Pooled referral, also known as centralized referral intake (CRI), involves collecting referrals in a central location and then distributing the referrals so that patients have access to the specialist with the shortest wait time. When our urology group implemented this system several years ago, the reception from referring physicians was very positive. (Here's the post looking at wait times for pooled referrals.) They liked the fact that they didn't need to do the "heavy lifting" of figuring out which urologist had the shortest waiting list, or which one of us subspecializes in a certain problem.
When I have the chance to share our practice's learning and improvements, the idea of pooled referrals has an immediate appeal to both referring and consulting physicians. However, physicians do have some trepidation about the system.
First, they're concerned about patients (and referring physicians) having the choice of which consultant they will see. Our group's philosophy has been that patients and referring physicians have the choice of which urologist they see. We don't require participation in pooled referrals, however, if someone "opts out" of pooled referrals, they may wait longer to see the urologist of their choice.
Continuity of care is also a consideration. Physicians recognize that time and effort is wasted, and important clinical details may be overlooked, when patients switch between specialists. A pooled system should try to maintain any previously-established patient-physician relationships (as long as the patient wishes to do so).
Finally, I'm often asked a very thorny question: How can a pooled referral system ensure that patients will have a consistent experience no matter which specialist they see (AKA not all docs are created equal)? This applies to the interpersonal, as well as technical, skills of the specialist. This is very difficult to answer as there is often no formal tracking and reporting of individual surgeon's treatment outcomes and complications. Communication skills, empathy, and affability may only be judged through word of mouth.
This raises an ethical question: If we promote a new referral management system, and that system has the potential to adversely affect the experience and outcome of some patients, what is our responsibility to assess and improve the abilities of the specialists so that patients receive consistent, competent care that is constantly being improved?
I think that, by its very existence, a pooled referral/CRI system begins to address this concern. In order to implement this system, specialists must be prepared to communicate and collaborate, often to a degree that they previously didn't do. This lets them share information about, and expose differences in, individual practices. In our urology practice, learning about differences in our practice habits made us curious about what could be considered "best practice" and how we could offer more consistent care.
Pooled referral/CRI has the potential to improve patients' access to specialist care, and make sure that they receive care from the appropriate practitioner. However, it's not without drawbacks, and we must proceed with eyes wide open.