Most physicians engage in a specialty practice, with almost all new licensees
being specialists. Specialties range from narrow interests in an obscure disease
to family practice. The more narrow the specialty is, the smaller is the
potential patient population. If patients selected physicians at random, then
narrow interest specialists would spend all their time turning away patients.
The reality is that specialists with narrow interests traditionally depend upon
referrals from other physicians rather than marketing their services to patients
The most important limitation on a physician’s willingness to accept a patient is
that of a self-imposed specialty. Although there is nothing in the law to prevent
a dermatologist from practicing general medicine, most dermatologists will
decline to regulate a patient’s diabetes. In the same sense, a family physician
may be willing to treat acne and diabetes but unwilling to perform surgery.
These limitations cause a problem only if they are not known to the patient
when making an appointment. For example, a patient with severe
hypertension makes an appointment with an internist. After taking the
patient’s medical history, the physician tells the patient that he limits his
practice to gastroenterology. The patient would be justified in refusing to pay
for the visit. More important, this unnecessary appointment may delay proper
treatment for the patient’s condition. In this situation, the physician should
arrange for a referral and send the patient to an emergency room if he is
concerned with the delay in seeing the second physician.