You’ve seen your primary care doctor, and she feels you need to see a specialist or have more tests. She identifies the specialist (or lab or imaging facility) and tells you that’s where she wants you to go. Sometimes, she’ll even have her front office staff schedule the appointments for you. Now that’s service! But did you know that you can go wherever you would like to go for your medicals care? You don’t need to go where your doctor sends you.
Here are some falsehoods that you should consider when you need specialty care or services:
I Must Go Where My Doctor Sends Me.
FALSE. In fact, it might be a violation of federal and state laws if your doctor tells you where you must go for care. Your doctor’s opinion should be seriously considered as a factor in choosing your care. But it should be just one factor among many others to consider: location, family and friend testimonials, appointment availability, and treatment philosophy are some things you should look into to find the specialist or service provider that’s right for you. One size does not fit all, so find the provider that fits your needs.
My Doctor Is Always Looking Out For My Best Interests jitendra swarup.
FALSE. Have you ever heard of a “Quality Score”? I hadn’t either until an MD friend of mine slipped up and mentioned this over dinner one night. It’s a dirty little secret among physicians.
I think the easiest way to look at this is to look at how salespeople are sometimes compensated. If a business wants to sell more of product A than product B at some point in time, the salespeople will be paid a higher commission for selling product A. It’s human nature in a capitalist economy; we’ll usually push what can bring us more money. Well, doctors who are parts of groups are usually paid bonuses to drive specific behavior that management wants, and some of that bonus is based on where you are sent for specialty care.
Over the years, at least a half-dozen referring doctors have called us and informed us that they would no longer be sending patients to us. They each told us that they recognize that we provide the highest possible quality care available, but that they just couldn’t deal any longer with the pressure from management to refer to the group’s “preferred providers”. In fact, one patient related to me that his doctor said he didn’t feel he needed to send his patients to “the best”, that the specialists or service providers to whom he referred just need to be “good enough”.
So, once again, you need to be looking out for yourself and use available resources (friends, family, etc.) to find the specialists that are right for you.
My Doctor Would Not Refer Me For Specialty Services If I Didn’t Need Them.
FALSE. There was an interesting blog post in the Washington Post  from January 2012:
“Referrals to medical specialists have more than doubled in the past decade, according to research published… in the Archives of Internal Medicine… The big question is why doctors have become more likely to send their patients to specialists… And, part of it likely has to do with the economics of referrals: Doctors who have an ownership stake in their practice are 50 percent more likely to refer to a specialist, which would increase the total revenue generated by a given patient.
“Remember my previous point? Compensation is a motivator and a factor among many physicians. If the doctor can benefit from the referral, she’s 50% more likely to make that referral.
The bottom line is that you need to look out for yourself and choose the specialists and specialty care that are right for you. Of course, make sure that the provider you choose accepts your health insurance. But THE CHOICE IS ALWAYS YOURS.