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Rate of referrals after ambulatory care doubled during 10-year period
The increase was difficult to explain with other factors, researchers said.
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The likelihood of a patient being referred to another physician after an ambulatory visit increased from 4.8% to 9.3% between 1999 and 2009, according to a study recently published in the Archives of Internal Medicine.
We found a startling — over twofold — increase in the number of referrals being made by both primary care and specialist physicians, which we found hard to explain by looking at patient or demographic factors,” Michael L. Barnett, MD, lead study author, told Orthopedics Today.
Barnett, an internal medicine and primary care first-year resident at Brigham and Women’s Hospital in Boston, Mass., and colleagues based their results on a sample of 845,243 patients who participated in the National Ambulatory Medical Care Survey. Overall, the researchers found that number of referrals during same period increased 159% from 41 million to 105 million nationally.
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Reasons for referral increase
The researchers noted changes in referral rates by patient symptoms, particularly in patients seeing primary care physicians while displaying orthopedic, gastrointestinal, dermatologic, cardiovascular symptoms or symptoms of the ears, nose and throat, according to the study abstract. Among physician practices, slower growth was seen in practices where physicians had a stake in ownership or where physicians received a “majority of income from managed care contracts,” according to the abstract.
One suggested reason for the spike in referral rates was an increased responsibility for primary care physicians to do more for a patient during a visit.
“Sometimes physicians may find it easier to refer a patient to another doctor than to find the necessary time to spend with him or her,” paper co-author Zirui Song, a Harvard Medical School student and PhD student in health policy, stated in a press release.
More research needed
A specialist’s opinion may not be needed in some patient cases. To decrease the rate of referrals, the researchers recommended primary care physicians first look into alternative treatments, such as physical therapy, rather than referring a patient to a specialist or an unnecessary test.
Barnett said further research would be needed on patient referrals.
“The survey we used does not provide enough detail for us to understand exactly why this is happening, but it should serve as a wake-up call to physicians that the process of how we make referrals should be re-examined to help eliminate waste in our health care system,” he told Orthopedics Today. – by Jeff Craven
Reference:
- Barnett ML, Song Z, Landon BE. Trends in physicial referrals in the United States, 1999-2009. Arch Intern Med. 2012; 172(2):163-170. doi:10.1001/archinternmed.2011.722.
For more information:
- Michael L. Barnett, MD, can be reached at the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, 1620 Tremont St., BC-3, Boston, MA; 617-732-7063; email: mlbarnett@gmail.com.
- Disclosure: Barnett has no relevant financial disclosures.