"Survival has not doubled in the United States during this [10-year] time. We haven't seen major improvements in health outcomes during that time.... I don't want to give it a number, because there's no data, but as a practicing doctor, I would say a large number of specialty referrals do not in and of themselves lead to benefit."
Those could be fighting words. Katz says that in his experience, often these referrals happen even though the generalist is confident of the diagnosis and could manage the patient with a prescription or advice, but decides to refer to escape legal responsibility or a lawsuit if something about the case goes wrong, he says.
One hint that seems to support some of Katz' view comes in a few lines from the Harvard paper indicating that referral patterns are much more discretionary, a function of economic interests, than most doctors would like to admit.
The increase in referral patterns to specialists was upwardly consistent "across all subgroups examined, except for slower growth among physicians with ownership stakes in their practice or those with the majority of income from managed care contracts," the Harvard researchers wrote.
So doctors refer when they have no financial stake in keeping the patient, and don't when they do?
The authors said this "might reflect a financial incentive for these physicians to keep patients' care within their practice."
Katz expands, saying that he even questions the reason why a referred patient actually has to physically "visit" a specialist. "If the primary care doctor is unsure, why can't that doctor just call the specialist? That would be less expensive for everybody, and more convenient for the patient.