Profession

Process changes, but skill still top factor in referrals

A study looks at the decision-making process primary care physicians use when selecting a specialist.

By Damon Adams — Posted July 19, 2004

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Before managed care, family physician Jim King, MD, used a smaller number of specialists for patients. He would call the specialist, make sure the doctor was available, then send over his patient.

The process isn't as simple these days.

"The first question has changed from what problem do they have to what insurance do they have," said Dr. King, who practices in Selmer, Tenn., and is a board member of the American Academy of Family Physicians.

After checking on a patient's insurance coverage, Dr. King looks at the specialist's medical skill. Then he considers the working relationship he has with the specialist.

Dr. King's process for choosing a specialist is similar to those of other primary care physicians, according to a new study in the May/June Annals of Family Medicine. The national study examined what factors primary care physicians consider when selecting specialists for their patients. Approximately 4.5% of all patient visits in the United States lead to referrals, and doctors get up to 45% of new patients by referral, the study said.

In the study, a specialist's medical skill was viewed as the most important factor by 88% of doctors -- the highest amount of any factor in selecting a specialist. The next highest factor was previous experience with a specialist, cited by 59% of the 623 primary care physicians in the study. Appointment timeliness was listed third in importance.

About half of respondents placed great value on quality of communication with a specialist, likelihood of good patient-physician rapport, returning the patient to the referring doctor and insurance coverage.

Least important when picking a specialist were medical school and institution of fellowship training, patient referrals from the specialist, office location and hospital affiliation.

"If I was a specialist I would look at this very carefully because it would tell me what I would need to be doing" to get referrals, said Neil R. Powe, MD, MPH, professor of medicine, epidemiology and health policy and management at the Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore.

Race and gender differences

Researchers found some differences based on race and gender. For example, white physicians were more likely than black physicians to place more importance on previous experience with the specialist and on board certification. Female doctors were more likely to rate insurance coverage of greater importance in referral decisions.

"Men were more concerned about returning patients [to them]. Women seemed more concerned about patient coverage," Dr. Powe said.

New Orleans internist Kathleen W. Wilson, MD, agrees with other doctors who said that over time managed care plans have loosened their restrictions, making it easier to send patients to specialists. But she is among those primary care physicians who want to make sure patients have insurance coverage before sending them to specialists.

Dr. Wilson also likes specialists who keep her posted about her patients' progress.

Some things won't lead to a referral from Dr. Wilson. She will pick another specialist if the wait at one specialist is too long. If she gets feedback that a specialist was disrespectful or mistreated a patient, Dr. Wilson won't use that specialist again.

"I prefer a specialist or surgeon who gets a good result [for patients] every time. That's the No. 1 important thing for me," she said.

Back to top


ADDITIONAL INFORMATION

Talent rules

Skill is the key consideration of primary care physicians when choosing a specialist for referral. Least important is where a specialist went for medical school and fellowship training. Physicians who say factor is "very important":

Medical skill 88%
Previous experience with specialist 59%
Appointment timeliness 55%
Quality of communication 53%
Likelihood of good patient-physician rapport 51%
Specialist returns patient to primary physician 51%
Insurance coverage 50%

Source: "Referral of Patients to Specialists: Factors Affecting Choice of Specialist by Primary Care Physicians," Annals of Family Medicine, May/June. Note: Percentages are rounded.

Back to top


Referral rates

Primary care doctors tend to be do-it-yourselfers, with the majority of referring physicians sending less than 10% of patients to specialists in any given week.

Patients
referred
Physicians
who refer
Less than 5% 22.5%
5%-10% 43.4%
11%-15% 19.9%
16%-20% 10.2%
More than 20% 4.0%
Total 100%

Source: "Referral of Patients to Specialists: Factors Affecting Choice of Specialist by Primary Care Physicians," Annals of Family Medicine, May/June

Back to top


External links

"Referral of Patients to Specialists: Factors Affecting Choice of Specialist by Primary Care Physicians," Annals of Family Medicine, May/June (link)

Back to top


RELATED CONTENT

ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn