A physician may have the personal skills necessary to provide certain types of specialty care but lack the necessary resources. For example, an internist may be trained in cardiology but be practicing in a hospital that does not have an intensive care unit, or a patient may have a rare disease that can be treated by experimental drugs, but the drugs are licensed only to research centers. In such cases, the patients should be referred to a physician and medical center that have the necessary resources. Physicians must resist institutional pressures not to transfer insured patients if the original institution cannot provide appropriate facilities.

Providing very specialized care may require transferring the patient to a specialty hospital or regional center where none of the staff is known to the referring physician. In this case, the referring physician may have difficulty ensuring the quality of care that the patient will receive. To a large extent, the referring physician may have to rely on the reputation of the center; nevertheless, it is always a good idea to keep in touch with the patient and to request reports from the caregivers to ensure that the referral was appropriate and that the patient is receiving appropriate care.