Why do physicians vary so widely in their referral rates?

Peter Franks, Geoffrey C. Williams, Jack Zwanziger, Cathleen Mooney, Melony Sorbero

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

OBJECTIVE: To determine which physician practice and psychological factors contribute to observed variation in primary care physicians' referral rates. DESIGN: Cross-sectional questionnaire-based survey and analysis of claims database. SETTING: A large managed care organization in the Rochester, NY, metropolitan area. PARTICIPANTS: Internists and family physicians. MEASUREMENTS AND MAIN RESULTS: Patient referral status (referred or not) was derived from the 1995 claims database of the managed care organization. The claims data were also used to generate a predicted risk of referral based on patient age, gender, and case mix. A physician survey completed by a sample of 182 of the physicians (66% of those eligible) included items on their practice and validated psychological scales on anxiety from uncertainty, risk aversiveness, fear of malpractice, satisfaction with practice, autonomous and controlled motivation for referrals and test ordering, and psychosocial beliefs. The relation between the risk of referral and the physician practice and psychological factors was examined using logistic regression. After adjustment for predicted risk of referral (case mix), patients were more likely to be referred if their physician was female, had more years in practice, was an internist, and used a narrower range of diagnoses (a higher Herfindahl index, also derived from the claims data). Of the psychological factors, only greater psychosocial orientation and malpractice fear was associated with greater likelihood of referral. When the physician practice factors were excluded from the analysis, risk aversion was positively associated with referral likelihood. CONCLUSIONS: Most of the explainable variation in referral likelihood was accounted for by patient and physician practice factors like case mix, physician gender, years in practice, specialty, and the Herfindahl index. Relatively little variation was explained by any of the examined physician psychological factors.

Original languageEnglish (US)
Pages (from-to)163-168
Number of pages6
JournalJournal of General Internal Medicine
Volume15
Issue number3
DOIs
StatePublished - 2000
Externally publishedYes

Fingerprint

Referral and Consultation
Physicians
Psychology
Diagnosis-Related Groups
Malpractice
Managed Care Programs
Fear
Organizations
Insurance Claim Review
Databases
Risk Adjustment
Family Physicians
Primary Care Physicians
Uncertainty
Motivation
Anxiety
Logistic Models

Keywords

  • Physician's practice patterns
  • Primary health care
  • Referral and consultation

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Why do physicians vary so widely in their referral rates? / Franks, Peter; Williams, Geoffrey C.; Zwanziger, Jack; Mooney, Cathleen; Sorbero, Melony.

In: Journal of General Internal Medicine, Vol. 15, No. 3, 2000, p. 163-168.

Research output: Contribution to journalArticle

Franks, Peter ; Williams, Geoffrey C. ; Zwanziger, Jack ; Mooney, Cathleen ; Sorbero, Melony. / Why do physicians vary so widely in their referral rates?. In: Journal of General Internal Medicine. 2000 ; Vol. 15, No. 3. pp. 163-168.
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