Background
: Knowledge and experience of the family physician who sees patient for the first contact care have an effect on the referral content and outcome. So we carried out this study to determine the relationship between the knowledge and experience of the physician and the referral content and outcome by comparing the physician according to grade.

Methods : We select March, May, September and December according to the seasons in order to stand for one year, from June 1991 to May 1992. We review the medical record of the 449 patients who visited our OPD of family medicine then referred to other specialties.

Results : Total referral rate was 3.7%. Compared referral rate according to grade, 3rd-year residents had lower referral rate than 2nd-year residents and staff has lower referral rate than residents.(P<0.05, P<0.001 respectively) The most common reason for referral was for diagnosis and treatment(29.4%), and then for treatment(24.1%), request by the patient(23.6%). The most frequently referred specialty was Internal Medicine(33.5%), and then Orthopedis, neurology. There was a trend to increase the treatment rate and relationship between the referral and minor problem by rising the grade of the physician.(P<0.001, P<0.01 respectively)
Agreement rate of diagnosis before and after referral was 63.3%. There was no significant difference according to grades. In the outcome of referral, no follow-up patient was most common(43.9%), and then improved(31.2%), admitted(18.9%).

Conclusion : There were significant differences according to grade in the treatment rate, relationship between referral and main problem before referral. But there were no significant differences in the reasons for referral, referred specialties, agreement rate of diagnosis before and after referral. In the referral rate, there were significant differences between 2nd-year residents and 3rd-year residents, and between residents and staff. Many biases may be in the study of the referral, so the study to minimize these biases is needed.