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Decisions to refer obstetric patients are often complicated by social and financial considerations as well as medical risks. To study such decisions, 600 Fellows of the American College of Obstetricians and Gynecologists were studied using a new decision analysis technique. It was found that obstetricians base their referrals predominantly on medical factors, but that other considerations can affect a close decision. Physicians differed on their indications to refer, as well as on the weight placed on some factors. Such differences could not be explained by age, training, or practice characteristics. Studying the referral process is important because successful regionalization depends on appropriate referral.
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