This page is currently under revision. Please return for what we hope will be useful information. We have noticed that as the delivery of medical care has changed over the past two decades there has been a concomitant change in the way in which physicians interact with one another. This change is largely the result of contracting. Not so long ago, personal referral relationships between physicians were the driving force directing flow of patients to specialists.
Contracts now drive the way physicians are referred new patients.
Indeed, it is not at all uncommon in large urban areas such as Los Angeles for physicians to correspond with primary care physicians by way of consultation reports and authorization requests and never personally meet one another. This is particularly so in those managed care settings that employ hospitalists to manage inpatients. A primary care physician may refer a case that requires surgery. Then, on admission, the patient is turned over to the hospitalist. The opportunity to interact on a more personal basis with the primary care physician is lost in the reality of time, increased patient loads, and the hospitalist system.