Specialist referrals doubled over decade

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Physician referrals to specialists have roughly doubled during the past decade, reveals a study published in the Jan. 23 issue of the Archives of Internal Medicine. Although the increase in referrals made by both primary care and specialist physicians is clear, the research itself does not point to definitive reasons behind the surge, Medscape Today reported.

But the lack of causation data hasn't prevented the authors and other health experts from taking a crack at solving the puzzle. One theory proposed by the authors and backed by Sarah Kliff, blogger at The Washington Post's Wonkblog, is that financial incentives lead physicians with an ownership stake in their practices to be more than 50 percent more likely to refer a patient to a specialist. Although Kliff argues that referrals "would increase the total revenue generated by a given patient," internist and blogger Kevin Pho counters that, stating that very few physicians have any financial incentive to make referrals, and that the point becomes even less relevant as more doctors enter salaried hospital positions.

The next hypothesis is that the increasing complexity of healthcare combined with "the tyranny of the 15-minute office visit" leads doctors to refer out more cases. Bloggers, for the most part, indicated this theory was plausible.

Finally, Pho argues that "failure to refer" is the leading reason why physicians are sued; it essentially represents another form of defensive medicine.

Nonetheless, Mitchell H. Katz from the Los Angeles County Department of Health Services in California points out in an editorial accompanying the study that it is unclear from current medical literature what might be the right frequency of referral. Despite the possible reasons driving referrals, we still don't know whether physicians are "referring too often, too infrequently or (most likely) both," he said.

To learn more:
- read the article from Medscape Today (registration required)
- see the post from The New York Times' Prescriptions blog
- see the post from The Washington Post's Wonkblog
- see the post from KevinMD.com
- see the study abstract from the Archives of Internal Medicine

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