As primary care providers, physician assistants (PA) refer patients to specialist physicians for complex care beyond the realm of primary care providers. Referral of a patient to a specialist for consultation is an important link in the continuum of patient care, and efforts to improve the referral system may enhance the satisfaction of the primary care provider, specialist, and patient. Methods: A survey was mailed to a random sample of specialist physicians in Johnson and Sedgwick counties in Kansas. Results: A significant majority of respondents are generally satisfied with appropriateness (94%), timing (80%) and communication (85%) of referrals from PAs. Of the small number expressing dissatisfaction, the most frequent reason for dissatisfaction stated was misdiagnosis of the patient’s condition. In addition, a majority of specialists (73%) agreed that referrals received from PAs were of the same quality as referrals received from physicians. Conclusion: Specialist physicians are highly satisfied with referrals from PAs, however there are specific areas in the referral process that may be improved to increase the satisfaction of specialists physicians with referrals from physician assistants. In addition, an important finding not previously noted in the literature is that the majority of specialist physician respondents in this pilot study perceived no significant differences between the quality of referrals received from PAs compared to nurse practitioners and primary care physicians.