Many physicians report encountering barriers when referring cancer patients to specialty care, according to research published in Cancer.

Daniel H. Kwon, from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues analyzed responses (1,562 primary care physicians [PCPs] and 2,144 specialists) to the multiregional Cancer Care Outcomes Research and Surveillance Consortium physician survey.

Assessed physician-reported barriers to cancer specialist referrals included: restricted provider networks, preauthorization requirements, patient inability to pay, lack of surgical subspecialists, and excessive patient travel time.

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The researchers found that three in five physicians reported always, usually, or sometimes encountering any barrier to cancer patient specialty referrals.

International medical graduates, physicians practicing in solo or government-owned practices, and physicians with <90 percent of their patients in managed care plans had higher barrier scores than others (P < 0.05), after adjusted analyses.

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These high barrier scores were also tied to lower physician career satisfaction among both PCPs and specialists (P < 0.05).

“Uniform systems for providing and tracking timely referrals may enhance care and promote physician career satisfaction,” the authors write.


  1. Kwon, Daniel H., BA, et al. “Physician-reported barriers to referring cancer patients to specialists: Prevalence, factors, and association with career satisfaction.” Cancer. DOI: 10.1002/cncr.29019. September 5, 2014.