Journal of Medicine - The specialist will see you now — and it’s one of the reasons that medical care has become more expensive.

In a recent study researchers from Harvard Medical School found that the likelihood that a doctor referred a patient to another doctor, often a specialist, nearly doubled from 1999 to 2009.

Doctors decided to send their patients to other doctors 9.3 percent of the time in 2009, compared with 4.8 percent a decade ago, according to the researchers’ work. The estimated number of visits resulting in referrals more than doubled over the same period, from 40.6 million to 105 million, according to the researchers.

“This evolution in care patterns may be playing a role in the rising trajectory of health care spending in the U.S., as referrals to specialists may lead to increased use of higher-cost services,” the researchers say. While some of these referrals lead to necessary treatments, others are responsible for additional tests and procedures that do little to benefit patients, the authors say.

Either way, costs go up.

So why are doctors quicker now to send a patient to a specialist?

Dr. Bruce E. Landon, a physician and health policy professor at Harvard Medical School and one of the paper’s authors, says medicine has become more complex, with specialists and subspecialists seen as expert in the latest treatments. “Medicine is becoming increasingly technologically sophisticated,” he said in an interview.

But Dr. Landon also points to the “tyranny of the 15-minute visit,” during which the average primary-care physician does not have the time or resources to delve into any potentially complicated medical condition.

Dr. Landon says it is important for more work to be done about when these referrals are appropriate and when they should be avoided. Researchers have not conducted extensive analysis about how doctors make use of specialists, he said.





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