I’m a gyn oncologist new to private practice (been in academics my whole time) so this is somewhat new to me. In academics, the referral are always pretty straight forward and typically almost always follow standard of care down to the letter. As I’m closing into 6 month at my new job, it seems like the spectrum of referrals are wild.
Some examples are I got several referrals for sarcomas where the primary OBGYN did a supracervical hyst. No mentions of why, they just left the cervix. My gut feeling is that a total hyst and supracervical hyst pays the same, and it’s much easier/faster to do a supracervical. But now this means I have to go do a trachelectomy, which is an extremely unpleasant procedure that doesn’t pay well; but it’s the right thing to do so I sort of feel obligated to.
Another example is I keep getting referred endometrial cancer patients where the primary OBGYN just didn’t do a biopsy. They just did the hyst and went whoops I guess there’s cancer. These patients all fit the clinical picture of cancer (older, obese) so it’s wild there was no biopsy. Now I have to counsel on full lymphadenectomies whereas if I had the referral prior to the hyst, I could’ve done sentinel nodes and saved her a lot of morbidity.
I’m the new guy here so I definitely don’t want to rock the boat or potentially lose out on future patients, but at the same time it seems like a lot of private practice physicians do stuff that I find odd. Any tips on how to navigate this?