Referral Relationships Between Internists and Psychiatrists in Fee-For-Service Practice: An Empirical Examination

Increased demand for mental health services has focused increased attention on the nature of referral relationships between primary care physicians and psychiatrists in the delivery of psychiatric care. Using data collected from a population of internists in fee-for-service practice in the northern suburbs of Chicago, this paper focuses on issues involving the extent to which internists see psychiatric conditions in their practice; the extent of referral to and from psychiatrists; the most common conditions referred to psychiatrists; the most common treatment modalities used by psychiatrists; the most common reasons psychiatrists refer to internists; and internists ratings of satisfaction with various aspects of their psychiatric referral relationships. A contingency model is proposed as a framework for further understanding the process. Specific propositions to be tested in future research are presented.