LA CROSSE, Wisconsin (WXOW) - Sabrina Alexander walks into a hospital and happily greets a doctor.
"Hi Dr. Cepeda!" she exclaims.
A meeting like this may be the reason your primary care doctor recommends the next specialist you see. Alexander spends most days visiting different physician's offices armed with brochures and head shots touting the qualifications of the doctors in the orthopedic group where she works.
"The things that I can do really help my specialists shine to other primary care physicians and help them stand out against the- our competition," says Sabrina.
She's part of a growing industry of "client liaisons." Front line "go-betweens" like Sabrina --- and even entire marketing firms --- are hired by specialty physicians to hit the road. To let primary care docs know their expertise is available.
"Oftentimes that is the only way that we learn about a new doctor in town," says Pediatrician Dr. Michael Cepeda.
That's because health care has changed dramatically over the last decade. One study found the number of patients referred to specialists nearly doubled. And busy primary care docs, like Dr. Cepeda, don't spend as much time in the hospital meeting other specialists. Instead they're booked solid in their offices, with patients, charts and follow up care.
Dr. Cepeda says he's happy to meet with specialists' representatives. "Whenever I need another resource they're the best way for me to find out what else can be done for your health care."
But critics worry these office-to-office pitches could pose an ethical health hazard.
"I don't think patients have the vaguest idea of, uh- that their referral might have been the result of a marketing campaign," says Bioethicist, Lawrence Nelson.
Nelson hopes primary care docs are basing referrals only on specialists' qualifications.
"The best protection for patients is physicians who are following their ethical obligation to make referrals based upon the patients need and personal preferences and not on slick marketing or any kind of other inducements," Nelson says.
The American Medical Association says there's strict ethical guidelines and laws regarding patient referrals---similar to rules regulating pharmaceutical sales reps. Physicians have to be knowledgeable about a specialist's experience and can't accept referral fees.
"My job is to refer my patients to whoever I think is going to provide the highest level of medical care in that situation," argues Dr. Cepeda.
And Sabrina says her office visits are just one step in initiating long-term personal relationships between primary care doctors and specialists. And, she points out, if a patient is steered the wrong way--it affects the doctors too.
"The primary care physician's reputation is also on the line. So they have to be comfortable with the specialists that they're referring their patient to," says Sabrina.
Experts say patients should always ask any specialist they're referred to basic questions like: "Have you seen problems like mine before?" "How many patients have you treated with this condition?" and, "What were the outcomes?"