[pchivers]

>A good start, but shopping around is hard, if not impossible

I think shopping around, properly conceived, should be the primary care physician's job. If a doctor is referring e.g. 10 people a month to a specialist, then obviously they are going to be in a much better position to evaluate the options than a patient.

I believe that Sherpaa, Jay Parkinson's company, provides this "shopping around" service (https://sherpaa.com/).

[Spooky23]

Not really. Hospital networks are merging, affiliating and consolidating. So if your primary care doctor is affiliated with Hospital X, and specialist group Y is also affiliated with hospital X, there's a good chance that you're going to be referred to specialist group Y.

The exception is when you have some unusual circumstance, and they try to find the world's authority on your condition.