Training in cardiothoracic surgery is long and arduous. Through it all, one’s chief concerns are generally limited to becoming a proficient physician and surgeon while attending to the basic necessities of life (i.e., sleep and the occasional meal). Then, mercifully, it ends, and you take that first job, typically move to a new city, and, if you’re lucky, get right to work with a full clinic and caseload. On the other hand, as is common for many, you now have an ample amount of time and very few patients or cases. At this point you have two options: Sit and wait, or get out there and do what comes least naturally to most of us; promote yourself.

Full disclosure, I’ve done a lot of this self-promotion; driving around, shaking hands, getting gently rebuffed or offered empty pleasantries. Admittedly, it’s not a lot of fun, and at the end of the day you might come home feeling a bit like Willy Loman in “Death of a Salesman,” with no clear idea if you have accomplished anything or not. Please don’t despair, however, because even in the era of social media there remains no substitute for the face to face, and I can tell you from personal experience that, with persistence and a strategic approach, good things can happen. The following are some key steps in the process of self-promotion and practice building:

• Familiarize yourself with your institution’s marketing department. Each institution typically employs liaisons whose job it is to promote new hires. In addition, they can arrange meetings between you and referring physicians.

• Make yourself available to travel with the liaisons. They can sell you only so much in your absence. The more they hear you speak about your clinical interests, the better equipped they are to discuss your practice when you are not with them.

• Determine how you want to market yourself. It is not enough to say you are a new cardiac surgeon. Make sure marketing and potential referring physicians know exactly what it is you do (i.e., cardiac surgeon with aortic expertise or thoracic surgeon with interest in benign esophageal disease).

• Learn the demographics of your state and/or region. It is important to know the key population centers and their access to care. People of means will usually perform thorough research and seek out the best care, whereas individuals of lesser means will be motivated by proximity. In the case of the latter, consideration for a satellite clinic may be in order.

• Learn the geography of your state and/or region. The physical location of your hospital can heavily influence referral patterns. If patients believe that your hospital/clinic is hard to get to, and they are overwhelmed by the idea of navigating the campus, you may have a problem. In this case, once again a satellite clinic with easy access and parking may go a long way to keeping those patients.

• When you are out and about, take the time to learn who are the new members of the group that you are visiting. These are individuals who have no established referral patterns and would probably be more than happy to send you a patient or two. Older members tend to have their preferences, which they have developed long before you came to town.

• Give out that cellphone. Accessibility is still king and it can’t get any easier for the busy cardiologist or oncologist than to have your phone number. Plus, some hospital systems track the referral patterns of their physicians in an attempt to discourage sending patients outside the system. Thus, the cellphone provides a way around that barrier.

• Make the most of your call! When the outside hospital wants to transfer someone in, take that patient. Even if you don’t operate on them, that patient has an internist or a pulmonologist or an oncologist, and your subsequent phone call lets them know that you are out there and eager to help.

Did I mention that practice building is hard? Some of the bullet points listed above will work well, and others will be less fruitful. If things remain slow, a little introspection and reinvention may be required. Try to think of yourself as the Rolling Stones (or not, your choice, but this is my analogy). The Stones made a couple of nice pop records and could have drifted into oblivion, but instead they escaped to the south of France (for tax reasons mind you) and turned out “Exile on Main Street.” The result was sustained relevance and an album that is forever etched in the rock pantheon.

So ask yourself, What can I do to make myself unique and offer what others want or need and will continue to both want and need into the future? Many times this requires a willingness to take on challenging cases and to develop new skill sets. Not an easy pursuit, mind you, but one that will be recognized by your peers both within your institution and outside of it.

Personally, I recognized a need for the treatment of large paraesophageal hernias. Perhaps not my first choice, but clearly a group of patients who were underserved and an operation I was willing to offer.

Perseverance is in order when you first start out, and it can be easy to get discouraged, but continued belief in oneself and your abilities is tantamount to success. For instance, take F. Scott Fitzgerald. In 1925, he published “The Great Gatsby,” to less than rave reviews, and by 1940 the book was largely forgotten. Despite this setback, Fitzgerald never stopped believing that Gatsby was his masterpiece and promoted it as such. Interestingly, in 1942, a group of publishers began to distribute leftover copies to GIs fighting overseas, who loved it, and now today the book is considered by some to be one of the great American novels. So get out there, tell your story, believe in yourself, deliver good service to your patients and referring physicians, and good things will happen.

Dr. Klapper is an assistant professor of surgery in the division of cardiothoracic surgery, Duke University Medical Center, Durham, N.C.

Promoting yourself and building your practice