Physician Referrals to Specialists Becoming More Automated

In the past, referrals to otolaryngologists from primary care physicians (PCP) were made on a person-to-person basis. Patients were referred to specialists not only due to their reputation for good patient care and communication but also because of how well the PCP and specialist got along and how well they knew each other.

That has changed, and will continue to, as the ongoing transformation in healthcare plays out. As healthcare insurers continue to narrow their networks, hospitals take ownership of private practices, and accountable care organizations (ACO) emerge, referrals are becoming less personal and more randomly assigned.

“This process has changed from the time when our physicians ran into a PCP on hospital rounds,” said Kevin Watson, practice administrator at Colorado ENT and Allergy in Colorado Springs. “It is more difficult to get face time with community physicians; therefore, practices are turning to administrators and marketing representatives to communicate with referring physician offices.”

This shift has been exacerbated by the removal of traditional channels of communication. Medical conferences and events where physicians of different specialties get together and mingle have moved online, making it harder for referring physicians to know about the latest procedures and treatments in a specialty. Referrals may be missed because the PCP doesn’t know an intervention is available.

Meanwhile, the number of specialists and subspecialists has increased dramatically. This dilutes the number of patients available to an otolaryngologist, as new categories of physicians siphon off patients who would have gone to an otolaryngologist in the past. It also makes it harder for PCPs to decide which doctor is best suited to a particular patient, and for the specialist to be recognized by the generalist.

Likewise, an increase in healthcare options available to patients further complicates referral patterns. Patients can get medical attention at an urgent care center, a grocery store, or their local pharmacy. Many are going online to self-diagnose, bypassing primary care entirely. All of this makes it harder for a physician to come to the attention of the person making the referral, especially when patients refer themselves. This has served to move the relationship to a less personal level, making it more difficult to establish trust.

“We believe that relationships are still very important,” said Danielle DeMaio-DeAngelis, MHA, COPM, department administrator for otolaryngology-head and neck surgery at Jefferson University in Philadelphia. “Trust in the provider you are sending your patient to is still very important to the practitioners, but there are now other things playing increasingly important parts in decision-making.”