Should doctors send patients to another hospital?

They should refer but most dont. The ER group at the hospital I work at risks loosing their contract if they do the right thing and transfer outside the network even when the best care in some situations is clearly out of the network. An example, our hospital has a non-interventional cardiac cath lab which is a cath lab that can do angiograms but cannot fix the problem by placing a stent in the coronary artery. The standard of care for an acute MI is to send them to a interventional cath lab in most cases. We keep them, try clot disolving meds which work sometimes but not always. The patient is held for the non-interventional cath at our facility then referred once that test has been done only to undergo another cardiac cath and stent placement. Try to go around it and get the patient striaght to the right cardiac cath lab and you risk loosing your job.