Primary Care

Doctors' psychological traits have little if any bearing on their referral decisions

Primary care physicians (PCPs) in the United States vary widely in the rates at which they refer patients to specialists. Patient characteristics and physician practice factors, rather than physician psychological factors, appear to influence physician referral patterns, according to a study supported by the Agency for Healthcare Research and Quality (HS09397). University of Rochester researchers, led by Peter Franks, M.D., analyzed 1995 referral data from a large managed care organization that did not link financial incentives directly to referrals. They combined these data with a survey of 173 PCPs in the organization who reported their age, sex, and psychological characteristics, as well as practice characteristics.

Results showed that about 40 percent of patients were referred by their PCPs to specialists in 1995. Patient severity of illness (case mix) and certain practice characteristics explained most of the variation in referral rates. Both the observed and case-mix-adjusted referral rates showed moderate correlations with a number of physician practice variables. For example, patients were more apt to be referred if their physician was female, had been in practice longer, was an internist, or used a narrower range of diagnoses. Other physician practice variables were not significant.

Of physician psychological factors, only greater psychosocial orientation and malpractice fear were associated with greater likelihood of referral. When physician practice factors were excluded from the analysis, risk aversion was positively associated with referral likelihood.

For more details, see "Why do physicians vary so widely in their referral rates?" by Dr. Franks, Geoffrey C. Williams, M.D., Ph.D., Jack Zwanziger, Ph.D., and others, in the March 2000 Journal of General Internal Medicine 15(3), pp. 163-168.

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