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Viewpoint |

Selecting a Specialist Adding Evidence to the Clinical Practice of Making Referrals

Niteesh K. Choudhry, MD, PhD1; Joshua M. Liao, MD1; Allan S. Detsky, MD, PhD2,3
[+] Author Affiliations
1Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
2Institute for Health Policy, Management and Evaluation, Department of Medicine, University of Toronto, Ontario, Canada
3Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario
JAMA. 2014;312(18):1861-1862. doi:10.1001/jama.2014.12963.
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This Viewpoint discusses data about consultants becoming available to referring physicians and patients in an effort to improve the selection of specialists.

Referring patients to other physicians is one of the most fundamental and frequently performed tasks in clinical practice. In 2009, referrals to other physicians were made during almost 1 in 10 ambulatory visits in the United States for a total of more than 100 million referrals.1 Despite the routine nature of referrals, there is significant variation in how and when physicians choose to ask for specialist involvement. Rates of referral appear to vary up to 5-fold, with both overreferral and underreferral being common.2 Decisions about whether to refer appear to be influenced by both patient factors, such as illness severity and expectations, as well as physician training and expertise.2 As a consequence, standardizing and optimizing the referral process may affect the cost and quality of care.3

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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