It's "Just Business"

A colleague saw a patient for shoulder surgery. The patient was sent to him by another orthopedic surgeon. His family doctor had sent him there. It was strange, because that surgeon asked the patient: "Why did he send you here? I don't do shoulders." So he sent him to this other orthopedic surgeon. You would think, perhaps, that maybe the "primary care" physician thought the other surgeon was better. However, that wouldn't explain why he had sent his wife to the second doctor. In other words, he would send his wife to one physician for surgery and he would send his patients to another one - one who doesn't do shoulders. Well, it's not really much of a surprise. People send the patients where they're "supposed to". That may be the best specialist for the job in some people's minds. However, if you are an administrator who employees physicians, the physician that your employees send patients to may be the one who has the best economic performance gains for your interests. It's "just business," after all.
I hate the medical "business".
In my town, the new hospital CEO has spent the last two years buying every internal medicine practice that can be bought. At this point, they are all owned except for two. So what the CEO says is what happens. Since they are now going to be hiring a neurologist, all of the referrals for neurology are likely going to go there. But that's "just business". I'm lucky, because a great deal of my practice comes through referrals from patients that have seen me previously. But it's still disconcerting. I think patients expect that their doctors are going to make referrals on the basis of quality.