Competing for Referrals for Cardiac Diagnostic Tests: What Do Family Physicians Really Want?

In recent years, there has been a substantial shift in where many cardiac diagnostic tests are performed. Not-for-profit hospitals now have to compete with for-profit private clinics for referrals from family physicians. This study aims to evaluate the key factors that family physicians consider when deciding where to refer their patients for several cardiac diagnostic services. Ninety-one family physicians were recruited from one of Ontario's 14 regional local health integration networks (LHINs). These physicians reported on 1,262 referrals made in the previous month for echocardiography, cardiac stress testing, cardiac nuclear imaging, and arrhythmia management. Family physician referrals were almost evenly split between not-for-profit hospitals and for-profit private clinics. The primary criteria influencing the location of referrals were: (1) speed of notification of test date; (2) short wait time for patients; and (3) speed of obtaining test results. Study findings also revealed that 23% of participating family physicians referred 25% or more of all patients needing cardiac diagnostic tests outside of their local LHIN, even though 80% of participants indicated that it is "important" or "somewhat important" to have their patients access cardiac diagnostic services within their local LHIN. Knowledge of the criteria that influence family physician decisions on where to refer patients for cardiac diagnostic testing may be used to assist both hospitals and private laboratories in better meeting the needs of physicians and patients. In particular, failure to meet physicians' expectations regarding fast access and communication of results can be expected to have a negative impact on referrals for cardiac diagnostic testing to a particular facility.