Background and Objectives: Physician referral patterns significantly impact
costs, quality of care, and access to the health system. This paper examin
es factors predictive of patient referrals to specialists by primary care r
esidents. Methods: New adult patients (n=509) were randomly assigned to pri
mary care residents at a university medical center. Patient referrals to sp
ecialists were monitored for I year of care. Self-reported patient health s
tatus, sociodemographic information, number of primary care visits, and phy
sician practice style behaviors were incorporated into statistical analyses
predicting specially referrals. Results: Patients who were referred to spe
cialty care were significantly older, had poorer physical health, and saw t
heir primary care physicians more often than patients who were not referred
. Patients were most frequently referred to surgical specialty clinics. Aft
er controlling for physical health status, gender and age, more frequent vi
sits to a primary care resident physician who had a technically oriented st
yle of care was associated with a greater total number of specialty clinic
referrals. Conclusions: Patient variables, as well as physician practice st
yle, have an important impact on the specialty referral process. Although t
he appropriateness of referrals was not evaluated, these findings have impl
ications for health care delivery.