DOES THE DOCTORS PROFESSIONAL EXPERIENCE REDUCE REFERRAL RATES - EVIDENCE FROM THE FINNISH REFERRAL STUDY

Objective - To examine hospital referral rates in Finnish health centr es according to doctors' and health centres characteristics. Design - Survey of all general practice hospital referrals over one week. Setti ng - Central and northern part of Finland, in a region comprising 72% of the area of the country and one-third of the population. Participan ts - 851 health centre doctors. Outcome measures - Referral rates in t erms of characteristics of doctors and health centres. Results - Durin g the study period, the 851 health centre doctors had 58 760 consultat ions (mean 69 patients/week), and 2 921 (5%) patients were referred to secondary care. The variation between the highest and lowest referral quintile of the doctors was almost 17-fold, and of the health centres 2.4-fold. Relatively more referrals were made by locums, young, not y et graduated and female doctors than by specialized, more experienced and male doctors. Conclusion - A low referral rate is closely connetec ted with the extent of the general practitioners' professional experie nce and specialist training. Investing in specialist training and cont inuing medical education seems to be the best way to reduce high refer ral rates.