Selecting a Specialist: Adding Evidence to the Clinical Practice of Making Referrals

Referring patients to other physicians is one of the most fundamental and frequently performed tasks in clinical practice. In 2009, referrals to other physicians were made during almost 1 in 10 ambulatory visits in the United States for a total of more than 100 million referrals.¹ Despite the routine nature of referrals, there is significant variation in how and when physicians choose to ask for specialist involvement. Rates of referral appear to vary up to 5-fold, with both overreferral and underreferral being common.² Decisions about whether to refer appear to be influenced by both patient factors, such as illness severity and expectations, as well as physician training and expertise.² As a consequence, standardizing and optimizing the referral process may affect the cost and quality of care.³