Pulling Back the Curtain on Physician Referrals

Over 100,000 times today in the United States, a visit between a patient and his/her physician ended with something like this:

“I recommend you speak with a surgeon.”

That simple statement sets a complex set of wheels in motion, not the least of which are the wheels turning in the patient’s head.

“How will I know where to go?”

“Who do I trust?”

“Do I know anyone who might be able to help me?”

“How sick am I?”

“When can I get back to ‘normal’?”

Last year, we surveyed 200 individuals about how they would make a surgery decision. The results? The most vulnerable individuals leaned on factors like referrals as well as proximity to the doctor. But not because that’s the approach they preferred. In fact, the survey respondents wished to make informed decisions, based on (difficult to find) data like the physician’s experience with minimally-invasive surgery.

In the absence of better options, and with other things weighing on their minds, the reality for most patients is surgeon availability and referrals win out.

Which brings us to the question, how do primary care physicians make referrals?

Let us begin by saying we believe most primary care docs are well-intended with their referrals and other recommendations. That doesn’t mean, however, they should be blindly trusted. Nor should we not seek to better understand some of the forces at play.

With that, we believe surgical referrals fit into three categories:

  1. “The Gold Standard”

Well-researched and intended to help the patient meet his/her goals, these recommendations include considerations like faster recovery and minimized opioids. Unfortunately, this is very rare.

  1. “If It Ain’t Broke, Don’t Fix It”

This sounds something like, “I always refer patients to Dr. Smith and they never come back to me with concerns, so it must be going ok over there.” This is very common. Would this be good enough for you? Yet, this seems quaint when compared with the third category.

  1. “Don’t Bite the Hand That Feeds You”

Health systems have been on an acquisition spree in recent years, gobbling up thousands of physician practices in an effort to gain size and control. As of January 2018, nearly 50% of physicians were employed by hospitals or health systems, double the amount just six year earlier. A Wall Street Journal article entitled, “The Hidden System That Explains How Your Doctor Makes Referrals” pulled back the curtain to what this rapid change in physician employment means to the way specialists, including surgeons, are recommended. Terms like “keepage” (a patient stays in the health system for care) and “leakage” (a patient leaves a health system to go elsewhere for care) have been introduced to the operations of physician practices. Notice the lack of consideration around quality in those terms. We heard from an independent surgeon recently who told us the doctors in his area have stopped referring patients to him. But guess who shows up in his office when they need surgery? Those exact same surgeons. They know where they want to receive care but incentives drive them to refer their patients elsewhere.

So what can you do for yourself, a loved one or even your employees/health plan members?

First, take some steps to become an informed patient. Learn what to expect and get a general idea of surgery done well.

If you’re looking for more, consider the Goldfinch Health program for individual patients. Or ask your employer or health plan about Goldfinch. And remember that surgery doesn’t have to be the major life event with big risks it once was. A much improved option is available and, by becoming an informed patient, you are well on your way to finding it!

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