Medical Specialists – The Choice Is Yours!

You’ve seen your primary care doctor, and she feels you need to see a specialist or have more tests. She identifies the specialist (or lab or imaging facility) and tells you that’s where she wants you to go. Sometimes, she’ll even have her front office staff schedule the appointments for you. Now that’s service! But did you know that you can go wherever you would like to go for your medicals care? You don’t need to go where your doctor sends you.

Here are some falsehoods that you should consider when you need specialty care or services:

I Must Go Where My Doctor Sends Me.

FALSE. In fact, it might be a violation of federal and state laws if your doctor tells you where you must go for care. Your doctor’s opinion should be seriously considered as a factor in choosing your care. But it should be just one factor among many others to consider: location, family and friend testimonials, appointment availability, and treatment philosophy are some things you should look into to find the specialist or service provider that’s right for you. One size does not fit all, so find the provider that fits your needs.

My Doctor Is Always Looking Out For My Best Interests.

FALSE. Have you ever heard of a “Quality Score”? I hadn’t either until an MD friend of mine slipped up and mentioned this over dinner one night. It’s a dirty little secret among physicians.

I think the easiest way to look at this is to look at how salespeople are sometimes compensated. If a business wants to sell more of product A than product B at some point in time, the salespeople will be paid a higher commission for selling product A. It’s human nature in a capitalist economy; we’ll usually push what can bring us more money. Well, doctors who are parts of groups are usually paid bonuses to drive specific behavior that management wants, and some of that bonus is based on where you are sent for specialty care.

Over the years, at least a half-dozen referring doctors have called us and informed us that they would no longer be sending patients to us. They each told us that they recognize that we provide the highest possible quality care available, but that they just couldn’t deal any longer with the pressure from management to refer to the group’s “preferred providers”. In fact, one patient related to me that his doctor said he didn’t feel he needed to send his patients to “the best”, that the specialists or service providers to whom he referred just need to be “good enough”.

So, once again, you need to be looking out for yourself and use available resources (friends, family, etc.) to find the specialists that are right for you.

My Doctor Would Not Refer Me For Specialty Services If I Didn’t Need Them.

FALSE. There was an interesting blog post in the Washington Post [1] from January 2012:

“Referrals to medical specialists have more than doubled in the past decade, according to research published… in the Archives of Internal Medicine… The big question is why doctors have become more likely to send their patients to specialists… And, part of it likely has to do with the economics of referrals: Doctors who have an ownership stake in their practice are 50 percent more likely to refer to a specialist, which would increase the total revenue generated by a given patient.

“Remember my previous point? Compensation is a motivator and a factor among many physicians. If the doctor can benefit from the referral, she’s 50% more likely to make that referral.

The bottom line is that you need to look out for yourself and choose the specialists and specialty care that are right for you. Of course, make sure that the provider you choose accepts your health insurance. But THE CHOICE IS ALWAYS YOURS.

[1] “Why are we seeing so many specialists?”, Sarah Kliff, 01/24/2012, The Washington Post, Wonkblog

Study Shows Doubling of Patient Referral Rates

A recent study showed that patient referrals from primary care doctors in the first 10 years of the 21st century have nearly doubled. This is impressive considering that the population of the United States has definitely not doubled.

The new study was published in the Archives of Internal Medicine and showed that the number of patient visits in the decade rose approximately 25%. However, the probability that a patient will be sent to a specialist almost doubled.

In looking at the data, the researchers actually became confused as to why this is occurring. Multiple theories were put forth including the fact that medicine overall is becoming more complicated.

For instance, referrals for cardiovascular symptoms, dermatology symptoms, and ear, nose and throat symptoms rose significantly. As technology increases and care becomes more complicated, primary care offices do not have all the necessary equipment for diagnosis and treatment.

The paper did not specifically look at pain management, however, more and more primary care doctors are unwilling to prescribe narcotics on a chronic pain management basis. Therefore, referrals to pain management specialists have been on the rise for years.

One of the main reasons it is postulated that referral rates are increasing is the fact that medicine is turning into a volume game. Primary care doctors need to see more and more patients to make a living and pay their overhead. As reimbursement falls and overhead rises, one answer to this is simply to see more patients and spend less time with each one. Writing for referrals to specialists can help ease the time burden.

With regards to pain management, there is significant liability associated with prescribing narcotic medications. This liability is mitigated by referring those patients out. Also, pain management patients typically have stories that cannot be related in simply a couple minutes. Typically something significant is going on with that person and necessitates a lengthy explanation. Simply referring the patient out takes care of both the time crunch and the liability problem.

A theory that I thought of that goes along with this line of thinking revolves around a medical legal one. With tort reform not being very significant in this country, it is appropriate for primary care doctors to refer out a lot of cases. This way the liability is further mitigated and shifted over to the medical specialist. What this effectively does is significantly increase the cost of medicine because specialty care simply cost more. This is by no means the fault of the primary care doctors, this is simply them looking out for practice preservation.