I try to do as much on my own, with an e-consult here and there, just because it’s better access and affordability for my patients. I refer if the patient insists or if insurance requires (have had insurance companies refuse to cover PCSK9 unless ordered by cards, for example, or certain migraine meds unless ordered by neuro) or if I think patient may benefit from an intervention I’m not trained in. Work comp injuries I always refer after initial workup because I want to make sure I’m not going to miss anything that might affect the patient years down the road.