Patients should have the freedom to choose their physicians, other clinicians and settings, with clear information on coverage, network quality, access restrictions and costs (deductibles and copayments). Ensuring quality care and facilitating patient choice often involves consultations, referrals and transfers of care.
The terms “consultation,” “referral” and “transfers of care” are, at times, used interchangeably. However, the American Academy of Family Physicians believes there are essential differences among these terms.
A consultation is a request from one physician to another for an advisory opinion. The consulting physician performs the requested service and makes written recommendations regarding diagnosis and treatment. The consulting physician is personally involved in every consultation during the hospital admission. The requesting physician utilizes the consultant’s opinion, professional judgement and other considerations (e.g., patient preferences, other consultations, family concerns and comorbidities) to treat the patient.
Equitable access to consultation is essential for comprehensive patient care. The AAFP believes all medical staff members should have access to consultation when necessary, and timely requests should not be refused. Hospitals have an ethical responsibility to provide timely consultation or backup. Mandatory consultations or referrals based on specialty or department membership without considering individual capabilities are discriminatory.
A referral is a request from one physician to another to manage one or more of a patient’s conditions. The accepting physician must maintain timely communication with the referring physician and seek approval for treating or referring the patient for any other condition not part of the original referral. Any physician receiving a referral is accountable for the care plan and overall quality, even when other team members deliver parts of the care.
It is improper for physicians to receive payment from an entity, including non-monetary items of value, to induce or reward referrals. This policy is not intended to preclude any safe harbors defined within the context of the Federal Anti-Kickback legislation, Stark legislation, accountable care organization contracts, bundled episodes of care payment or other similar business arrangements, such as legal gain sharing agreements or risk contracts.
A transfer of care occurs when one physician turns over responsibility for the comprehensive care of a patient to another physician. It can be initiated by either the patient or by the physician, either permanently or temporarily. The transferring physician should inform the patient of the transfer, assist the patient with timely transfer to ensure access and expedite care. (2007 COD) (October 2025 COD)