How Trainers Generate Client Referrals From the Medical Community
As United States senators are inching closer toward agreement on the nation’s health care reform bill, many fitness professionals still struggle to find acceptance by doctors to be seen as part of the healthcare continuum.
The barriers are high: Unlike in medicine, the fitness industry lacks a well-established standard of care, an evidenced-based protocol for treating patients turned fitness clients, a universally accepted foundation for training, program design, assessment, and so on.
At the same time, most doctors would agree that the nation’s alarming obesity and overweight rates and their associated healthcare costs make fitness professionals an integral part of the healthcare solution.
With 34 percent of Americans being obese and 32.7 percent overweight, the real problems of linked medical conditions, such as high blood pressure, diabetes, cancer and heart disease will likely only worsen without some type of intervention. Early detection and dietary interventions can only go so far. The government physical activity guidelines indicate that exercise may be the missing link for most Americans.
Given the need by the medical community to embrace fitness professionals and the supply of trained ACE-certified fitness professionals eager to fill that void, ACE consulted Dr. Steve Green, chairman of the department of family medicine at Sharp Rees Stealy Medical Group in San Diego and Dr. Nancey Tsai, assistant professor, neurosurgery, Medical University of South Carolina and an ACE-certified Personal Trainer, to discuss their requirements for patient referrals, best ways to introduce yourself to doctors and how to develop an ongoing rapport.
Tsai and Green agreed that most physicians are trained to think in terms of medicines and procedures rather than empowering patients through activity.
“I might be one of a handful of physicians at my medical school who routinely asks about patient exercise habits and advise them to follow government recommendations for exercise,” Tsai said. She added, “Most people don’t realize that “eating less and moving more will go a long way.”
Green is among the majority who has yet to refer a patient to a trainer. Behind his reasoning, however, is not an inherent bias against the fitness industry as Tsai feels is the case with many doctors. Rather, he attributes this to a lack of knowledge about trainers’ abilities in the medical community.
A competitive ultra-distance swimmer and coached athlete himself, Green said he isn’t opposed to the idea of referring his patients to a fitness trainer at all.
“We all have the same goals,” Green said. “I can give them different things (to do), but that’s probably not as effective as what a trainer could do.”
For him, it’s a matter of overcoming barriers.
Who pays?
For one, there is the money issue. In general, insurance companies do not reimburse for exercise sessions with nonmedical professionals such as personal trainers. Clients need to pay out of pocket for most services. This is a critical issue for doctors and their patients.
“Money is always a barrier,” Green said. “People just resist to pay for things and while some people would be willing to pay for this service, others wouldn’t.”
Also, trainers shouldn’t assume that doctors and patients realize that their service is an out-of-pocket expense, and thus, create awareness early on to avoid misunderstandings. Green said it is not uncommon for patients to walk into the doctor’s office and request a prescription for infomercial products or advertised alternative medicines he knows would never be reimbursed by their insurers.
Green suggests that trainers disclose their hourly fees early.
“I would want to make sure that my patients wouldn’t have to pay a lot upfront and at the same time I would need to be convinced that my patients would truly benefit from the exercise program,” he said.
Credentials and Education
Secondly, trainers need to persuade doctors that they are truly competent and responsible in their interactions with patients.
For Green, a degree in an exercise-related field is not a must. But he would want to see a certification from a nationally accredited organization and experience in training individuals with health conditions, if they chose to work with that population.
“I also would want to know about their approach and how they handle things physically and financially and what went into their education,” Green said.
For Tsai, training in dealing with specialized populations, is a minimum requirement.
“If there are many medical challenges, it is helpful if they have other credentials, such as being a nurse, a personal trainer or an emergency medical technician,” Tsai said.
Advanced Health & Fitness Specialist Certification
ACE specifically developed the Advanced Health & Fitness Specialist (AHFS) Certification to allow fitness professionals to collaborate with the healthcare community. AHFS trainers can demonstrate to the medical community that they have gained the technical and practical know-how to work with individuals who have disorders, diseases and injuries, detailing etiology, case studies and specific exercise and programming guidelines. In addition, the AHFS is competent in providing basic nutritional guidance within the scope of practice.
Green believes that healthy eating and fitness should go hand in hand.
“For me it’s really important that a trainer can not only provide an exercise regimen, but also help my patients with their diets,” Green said. At the same time, the AHFS needs to spot the signs of eating disorders and know when to refer patients back to their doctors or an appropriate allied healthcare professional.
Both doctors agree that fitness professionals are instrumental in helping bridge the healthcare continuum gap, especially regarding overweight and obese patients.
Said Tsai, “Left up to me, everyone with a body mass index greater than 30 generates an automatic referral to exercise.”
She would also refer patients with metabolic syndrome, back pain and heart health issues.
Green believes that most of his patients would also benefit from working with a trainer.
“For someone who hasn’t exercised, they really don’t even know how to get started and need help with the basics,” he said.
How to Build Rapport
Getting face time with doctors, or even physical therapists, who are also good candidates for patient referrals post-rehab, can be challenging for fitness professionals.
Doctors have little time to spare, so having a smart approach is key.
Green’s advice: Don’t call to try to schedule a meeting.
“I wouldn’t commit to it,” Green said, which reflects the likely sentiment of most physicians. Instead, he proposes that trainers send a one-page letter listing the following criteria:
- Objective: Start by telling doctors what you can offer their patients rather than listing credentials that sound like a selling point.
- Inform doctors that your services are not covered by health insurance
- Describe your work experience
- List credentials: Educational background, certifications, and specialty work
First Meeting and Building Rapport
Most doctors would want to meet the trainer face-to-face before referring their patients.
“It’s always best, if it is someone you know personally,” said Tsai about referring her patients to trainers.
Impress the physician by taking him or her through a workout session and offer suggestions for modifications during the various stages of health, she said.
Once you’ve gained the doctor’s approval, communicate your clients’ progress.
SOAP Notes
SOAP notes are an effective way to communicate with doctors. SOAP is an acronym for subjective, objective, assessment, and plan. SOAP notes offer an efficient way to communicate what the client feels and the trainer observes in the process of achieving stated goals.
Tsai likes the idea of receiving SOAP notes, because they offer clear and concise communication.
Trainers should always ask physicians how often and via which outlet to contact them. Green, for instance, would prefer corresponding with trainers via fax.
“This would allow me to look it over when I have time,” he explained.
The Healthcare Dilemma
The big elephant in the room, according to leading healthcare experts, when it comes to the national healthcare debate, is Americans’ love affair with fast-foods, all-you-can-eat buffets, and cheap junk foods.
Michael Pollan, a contributing writer for The Times Magazine, recently quoted a study that showed that the U.S. spends twice as much per person as most European countries on healthcare, mostly for one reason: “By our being fatter.”
Pollan stated that the U.S. spends $147 billion to treat obesity and $116 billion to treat diabetes, and hundreds of billions more to treat heart disease, which are all linked to diet.
Behavioral change toward healthier eating and regular exercise would go a long way toward curbing the nation’s healthcare spending and toward creating a healthier and more physically active society.
This leaves the window of opportunity wide open for trained ACE-certified fitness professionals wanting to make a meaningful and lasting difference.
Marion Webb is the managing editor for the American Council on Exercise and an ACE-certified Personal Trainer and ACE-certified Group Fitness Instructor. For specific fitness-related story ideas or comments, please e-mail her directly at marion.webb@acefitness.org.
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