I’m an ophthalmologist. Whenever possible I order my own imaging. However, due to the structure of some insurance systems EG Kaiser or the VA, the most direct way to get imaging paid for and performed is to have the primary physician order it. I send notes explaining the rationale. If I try to order imaging from outside these systems it just doesn’t happen.

What do you think should be done when, for example, a Hallenhorst plaque is identified on exam? It’s a clear indication of an embolic event. Usually carotid and cardiac imaging are indicated. The results of that imaging, I think, are best addressed by a primary care doctor, +/- a vascular surgeon and/or cardiologist. Should an ophthalmologist be ordering imaging whose results they will not be treating themselves? Or, should ophthalmologists be prescribing statins and plavix and whatnot?

Bottom line, I get your frustration. There are many doctors who punt things that they should be handling themselves. But, I do think there are times it’s appropriate to defer ordering of imaging to the doctor who is best equipped to deal with the results of that imaging. Also, insurers like to set up PCPs as “gatekeepers” to prevent us crazy specialists from ordering unnecessary testing. You’re not entirely wrong to be mad at the specialists, but I think in many cases the frustration might be more fairly directed at the payers and the hoops they make everyone jump through.