Keywords: Referral and consultation, General Practitioners, Gender role, Workload

Introduction:

The systematic return of referrals from Specialized Care (SC) represents a potential source of overload, whose clinical, administrative, and emotional impact on the family physician has barely been quantified empirically.
To analyze the volume of interconsultations returned by SC to PC, identify the specialties with the greatest impact, and evaluate the clinical-administrative attitude of the family physician toward this return.

Method:

Observational, descriptive, and prospective study (May 2025). 17 health centers in Catalonia. A continuous, real-time registry of daily activity was used. Main independent variables: Medical specialty issuing the return, professional's gender, and work center. Dependent variable: Action adopted by the physician regarding the return, categorized in: 0-No action, 1-Assumption of the order: "I do what the return requests", 2-Institutional complaint, 3-Phone call to the department, 4-Identical re-referral, and 5-Other actions.

Results:

57 phisicians. Clinical average of 145 visits/week . A total of n=98 referrals were recorded, 1.72 returns received per physician per week.
Volume by Specialties: Traumatology/Orthopedics (n=42; 42.9%), Gastroenterology (n=9; 9.2%), Rehabilitation (n=8; 8.2%), Pulmonology (n=6; 6.1%),
Global attitude towards the return: Option 1 (Assumes order): 50.0%; Option 2 (Institutional complaint): 16.3%; Option 3 (Phone contact): 2.0%; Option 4 (Re-referral): 12.2%; Remaining options: 19.5%.
Distribution by gender: Average returns received: 2.07 for women versus 0.76 for men.
Option 1 by gender: 52.8% in women vs. 30.0% in men.
Option 1 by specialty: Rehabilitation (75.0%), Pulmonology (50.0%), Traumatology (47.6%), Gastroenterology (33.3%).
Option 1 by health center: Ranging from 100% or 66.7% (3 centers) in the centers with the highest assumption rate, compared to 37.5% in 3 other centers.

Conclusions:

The study demonstrates an evident shifting of bureaucratic and clinical workload from the hospital to primary care, concentrated mainly in Traumatology and Rehabilitation. This assumption of workload is not homogeneous: it presents a marked gender bias and is dependent on the "Center Effect"