Family Physicians’ Referral Decisions

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Original Research

Family Physicians’ Referral Decisions

J Fam Pract. 2002 March;51(3):215-222

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References

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Implications for physician training

Fifty conditions accounted for 76% of all specialty referrals made during office visits in this study. Interactions with most types of specialists are generally limited to a few conditions; 3 health problems accounted for more than half of referrals to most specialties. Educators should ensure that these commonly referred conditions are emphasized in curricula that provide family physicians with the skills necessary to expand their scope of practice, when appropriate; determine when a patient should be referred; and identify the type of practitioner to whom the patient should be sent.

Physicians in training should be taught the skills required to recognize the boundaries of their clinical uncertainty and scopes of practice. A challenge for educators is to assist trainees in determining when to tolerate clinical uncertainty while employing a watchful waiting approach and when to initiate a more aggressive evaluation, including when to obtain specialty referral. Modes of implementing these approaches are likely to differ across conditions. Thus, it makes sense in physician training to place the greatest emphasis on conditions for which family physicians commonly refer.

Under certain circumstances, patient request for a specialty consultation may be a sufficient and legitimate reason for referral. For example, as we found in this study, patients with uncommon health problems may seek reassurance from specialists skilled in the management of their specific condition. Managing access to specialists, particularly when the physician is acting as an administrative gatekeeper to referrals, can be challenging.²¹ When doctors and patients disagree on the need for referral, patients may become dissatisfied with their health care²⁶ and decide to self-refer to specialty care.¹⁷ In consideration of the increasing complexity of medical care, developing skills that help physicians discuss and negotiate access to specialized services with both patients and specialists has never been more timely.

Acknowledgments

This study was funded by grant no. R01 HS09377 from the Agency for Healthcare Research and Quality. James Werner and Laurie Vorel provided technical assistance with data collection and project implementation. Many physicians collected data for this study. Their time and devotion were invaluable to the success of this study. These physicians are listed by the states in which they practice. Arizona: Scott Ekdahl, DO; Arkansas: John Scott, MD; California: Andrew Ness, MD; Colorado: Howard Corren, MD; Nell Davis, MD; Timothy Dudley, MD; Audrey Farley, MD; Tillman Farley, MD; Charles Kay, MD; Joan FAMILY PHYSICIANS’ REFERRAL DECISIONS MacEachen, MD; George Maxted, MD; John Miller, MD; Kathy Miller, MD; Steven Milligan, MD; Frank Reed, MD; Louise Schottsteadt, MD; Lynne Spicer, MD; Laura Stein, MD; Lynn Strange, MD; Dan Sullivan, MD; Georgia: Linda Casteel, MD; Randy Cronic, MD; Bruno Denis, MD; Keith Ellis, MD; Kelly Erola, MD; Craig Fabel, MD; Russell Leubbert, DO; Richard Liotta, DO; Mark Majoch, MD; David Najjar, MD; James Snow, DO; Roslyn Taylor, MD; Illinois: Steven Lidvall, MD; Anna Meenan, MD; Eduardo Scholcoff, MD; Loyd Wollstadt, MD; Indiana: Paul Daluga, MD; Steven Phillipson, MD; Iowa: Ken Miller, MD; Janet Ryan, MD; Kansas: Wendell Ellis, DO; John R. Eplee, MD; Robert Moser, MD; Daniel Sontheimer, MD; Louisiana: Linda Stewart, MD; Michigan: Linda French, MD; John Hickner, MD; Minnesota: Ravi Balasubraman, MD; Dave Bucher, MD; William Davis, MD; Richard Gebhart, MD; Katie Guthrie, MD; Anthony Jaspers, MD; Timothy Komoto, MD; Glenn McCarty, DO; Stephen Mitrione, MD; Thomas Retzinger, MD; Paul Spilseth, MD; Ashlesha Tamboli, MD; Montana: Curt Kurtz, MD; Nevada: Coleen Lyons, MD; New Hampshire: Richard Douglass, MD; Paul Friedrichs, MD; Peter Hope, MD; Jonathan Mishcon, MD; New Jersey: John Orzano, MD; Winifred Waldron, MD; New York: Carmella Abraham, MD; R. Eugene Bailey, MD; Lorne Becker, MD; John DeSimone, MD; Miguel Diaz, MD; Rebecca Elliott, MD; John Glennon, MD; James Greenwald, MD; Glenn Griffin, MD; Eileen Hoffman, MD; L. Thomas Wolff, MD; North Carolina: Ed Bujold, MD; Thomas Detesco, MD; Dave Rogers, MD; Phil Sherrod, MD; Oklahoma: Laura Miller, DO; Mike Pontious, MD; Oregon: Douglas Eliason, DO; L.J. Fagnan, MD; Jerry Flaming, DO; Tom Flaming, DO; Jeffrey Humphrey, DO; Michael Kelber, MD; John Sattenspiel, MD; Pennsylvania: John Farmer, DO; Penitha Williams, MD; South Dakota: Fred Thanel, MD; Tennessee: Dan Brewer, MD; Michael Hartsell, MD; R. Louis Murphy, MD; John Parham, MD; Texas: Michael Averitt, DO; Sharon Barber, MD; Kim Patrick Bolton, MD; Robert Cortes, MD; Paul Gerdes, MD; Robert Henry, DO; Michael Kirkpatrick, MD; John Manning, MD; Shane Maxwell, MD; Luis Moreno, MD; Larry G. Padget, MD; Peter Sullivan, MD; Utah: Scott Endsley, MD; David Flinders, MD; Jim Giovino, MD; Eric Hogenson, MD; Dwayne Roberts, MD; Virginia: Duane Lawrence, MD; James Ledwith, MD; June Tunstall, MD; George Wortley, MD; Washington: John Anderson, MD; Elizabeth Wise, MD; West Virginia: Dan Doyle, MD; J. Michael Herr, DO; Wisconsin: Richard Anstett, MD, PhD; Walter Boisvert, MD; Lea Cornell, MD; Anne Eglash, MD; Rod Erickson, MD; Tom Frisby, MD; Terry Hankey, MD; Kevin Jessen, MD; Dan Landdeck, MD; Dave Lonsdorf, MD; Michael Pace, MD; Michael Saunders, MD; Catherine Soderqueist, MD; Jon Temte, MD; Vince Winklerprins, MD; Brian Woody, MD.