008 Digestive Disease Week meeting. This involves creating good will through your patients, your colleagues and other members of the health care team.

“If you are nice to your neighbors, they talk about you. The word spreads. It is the same thing in your practice. Your patients, the nurses on the floor and your colleagues are your best advertisements,” said Dr. Fleisher, who emphasized the importance of treating every colleague with respect. He specifically named nonphysician colleagues. “Remember, you do not send them business—they send you business. Treat them with respect. Sell yourself to them. They can help you.”

Don’t Take Relationships For Granted

Building a practice can be time- consuming, but the principles are simple, according to Dr. Fleisher.

“It is all about building relationships. That is all it is.”

As an example, he suggested that gastroenterologists should not be dismissive of a simple case of reflux referred by another physician. By taking the case without hesitation and assuming a problem that your colleague did not want to address, “you bank more than money, you bank good will,” Dr. Fleisher said. “Banking good will means that when that guy has a problem again, he is going to call you, because you were nice.”

Don’t Be All About the Money

Financial success is likely to be high on the list of things that define a successful practice, but Dr. Fleisher suggested that a narrow focus on the financial aspects of a medical practice can be counterproductive. A successful practice will be financially remunerative by definition, “but if the only thing you crave is financial success, you will not be successful. If colleagues sense you are in it only for the buck, they will not send you business.”

Dr. Fleisher suggested that physicians need to cultivate concepts of success beyond financial gain, such as professional satisfaction. Overall, he said, income is unwisely divorced from other issues, including an ethical or moral sense of duty.

“Do not wait for financial success to be charitable. If you are charitable, it will lead to success. If you wait to be charitable, you will not be successful. People will see you are in it just for the dollar.” For example, he said, treat the uninsured patient “the same way you would treat Bill Gates.”

Don’t Miss Opportunities

Despite the stresses of managing a busy medical practice, Dr. Fleisher suggested that physicians should not forget that they have a privileged life—privileges that were earned through succeeding in the rigorous training inherent to the practice of medicine. In turn, this should generate a great sense of accomplishment that comes from being “incredibly well trained and part of the top 1% of individuals on the planet for intellect.” With this confidence, physicians are in an excellent position to sell their expertise.

However, Dr. Fleisher said, gastroenterologists need to seek opportunities to be the expert in order to establish a reputation. Pharmaceutical industry dinners for an audience of referring physicians, pharmacists, nurses or physician assistants are an example.

“After the dinner, you may get a curbside consult in which you give your advice for free, but this audience will remember you. You are the expert, and this will pay off down the road.” At a drug industry–sponsored dinner, it is important “to keep your integrity and keep your self-esteem, but do not stop selling yourself. These are opportunities.”

Go the Extra Mile

Dr. Fleisher also urged gastroenterologists to exceed expectations. Although this is hardly a revolutionary concept, he said that it is a commonly overlooked business principle. Examples include returning phone calls quickly, or taking extra time for a patient who needs reassurance. Seemingly minor favors and courtesies often pay off. Dr. Fleisher recounted a story in which he took uncommon steps to see a patient immediately when a colleague was concerned. The gesture was remembered, and the physician has been a major referral source ever since.

Love Thy Neighbor

“Love thy ER,” Dr. Fleisher also advised. The emergency department is a rich referral source for a cooperative physician. “Take the complicated ER patient. This is your chance to make friends, because you will need to call in several other specialists to handle the multiple problems. If an ER calls with a problem, do what you can to help. If not, the ER may never call again, and you will not see your practice grow. Once you say no, that faucet will close, and these faucets can be very hard to reopen,” Dr. Fleisher warned.

Be Compatible

Just being easy to get along with is an important business tool. Citing a colleague who is a tedious complainer and whom he avoids whenever possible, Dr. Fleisher emphasized that physicians, like others, are influenced by compatibility. He reiterated that “no one wants to work with someone they do not like. It is very simple.”

Referring to his annoying colleague, he said simply, “Do not be that guy. Be fun. Be pleasant. Chase the right carrot. Happiness leads to success.” Noting that physicians have already passed the hurdle of medical school and “are already by sheer definition successful,” he said that the main goal is to preserve this success by being cooperative.

Great Free Advice

This is “the best free advice I have heard since I was a fellow,” commented Colleen M. Schmitt, MD, chair of the symposium where Dr. Fleisher made his presentation and chair of the Health & Public Policy Committee of the American Society for Gastrointestinal Endoscopy.

Dr. Schmitt added her own anecdote about a physician who berated a nurse who dared pose a question by retorting, “Do you know what my time is worth?” Dr. Schmitt, who practices with the Galen Medical Group in Chattanooga, Tenn., explained that this physician, who was in the process of trying to develop a referral practice, was actually sabotaging his own success by such behavior. Although being accommodating is an obvious approach to creating the successful relationships required to build an effective practice, it is lost on some individuals.

“Your colleagues in medicine are your best resource,” Dr. Fleisher said. “Treat them nicely, honestly and respectfully. It will pay you back.”