• Caitlin B Finn, Jason K Tong, Hannah E Alexander, Chris Wirtalla, Heather Wachtel, Carmen E Guerra, Shivan J Mehta, Richard Wender, and Rachel R Kelz.
• NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA. Caitlin.Finn@pennmedicine.upenn.edu.
• J Gen Intern Med. 2022 Oct 1; 37 (13): 344434523444-3452.

BackgroundPhysician referrals are a critical step in directing patients to high-quality specialists. Despite efforts to encourage referrals to high-volume hospitals, many patients receive treatment at low-volume centers with worse outcomes. We aimed to determine the most important factors considered by referring providers when selecting specialists for their patients through a systematic review of medical and surgical literature.MethodsPubMed and Embase were searched from January 2000 to July 2021 using terms related to referrals, specialty, surgery, primary care, and decision-making. We included survey and interview studies reporting the factors considered by healthcare providers as they refer patients to specialists in the USA. Studies were screened by two independent reviewers. Quality was assessed using the CASP Checklist. A qualitative thematic analysis was performed to synthesize common decision factors across studies.ResultsWe screened 1,972 abstracts and identified 7 studies for inclusion, reporting on 1,575 providers. Thematic analysis showed that referring providers consider factors related to the specialist's clinical expertise (skill, training, outcomes, and assessments), interactions between the patient and specialist (prior experience, rapport, location, scheduling, preference, and insurance), and interactions between the referring physician and specialist (personal relationships, communication, reputation, reciprocity, and practice or system affiliation). Notably, studies did not describe how providers assess clinical or technical skills.ConclusionsReferring providers rely on subjective factors and assessments to evaluate quality when selecting a specialist. There may be a role for guidelines and objective measures of quality to inform the choice of specialist by referring providers.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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