[JoMar]

I think there are a couple things going on......first, someone has to diagnose the issue and usually GP's know the limits of their skill sets so they will refer. Second, some insurance plans require a referral before you can go to a specialist. If your plan doesn't have that restriction you can self diagnose and go directly to specialist. My GP in PA got a $20.00 co pay and had to spend time doing the diagnostic thing, running the tests, research etc. Then he forwarded me and all his results to a specialist who claimed the big bucks. Based on revenue streams if a referral fee exists I'm not against it but it does seem that there are less doctors becoming GP's and more going into the specialty fields. The cost of a medical education is hard to recover in the GP ranks.