Referrals Tapering Off? This May Be Why

Leigh Page


April 17, 2014

In This Article

Where Are the Referrals Going?

If you are an independent, self-employed physician and your referrals are drying up, it could be part of the growing trend of hospitals hiring their own doctors. Hospital-employed physicians are often asked to refer patients to in-house physicians, disrupting referral patterns that independent physicians have counted on for years.

Jewett Orthopaedic Clinic, with 25 physicians in 6 subspecialties, has thrived for 77 years in the Orlando area. But last year, "for the first time ever, we noticed a drop-off in business," said John W. McCutchen, MD, Jewett's former president and chairman of the board, who is now retired.

Dr. McCutchen blamed the drop-off on a hiring spree by the 2 dominant hospital networks in the area. In late 2012, Orlando Health paid $50 million for Physician Associates, the largest practice in Central Florida. With 95 physicians, Physician Associates was a major referral source for Jewett, but now more of its referrals are going to Orlando Health specialists.

The other local hospital system, Adventist Health, is also no slouch in hiring physicians, who then often change referral patterns, according to Dawn J. Lipthrott, a local patient advocate who runs a Website called Ethical Health Partnerships.

Lipthrott said she believes that Adventist has used its size to steer patients away from independent surgeons, fundamentally changing local referral patterns in a very short period of time.

A marriage counselor, Lipthrott became interested in physicians' referral patterns in her area several years ago in a conversation with her doctor, a breast surgeon. The doctor said she was losing referrals to newly arrived doctors employed by Adventist, so Lipthrott decided to research the problem, using data from the Florida Agency for Health Care Administration.

Tracking the volume of breast surgeries in the area, she compared the volume of surgeons who had long specialized in breast procedures with that of the Adventist surgeons, all but 2 of whom were new to the area.[1] Normally, it would take years for new surgeons to build a reputation, but their volume shot up and quickly surpassed that of the established surgeons.

In state data from 2006, Lipthrott found that the established surgeons logged more than 500 breast surgeries -- still way ahead of the Adventist surgeons, who logged about half as much. But by the next year, the Adventist surgeons' volume had almost doubled and had already beaten out the established group, whose volume had fallen to just over 400 surgeries.

Steven Lester, MD, a radiation oncologist in the Orlando area, read Lipthrott's findings and found them all too familiar. "Those data mirror what I've seen in my practice and what other independent physicians have seen with regard to practice referrals," he said.

Dr. Lester said his own practice has seen a decline in referrals from hospital-employed urologists, adding that freestanding imaging centers in the area have seen referral patterns from hospital-employed orthopedic surgeons "change overnight."


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