The other day I was presented with a spread sheet of all of my referrals, pointing out that my percentage to “network” specialists (doctors who work in the same physician group that I do) was too low and that I should only refer to the network physicians in the future.
This is a new twist to things, one that I find particularly disconcerting, and I wrestled over whether or not to write about it.
First, I am in a practice in an outlying community with a competing hospital just a few miles down the street with great, competent specialists. To refer to network physicians only, I would be asking patients to drive to a large city some distance away, forcing them to deal with the traffic and parking issues that come with that. A fair number of patients are elderly and this is a huge burden for them. Heck, I do everything I can to avoid it myself.
Further, some of the network specialists are not the best choice. They are not the best in their field, or they have office staff that make scheduling appointments difficult, or they are just the wrong personality for a certain type of patient. Some of my patients have very strong opinions about who they see, in network or not. Maybe a family member was cared for by a certain oncologist, or a friend’s knee was replaced by a certain orthopedist. Who am I to say that they cannot see that specialist?
There is the argument that referring to someone that shares the same electronic health record streamlines the process so work up is not duplicated but so many pay no attention to what I have done, even though it is staring them in the face.
But then, I guess what really gets my dander up is that I should be allowed to decide what is best collaboratively with my patients, not required to make choices because someone who is not directly responsible for these patients says it should be so.
Next point: I don’t think as a physician that you should be guaranteed a referral base just by affiliation. That has to be earned by being good at what you do…taking care of my patients so well that they think I am awesome as heck for sending them to you and then communicating back to me in a constructive way.
When I pointed these things out and asked if it was legal or even ethical to make this demand, I was told that So-And-So big group has a 90% internal referral rate. And that makes it ok? That is like saying I should write a certain antidepressant for a patient because “it is the most prescribed.”
I am struggling with what to do. Little indignities like this have added up over time, chiseling away at our autonomy. Where is the line in the sand? Is there a line? Should there be a line? Do patients care?