Loyalists, Splitters and Nevers: Where Your Team’s Time Goes, and Who Gets Left Out

Every physician relations team has to prioritize. There are always more referring physicians than there are hours for visits, so teams sort the market and spend their time where it’s most likely to pay off.

Most teams use some version of the same model to do that sorting. It’s a good model. But like any model built for a team with limited time, it leaves some people out. This post explains how the model works, where the time goes, and which physicians tend to fall through the gaps.

The three standard segments

The most common approach sorts referring physicians by how much of their referral volume comes to you. Loyalists send most of their referrals your way. One published version draws the line at more than 75% of their referrals staying within your system. Splitters divide their referrals between you and others, typically somewhere between 25% and 75%. And nevers, sometimes called non-aligned physicians or dissenters, send you little or nothing, under 25% (Becker’s Hospital Review, MGMA, Advisory Board).

Many teams also layer a trend on top of those segments, marking each physician as growing, steady, declining or lapsed (AbbaDox). That second layer matters. A loyalist whose referrals are falling needs very different attention from a loyalist whose referrals are growing.

Where the time goes, and why it makes sense

The standard advice on where to focus is clear, and it’s sound. Splitters come first, because they already send you something and there’s room to earn more. As one referral expert put it, splitters are “your No. 1 opportunities” (MGMA). Loyalists get maintenance. They need regular contact and good service, not courtship (BD Emerson).

Nevers get very little time. Their referral patterns rarely move, so visits seldom pay off (BD Emerson). MGMA’s guidance is blunt: unless they’re leading specialists in your area, they’re “probably not worth the effort” (MGMA).

For a field team with a fixed number of hours, that’s exactly the right call.

The math behind the model

To see why the model works this way, look at the numbers. A liaison typically manages a panel of 60 to 100 providers (MD Liaison). At 14 to 16 scheduled visits a week, that adds up to roughly 650 to 750 visits a year (Optum).

Now compare that with the full referral base. Penn Medicine once counted about 20,000 referring physicians, and 75% of them sent five patients or fewer a year (Penn Medicine case study). The segment model does exactly what it was designed to do. It points scarce visits at the physicians most likely to move. Everyone else gets a newsletter, an occasional event invitation, or nothing at all.

Who gets left out

When you look closely, four groups tend to slip through.

The first is the long tail: physicians who each send only a few patients a year. Individually they look small. Together, they can add up to a large share of your referral base, and no field team can visit them all.

The second is nevers who have the right patients. Think of a primary care physician with a large panel of patients who need exactly what your service line offers, but who has never gotten in the habit of sending them to you. It makes sense not to spend weekly visits on that physician. But the opportunity doesn’t go away just because the visits do.

The third is physicians who are new to your market. They haven’t formed referral habits yet, so there’s no history to segment them on. This is the moment when their habits are easiest to shape, and it’s often the moment they hear the least from you.

The fourth is your loyalists and splitters in the gaps between visits. Splitters can drift toward becoming dissenters if they don’t get support (Advisory Board). A visit every quarter leaves a long stretch of time for a competitor’s new program to get their attention.

None of these groups justifies a weekly visit. Taken together, they’re a big part of your market.

Let the segment choose the channel, not just the priority

Most teams use segments to decide who gets visited. They can also be used to decide how each group is reached.

Loyalists can get steady reminders between maintenance visits about new specialists, new programs and the results of their referrals. Splitters, your priority visits, can get messages that reinforce what the liaison said, focused on access, how to refer and introductions to your specialists. Declining or lapsed physicians can get a “what changed?” visit if they’re high value, and a re-introduction otherwise: what’s new, how much faster patients can be seen, and how easy it is to come back. Nevers with relevant patients can get introductory education about who you are, what you treat and how to refer. And physicians new to your market can get a welcome that introduces your specialists and explains how to reach them.

Two groups usually stay out of this kind of outreach: your own employed physicians, if a separate internal program already covers them, and physicians employed by a competing system.

What makes this practical is that a list of physician NPIs can become a digital audience. That lets you reach each segment between visits at a scale no field team can match, and see by name who engaged. We’ll explain how that works in the next post.

How you’ll know it’s working

Segments come with a built-in scorecard. Before you start, record each segment’s share of referrals to your service line. Then track the movement in your own systems over time. You’re looking for splitters keeping more of their referrals with you, lapsed referrers coming back, and nevers sending a first patient. Compare the physicians you reached with those you didn’t, and give it months rather than weeks, because referral habits change slowly.

If you want to put this to work this week, start with a few questions for your team. Do we segment our referring physicians today, and do we use clear thresholds or judgment? How many physicians fall into each segment for our priority service line? Which segments get no planned contact between visits or events? Which nevers have patient panels that match what we offer? And what share of our referrals does each segment send us today?

In the next post, we’ll explain NPI targeting in plain English: how a list of providers becomes a media audience, what you can include and exclude, and why it involves no patient data.

Want to see how your referral segments could map to a campaign? Let’s talk.

Ready to see how your loyalists, splitters and nevers could map to a campaign? Reach Kelley directly and start the conversation.

Q&A: Where Your Team’s Time Goes, and Who Gets Left Out

What separates loyalists, splitters and nevers?

Share of referrals. Loyalists send more than 75% of their referrals to you, splitters send between 25% and 75%, and nevers send under 25%.

Where should liaisons spend most of their time?

Splitters come first because there is room to earn more. Loyalists get maintenance, and nevers get little time unless they are leading specialists in your area.

Who usually falls through the gaps?

The long tail of low-volume referrers, nevers whose patients match your service line, physicians new to your market, and loyalists and splitters in the long stretches between visits.

How do we know segment-based outreach is working?

Record each segment's share of referrals before you start, then track splitters keeping more referrals with you, lapsed referrers returning and nevers sending a first patient. Compare reached and unreached physicians over several months, since referral habits change slowly.