Office practice organization: A determinant of physicians' rate and pattern of referrals.
Lamarche, Paul Auguste
1992
Abstract
This study is concerned with the effect of office practice organization on the rate and pattern of referral of general practitioners and medical internists. Office practice organization is defined by whether or not physicians share office location, expenses and income. The more items shared the more the office practice is described as being formally organized. Physicians sharing none of these items are said to be involved in solo practice. The referral rate is measured by the number of referrals requested by a physician over the total number of patient visits received over a year. The pattern is described by three characteristics of the clinicians selected as referral partners: the level of specialization, the specialty, and whether or not the consultants selected are affiliated with the same office practice as the referring physicians. The referral practice of physicians is examined on the basis of a model that assumes that physicians respond to two types of pressure: to integrate their professional activities with those of colleagues for channelling patients to an appropriate source of care, and to protect the autonomy of their practice. The model posits that, depending on the type of office practice, physicians are constrained either in their rate or in their pattern of referral in order to protect the autonomy of their practice. The universe of this study consists of 598 general practitioners and certified medical internists who practiced in the Montreal region of Canada in 1974. The analysis provided only partial support for the hypotheses. As expected, physicians involved in formal types of office practice tended to refer a greater proportion of their patient visits than did solo practitioners. Moreover, these physicians sent a greater proportion of their referrals to clinicians affiliated with their own office practice than physicians involved in less formal type of practice. These relationships held even when taking into account the influence of the referring physician's specialty, number of years in practice, work load, patient mix and the number of specialties represented in the office practice. Several hypotheses were unsupported by the results. Office practice organization did not account for the level of specialization of the clinicians selected as referral partners. It explained a small but statistically significant proportion of the variation in the number of different specialties to which patients were referred, but this influence was in the opposite direction to the one expected. Physicians in more formal types of office practice tended to refer to a larger variety of specialties than did their colleagues in solo practice.Other Identifiers
(UMI)AAI9226946
Subjects
Health Sciences, Public Health Health Sciences, Health Care Management
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