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Majority of Clinicians Rely on Existing Relationships When Referring Patients, Poll Finds

Op-Med is a collection of original articles contributed by Doximity members.

Fifty-one percent of clinicians mostly refer their patients to clinicians they have worked with, per a recent Doximity poll of nearly 3,000 clinicians. The figure is even higher among physicians and pharmacists, late-career clinicians, and in certain, often procedural, medical specialties.

While 51% of respondents refer to clinicians they’ve worked with before, 10% mostly refer patients to clinicians they have studied or trained with. Furthermore, 6% of respondents refer to clinicians they haven't worked with, but are friends with, and 20% refer to clinicians whom their colleagues have suggested. 

Referrals between peers have been found to improve the patient experience, with clinicians often providing more friendly and concerned treatment, offering clearer explanations, engaging in greater shared decision-making, and making more changes in prescribing.

The remaining 13% of clinicians mostly refer patients to clinicians they do not personally know, though the percentages vary widely by specialty. Twenty-two percent of family medicine physicians mostly refer patients to clinicians they do not know, compared with only 8% of general surgeons. 

Indeed, general surgery is the specialty most likely to refer within their peer network, with 73% typically referring patients to physicians they have worked with, compared with 41% of family medicine physicians and 51% of internists. PCPs have had a higher referral rate than specialists for decades, which may help explain why family medicine physicians may be less likely to know every clinician they send referrals to. Moreover, many PCPs now work only in outpatient settings, limiting the number of interactions they have with specialists.

Among all specialties, EM has the highest percentage of clinicians who refer patients to clinicians they do not personally know (28%). This trend may be due in part to the high volume, acuity, and pace of ED visits, including the many patients who are discharged with instructions to obtain follow-up care. EM clinicians may be referring many patients who require follow-up work back to their current primary care clinician, allowing for more affordable and personalized care. 

Referral practices also vary among clinicians in different professions: Roughly 51% of PAs and 44% of NPs mainly refer patients to a combination of clinicians they don’t know or clinicians their colleagues have suggested, compared to only 27% of physicians and 26% pharmacists. NPs and PAs have notably lower referral rates to co-workers than physicians and pharmacists, which may contribute to the lower co-worker referral rates in EM and primary care. Family medicine and EM are the top two specialties in which certified PAs practice, and more than 70% of NPs deliver primary care.

As clinicians grow their networks throughout their career, they’re increasingly able to tap into these peer relationships for patient referrals. While 45% of early-career physicians mostly refer their patients to clinicians they have worked with, that number climbs to 60% for late-career physicians. 

There are many factors that can influence who clinicians choose to refer a patient to, including insurance coverage, location, appointment availability, and cost. When it comes to relationships, clinicians appear to mostly refer patients to colleagues they have existing peer relationships with. The advantage is two-fold. It can help close the referral loop and lead to a better patient experience. 

“[I refer patients to] specialists whose knowledge, experience, wisdom, and good, kind treatment of my patients have impressed me positively in the past,” said Dr. Elizabeth Griffin, a pediatrician in North Carolina. “Also, I value excellent communications regarding those physicians' evaluations and recommendations or plans.”

Animation by Jennifer Bogartz

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