How referring doctors choose a specialist

When a primary care physician decides where to send a patient, the choice often takes a few seconds. It rests on years of impressions: which offices answer the phone, which ones send notes back, and which specialists the doctor has actually met.

Researchers have asked referring physicians directly what drives that choice. The answers are consistent, and they should encourage any independent specialty practice.

Skill is the price of entry

In a national survey of 553 primary care physicians published in the Annals of Family Medicine, 88% rated the specialist's medical skill as a major factor. That makes sense. No one wants to send a patient to a doctor they don't trust.

But most specialists a referring doctor knows are skilled. Once that bar is cleared, other factors decide the referral. In the same survey:

• 59% rated their previous experience with the specialist as a major factor.
• 55% rated how quickly the patient could get an appointment.
• 53% rated the quality of the specialist's communication back to them.
• 51% rated the specialist's effort to send the patient back to primary care.

Every one of those is about how the practice runs, not about clinical ability.

Referrals follow relationships

A 2011 study from Harvard Medical School surveyed 386 physicians about how they pick colleagues to refer to. Two-thirds of primary care physicians said they referred within their own professional networks. Primary care doctors also put more weight than specialists did on easy access for patients and on good physician-to-physician communication. Across all physicians, the most common reason for choosing a colleague was that their patients had good experiences with that doctor.

In other words, a referring doctor sends patients to people they know, whose offices make things easy, and whose patients come back happy.

What this means for your practice

1. Be known in person. A referring physician who has met you, or someone who represents you, is more likely to think of you first. Relationships don't build themselves from a website.
2. Make the first appointment easy. Give referring offices a direct line, tell them what to send, and see their patients quickly.
3. Send the note back. A clear consult note, sent promptly, tells the referring doctor their patient was cared for and that you respect their role.
4. Send the patient back. When the specialty care is done, return the patient to primary care with a clear plan. Referring doctors notice who keeps their patients and who returns them.