Rate of physician referrals nearly doubled

January 23, 2012

Physician referral rates in the United States doubled between 1999 and 2009, a new study finds, an increase that likely contributes to the rising costs of health care.

The increase in referral rates coincides with an increase in chronic conditions such as Type 2 diabetes. The results are staggering: over the same time period, the estimated absolute number of visits resulting in a referral increased 159 per cent, from 40.6 million to 105 million.

"If you add that up, it's real money," said Bruce Landon, senior author of the paper and professor of policy at Harvard Medical School.

The researchers found a 92 percent increase in referral rates (from 4.83 to 9.29 percent) over the last decade, analyzing a nationally representative sample of 845,243 ambulatory patient visits from the National Ambulatory Medical Care Surveys, 1993-2009.

"Understanding trends in physician referrals is critical both for improving patient care and for managing costs," said Michael Barnett, lead author on the study and a first-year resident in internal medicine and primary care at Brigham and Women's Hospital.

The results will be published January 23 in the . For many years, the rate of referrals stayed flat, until about ten years ago, when they began a steady climb. This paper is the first research to analyze referral data since the trend began. The marked increase in referral rates is likely due to increased specialization in medical care, and increasing responsibilities for during a typical 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," said coauthor Zirui Song, an HMS student and PhD student in health policy.

The researchers noted that referrals to specialists are often gateways to a cascade of potentially costly services which may or may not be needed: The cost associated with a referral isn't just the cost of a single visit, it's the potential for an ongoing series of visits, diagnostic tests, procedures and hospitalizations that might result.

In some cases, a more conservative approach can have better results and lower costs. For example, instead of referring a patient with ankle pain for an MRI and a visit to an orthopedist, a physician might first recommend rest and physical therapy.

"This study is step one, an attempt to start to get our heads around the question by describing the basic epidemiology of physician referrals," said Landon. In order to manage the rising costs of health care and guarantee the best outcomes for patients, he added, researchers need to understand the interactions between networks of referring physicians and the appropriateness of referrals.

Explore further: Referral decisions differ between primary care physicians and specialists

More information: "Trends in Physician Referrals in the US, 1999-2009" by Barnett et al. Archives of Internal Medicine, Jan. 23, 2012

Related Stories

Referral decisions differ between primary care physicians and specialists

September 19, 2011
How do physicians decide which colleague to refer their patient to? It differs depending on whether you ask primary care or specialist physicians, according to research from Harvard Medical School, Brigham and Women's Hospital, ...

Self-referral: A significant factor in imaging growth

July 1, 2011
A recent study in the Journal of the American College of Radiology suggests that self-referral in medical imaging may be a significant contributing factor in diagnostic imaging growth.

Rising barriers to primary care send many Americans to the emergency department

August 9, 2011
A shortage in the number and availability of primary care physicians may continue to mean rising numbers of emergency department visits, despite the expanded health insurance coverage required by the 2010 Patient Protection ...

Recommended for you

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

Safety of medical devices not often evaluated by sex, age, or race

July 25, 2017
Researchers at Yale and the University of California-San Francisco have found that few medical devices are analyzed to consider the influence of their users' sex, age, or race on safety and effectiveness.

Why you should consider more than looks when choosing a fitness tracker

July 25, 2017
A UNSW study of five popular physical activity monitors, including Fitbit and Jawbone models, has found their accuracy differs with the speed of activity, and where they are worn.

Dog walking could be key to ensuring activity in later life

July 24, 2017
A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.

Alcohol to claim 63,000 lives over next five years, experts warn

July 24, 2017
Alcohol consumption will cause 63,000 deaths in England over the next five years – the equivalent of 35 deaths a day – according to a new report from the University of Sheffield Alcohol Research Group.

Alcohol boosts recall of earlier learning

July 24, 2017
Drinking alcohol improves memory for information learned before the drinking episode began, new research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.