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A specialist survey at Mayo Clinic agreed that e-consult was less disruptive than consultations by telephone or pager by 67%. And at the San Francisco General Hospital there was a reduction of 2.1% in inappropriate specialty referrals by the surgical specialty clinicians compared to 9.8% of paper-based referrals.
However, "in the private fee-for-service context, the loss of specialist income is a powerful barrier to e-referral, a barrier that might be overcome if health plans compensated specialists for the time spent handling e-referrals." [20] In Canada, the proportion of services billed under FFS from 1990 to 2010 shifted substantially. [21]
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The huisarts (literally: "home doctor") administers first line, primary care. In the Netherlands, patients usually cannot consult a hospital specialist without a required referral. Most GPs work in private practice although more medical centers with employed GPs are seen. Many GPs have a specialist interest, e.g. in palliative care.
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There is a large volume research indicating that self-referral has a major effect on increasing medical costs in the US. David Levin estimated the cost of unnecessary self-referred imaging in 2004 to be, conservatively, $16 billion per year. [3] There are several examples showing that self-referral increases utilization and costs:
The U.S. Preventive Services Task Force released a draft recommendation advising against using vitamin D to prevent falls and fractures in people over 60. Pharmacist Katy Dubinsky weighs in.