Unlike a primary care practice where the patient is the only customer, a specialty practice has two customers—the patients and the primary care practices who refer their patients to them. The primary care practice referral network can be the lifeline or death-knell of a specialty practice.

A new physician seeking to join a specialty practice should inquire about the referral relationships the practice has developed. Specialists may think they are top-notch in the services they provide patients. However, if the primary care physicians in the community do not concur in this clinical assessment or there are unresolved personality issues between the practitioners or the primary care physicians’ patients have complained about some facet of the specialists’ services, the specialists’ negative reputation will be a significant obstacle to overcome.