haʊˈɛvɚ, "ɪnðə pɹˈaɪvət fˈiːfɔːɹsˈɜːvɪs kˈɑːntɛkst, ðə lˈɔs ʌv spˈɛʃəlˌɪst ˈɪŋkʌm ɪz ɐ pˈaʊɚfəl bˈæɹiɚ tʊ ˈiːɹᵻfˈɜːɹəl, ɐ bˈæɹiɚ ðæt mˌaɪt biː ˌoʊvɚkˈʌm ɪf hˈɛlθ plˈænz kˈɑːmpənsˌeɪɾᵻd spˈɛʃəlˌɪsts fɚðə tˈaɪm spˈɛnt hˈændlɪŋ ˈiːɹᵻfˈɜːɹəlz.
However, "in the private fee-for-service context, the loss of specialist income is a powerful barrier to e-referral, a barrier that might be overcome if health plans compensated specialists for the time spent handling e-referrals.