Uterine fibroid embolization (UFE) is a minimally invasive approach to treating fibroids when compared to myomectomy or hysterectomy procedures. Endovascular approaches for fibroid treatment have gained traction as increasing evidence supports its use in most patient populations. In episode 10 of the BackTable podcast, Dr. Keith Pereira and Dr. Chris Beck discuss marketing strategies and ways to increase referrals when building a UFE practice.
The BackTable Brief
A large number of hysterectomies are performed annually for fibroids; educating patients and providers about UFE may lead to increased referrals to your practice.
Few contraindications for UFE exist, says Dr. Pereira - relative contraindications include:
-Younger patients who may want to become pregnant in the future
-Patients with submucosal or pedunculated fibroids
Work in collaboration rather than competition with OB/GYNs to determine which patients are best suited for UFE versus hysterectomy.
Dr. Pereira has used social media and television to educate the community and to increase awareness of the fibroid embolization procedure.
Dr. Beck says working with device representatives may be helpful to get the first few patients into your practice; reps can help put together informational pamphlets, lectures, or dinners to boost referrals.
Disclaimer: The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Increasing Awareness for Uterine Fibroid Embolization
In the United States, upwards of 200,000 hysterectomies are performed annually for the treatment of fibroids. With few relative contraindications, many hysterectomy candidates could be considered for fibroid embolization, yet patients and providers alike may not be aware of UFE as an alternative. Dr. Pereira emphasizes the importance of education about the procedure to ultimately build referrals to your practice.
… I found 180,000 a year or 30% of hysterectomies in the United States are performed for fibroids. In your opinion, generally what proportion of those do you think are better suited for UFE?
Things have come a long way. There have been a lot of papers coming out now. There are various new techniques that can be used; partial embolization versus complete embolization. There are techniques that can help for pregnancy. I think it's something that will evolve over the next few years regarding the pregnancy part of it.
The rest of it, there is almost no contraindication. Again, There is a myth that pedunculated fibroids are a contraindication. Yes, it is a relative contraindication, but not an absolute one. Again, submucosal fibroids which are along the inner side as a contraindication? I don't think it's a contraindication as long as I speak to the GYN and the patient, and she knows that this fibroid could slough out and they're aware of it. I think it's not a contraindication anymore……...Relative contraindication is a young woman who comes who may want to get pregnant.
… It's important to educate people to speak to their GYNs about this treatment option. Just bring it up because the moment they bring this up, a lot of GYNs are like, you know ... I've seen that. They say, "Oh, yeah, you want this treatment? Yeah. I'll send a referral to my closest vascular IR guy." I think it’s important to know your treatment options. SIR has been telling everybody, trying to educate people, know your treatment options.
Working Side-by-Side with OB/GYNs
Working in collaboration with OB/GYNs is an important way to increase UFE referrals, however, endovascular specialists should not rely solely on other physicians for this. Dr. Pereira suggests educating physicians about UFE through grand rounds and talks, so that UFE can be discussed as a treatment option with patients.
Okay. It sounds like your practice regarding UFEs has really evolved in recent years, but as for all of this, there's plenty of room to grow. As of now, where do the majority of your patients come from? If you could, specifically touch on your relationship with OB/GYN.
… I think as a vascular interventional radiologist, we have to move beyond thinking of somebody's going to refer a patient to us. I think that we have crossed that phase of our specialty……..Yes, we have to have GYN. They’re our colleagues and we have to have them onboard. I absolutely agree.
We have grand rounds, talk to them, and do a lot of stuff to educate GYNs about this alternative option. I think, as I said, we have to move on. We have to touch the patient. We have to speak to the patient directly, communicate directly. Tell them about the advantages, the disadvantages, and why is it different than hysterectomy. The patient should know that this is a treatment option and it is a very time proven and time tested treatment option for uterine fibroids.
Okay. Chris, what about you? What's your relationship like with OB/GYNs?
We have a pretty good relationship with the OB/GYN docs. There’s the LSU Hospital which operates a lot of the community hospitals that I work at, and then there are some community private practice OB/GYNs. Originally, it just took me getting out there and meeting some of the OB/GYN docs and letting them know that we did UFEs. For a long time, I think they were interested in having that option for some of their patients.
Then another thing that I did to build the practice, we deliver a lot of babies where I'm from and we had a handful of cases of postpartum hemorrhage. So I did uterine artery embolizations for postpartum hemorrhage, not exactly fibroid embolizations. The OB/GYNs then come and they'll thank you afterwards and for helping them out in a jam. I'll say, "You know what? This was a great case. Happy to help you out but now you owe me a couple fibroid patients." Then we'd have a quick laugh about it and I'm like, "But seriously, you do."
Yeah, but very much our relationship with OB/GYN, it's been more collaborative than competitive. Also, I agree with Keith. I think we've moved past the point where we're sitting back and waiting for an OB/GYN to counsel the patient and then tell them, "Hey, I think you're a better candidate for fibroid embolization." I see a lot more practices and even some guys in New Orleans that get direct referrals from either primary care physicians, or some patients self refer. I think if you do a good job of marketing yourself and just make yourself available, I think patients will try and get in touch with you.
To answer the question, ultimately, we kind of have a collaborative approach with OB/GYN and they're sending me some good cases. I think there are some untapped resources, some reluctant referers. I think that we offer a good procedure and there are a lot of patients who bring it up themselves to their OB/GYN and then that prompts a referral.
That's an interesting point he raised. I think besides getting the self referrals, it's important to educate people to speak to their GYNs about this treatment option. Just bring it up because the moment they bring this up, a lot of GYNs are like, you know, I've seen that. They say, "Oh, yeah, you want this treatment? Yeah. I'll send a referral to my closest vascular IR guy." I think that's important. Know your treatment options. That's a good point, Chris.
What type of marketing is best for increased UFE referrals?
Marketing with ads may be financially cumbersome, which is why Dr. Pereira takes to social media to reach new patients. Another option is talking with local TV channels; television not only promotes the procedure, but also awareness about fibroid treatment options. Dr. Beck says talking with device representatives may be beneficial, as they may put together informational pamphlets or organize talks leading to increased referrals.
Chris, you brought up another important point about the self referrals. Are either of you involved with any kind of marketing outside of speaking to your doctors, like any kind of advertising or anything like that?
Yeah, we have been doing a lot of advertising. I'm working at a university hospital, so it's difficult to get the finances to advertise because those ads are expensive and everything, but yes. We got three referrals from just one small ad and this is two, three weeks ago. More than that, I think social media's excellent. I did a small Facebook live interview for social media. There were 5000 views and a lot of impressions on it. I think that's one thing.
Coming on the TV, your local channels, they're always interested in something that affects society. With something that is so prevalent, 50% to 80% of women have fibroids. That's high number. This is something that you should talk to your marketing team about and tell them to talk to the media. We should not promote the procedure only. We should promote awareness about this disease condition and that's how people become aware of the procedure for it. I think it's a social cause, you know? We are physicians. We're just not proceduralists. We should make people aware of this disease condition and there are options available for it. So yeah, I think social media, TV media, and newspapers are very effective.
As you know, these women are young. Your target population is not 65 year olds. Your target population is 35 to 50. These are the women who go to the internet, who read newspapers, who look at TV, so these are people who want to know options. Easy population to target.
He does a good point in bringing up the patient population of your fibroid embolization patients. They're 35 to 50. I'd say virtually all of the patients that I see have Googled the procedure, know something about the procedure and for the most part are pretty well informed on their options. I think that makes them kind of a good patient population to target, like Keith said, with either traditional media like television, radio, newspaper, or social media.
… Another avenue to think about is whatever device reps you might use, they'll help you put together something, like a brochure, that you can hand out to your patients.
Absolutely. That's a very good point. Unfortunately I cannot do it because of the university has its own rules. That is a great way of promoting your practice through reps who sell these devices.
Chris, you answered the question I was going to ask which is how you would recommend somebody go about trying to build referrals? Say we're going with the rep system to help you get a few patients in the door. What kind of rep are you targeting? Is it the embolic rep? Catheters? Is it the radial sheath? Who are you going to?
Well, that's a great question. For fibroid embolization I usually go to the embolic rep and that's just one way to go. I wouldn't bank on your rep really going the extra mile for you. In the end, it's going to be on you to push this agenda as far as building up your practice. You can have the reps help you put together a dinner, talk, or a lecture for physicians. It's just thinking a little bit outside the box when you're just trying to get started and getting the first couple patients in the door.
Dr. Keith Pereira is a practicing interventional radiologist at the Saint Louis University School of Medicine in Saint Louis, Missouri.
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans, Louisiana.
Dr. Michael Barraza is a practicing interventional radiologist at Radiology Alliance in Nashville, Tennessee.
Cite this podcast:
BackTable, LLC (Producer). (2017, August 25). Ep 36 – Uterine Fibroid Embolizations with Dr. Keith Pereira and Dr. Chris Beck [Audio podcast]. Retrieved from http://www.backtable.com/podcasts
The Materials available on the BackTable Blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.