Enquirer Consulting Group

Reachable Referral Map

Prepared for Murali Dharan, MD · East Bay Cardiovascular and Thoracic Associates · Alameda and Contra Costa counties, California · August 2026
In this specialty the patient almost never arrives directly. Volume follows the clinician who refers, so reach is a question of which referral desks know a practice by name and remember it at the moment of decision. That is usually built through hospital corridors and long relationships, which is a real channel with a hard ceiling: it covers the people already standing in the same corridors. This map is the rest of that layer across Alameda and Contra Costa counties. Who refers, who signs inside each group, and roughly how many sit there.
Cardiology
General cardiovascular disease, interventional cardiology and electrophysiology. The nearest referral layer to a cardiac surgical practice, and the one where a single relationship can carry a steady stream rather than a single case.
Who signs: the referring cardiologist personally. Inside a group, the managing partner or medical director, and the practice administrator who maintains the referral list.
400 to 450
clinicians in the two counties enumerated under cardiovascular disease, interventional cardiology or cardiac electrophysiology
Nephrology and dialysis
Vascular access arrives through a completely separate door from the cardiac path, and it recurs. The deciding seat is often a facility medical director rather than an office practice.
Who signs: the nephrologist, the medical director of the dialysis facility, and the facility administrator who holds the access schedule.
150 to 175
nephrology clinicians in the two counties, alongside roughly 70 enumerated dialysis facility records
Pulmonary medicine
The thoracic half of a practice reaches the market through a different set of names than the cardiac half. Nodule and staging work tends to sit with the pulmonologist and the tumor board long before a surgical opinion is requested.
Who signs: the pulmonologist, the group medical director, and the thoracic multidisciplinary lead where a program runs one.
140 to 160
pulmonary disease clinicians enumerated at practice addresses in the two counties
Primary care, the widest door
The slowest layer to move and the largest by a distance. Recognition here rarely produces a referral this month. It produces the one that arrives through a cardiologist two steps later, which is why it usually goes unworked.
Who signs: the physician personally at small practices, the practice manager for scheduling, the group medical director once a practice passes a handful of clinicians.
1,950 to 2,050
family medicine clinicians in the two counties; general internal medicine is larger again, and the register does not cleanly separate general internists from their subspecialties
Hospitals and health systems
Where privileges, service line agreements and call coverage are decided. This is also the layer where a raw count misleads most, because a single system enumerates many entities separately.
Who signs: the cardiovascular or surgical service line director, the chief medical officer, and the medical staff office for credentialing.
About 145 organization records
entries enumerated as acute care hospitals across the two counties; the number of distinct campuses is far smaller, since systems register multiple entities

Where the openings are

1
The specialist layer is small enough to name in full. Cardiology, nephrology and pulmonary medicine come to roughly 690 to 785 named clinicians across the two counties. In this category, operative volume tends to follow that layer, and it is a list one person can work deliberately over a year rather than a market that has to be advertised to.
2
A referral is a relationship with a seat, not with a building. Clinicians move between groups, hospitals and systems, and every move resets where their referrals land. Watching the seat catches that moment. A directory listing and a website do not, because they are read only by whoever already went looking.
3
Dialysis access is a separate market with its own gatekeeper. Roughly 70 enumerated dialysis facilities sit in the two counties, and who performs access work is usually settled with a facility medical director rather than in a referring office. That seat is reached by name or it is not reached at all.
4
The two halves of the practice do not share one referral list. Cardiac work arrives through cardiology, thoracic work arrives through pulmonary medicine and the tumor board, and access work arrives through nephrology. A relationship channel tends to keep returning to the same door. Three named audiences is a different reach problem, and a solvable one.
Built from the public federal register of enumerated US clinicians and health care organizations, read in August 2026 for practice addresses across Alameda and Contra Costa counties, California. Counts are banded deliberately. An entry in that register proves enumeration only, not licensure, current activity or referral volume, and the internal medicine figure is a floor rather than a full count. It describes the market rather than your business, and there is nothing to buy at the end of it.
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