What do family doctor referral patterns look like in the Greater Toronto Area?

In our first 5 months connecting family doctors and specialists in the Greater Toronto Area, we’ve started noticing some interesting referral patterns at ConsultLoop.

The initial group of 75 family doctors sending referrals through ConsulLoop are all located within 50 kilometres of each other (spanning Scarborough to Oakville to North York). However, looking at the first 1000 referrals sent by these doctors, the referrals have been directed to specialists of their choosing that span from Niagara Falls to Newmarket to Oshawa, a 190-kilometre distance.

Of note, even with this small group, these referrals have cut across six of the provincial Local Health Integration Networks (LHINs) clustered around the Greater Toronto Area, specifically: Mississauga Halton, Hamilton Niagara Haldimand Brant, Central, Toronto Central, Central East and Central West. Even when looking at the referrals being sent by a single doctor, his or her choices of specialist routinely cut across three, four or five LHINs!

A map of specialists across 4 different LHINs receiving referrals via ConsultLoop from a single family doctor in the GTA.

A map of specialists across 4 different LHINs receiving referrals from a single family doctor in the GTA via ConsultLoop.

While some of this is the product of family doctors practicing near “corners” — where multiple LHIN boundaries abut one another — the sometimes 100-plus-kilometre distances between referral destinations originating from a single clinic have other explanations. One factor may be that patients live in different regions than where they work or where they are enrolled with their family doctor, one of the inevitabilities of a health system based in a large metropolitan area.

However, ConsultLoop is also doing something unprecedented in Ontario — giving physicians access to actual wait times and detailed practice information on clinicians they may refer to, both near and far, at the time of referral. This data helps doctors make an informed decision on which specialist might be best for their patient — based on practice focus, wait time, location etc — rather than only relying on a familiar (but limited, and usually very local) referral network.

What this means is that ConsultLoop can help a doctor from Newmarket find the next available lupus specialist in downtown Toronto; or help that patient seeing their family physician in Etobicoke visit a urologist closer to where they now live in Scarborough. Often, e-referral systems in Ontario have been limited to a LHIN’s borders, which fails to take into consideration this regional complexity. As clinicians ourselves, we usually don’t “feel” the borders of a LHIN, and patients almost certainly do not.

As many referrals being sent via ConsultLoop continue to follow existing relationship patterns (directed to nearby specialists, and to specialists to whom the family doctors has previously referred), our aim at ConsultLoop is to continue to support these existing referral networks, while also providing key information and other options when this is most needed.

And by providing this information on specialists in the Greater Toronto Area and beyond — and by crossing clinically artificial LHIN borders — we feel that ConsultLoop can help optimize timely access for the patient and provide value to the larger healthcare system, balancing wait times across regions, and ensuring that patients are always being directed to the right specialist.

We’ll keep you posted as more patterns emerge in the coming months!

stevep

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