From 1999 to 2009, the number of referrals of patients more than doubled from 41 million to 105 million. Outpatient visits to specialists that resulted in referrals rose from 11 million in 1999 to 38 million in 2009. Primary care physician visits resulting in referrals increased from 22 million to 51 million. Reasons for referrals included cardiovascular, gastrointestinal, orthopedic, dermatologic, and ear/nose/throat symptoms. The study was conducted by by Bruce Landon, MD, MSc, Professor at Harvard Medical School’s Dept. of Health Care Policy. Rising referral rates may be attrubted to increasing specialization of medicine, aging demographics with rising patient complexity and increasing time pressures on the primary care physician.