Providing consistent access to outpatient specialty care for underserved populations remains a problem. Up to 25% of patients who present for care at community health centers need specialty and diagnostic services that are unavailable at these facilities. This paper, by Gail Patrick, MD, and John Hickner, MD, looks at ways that specialty care is being successfully provided to low-income patients.

Approaches to improving access to specialty care fall into three categories: (1) Expand the procedural, diagnostic, and management skills of community clinic primary care physicians; (2) improve the efficiency of the consultation and referral process; and/or (3) increase the supply of specialists willing to care for the underserved by addressing reimbursement and other logistical issues.

The selected programs can be categorized into four models:

• The "mini-fellowship" model of training and mentorship for individual physicians.
• The "registrar" model of primary care doctors working together with specialists to expand service.
• Innovative continuing medical education (CME) that provides opportunities to expand skills.
• Models that encourage the use of guidelines to streamline the referral process.

Case studies illustrate how each of these models has been implemented. Common themes that emerged from the research include the need for locally responsive solutions, building relationships with a network of specialists, acquiring direct access to diagnostic and imaging services, and implementing referral and management guidelines.

The complete paper is available under Document Downloads.