The nature of the relationship between the primary care PA and the specialist physician has not been well studied. It is apparent that although the majority of specialist physicians accept referrals from PAs and are accepting of the role of primary care PAs in the referral process, they are less satisfied with the appropriateness of the referral and patient management prior to referral. Certainly, referral to specialist physicians is an important facet of primary care practice and any barriers to effective and timely patient care provided by PAs should be identified. The results of the study also suggest that further exploration of the PA-specialist physician relationship is indicated and that results need to be compared to the level of satisfaction with referral from primary care physicians.