Is it common for a general oncologist to refer to an AML specialist?

Is it common for a general oncologist to refer to an AML specialist? I would say that it depends on the city and the practice. There are practices that by default will just refer all of their leukemia or AML patients out to academic centers knowing that this is a difficult disease that has very complicated therapies and need for transplant. So they tend to refer out. There are certain practices that feel comfortable treating patients on their own. There's also a little bit of, I would say, fear when somebody gets admitted into the hospital. They have leukemia, the white cell counts high, and there's this pressure that we want to start treatment right away. So there are several reasons why such a referral may not happen. I would say that most of the time if you call an AML center, we transfer patients right away without even going through insurance approval or anything knowing this is a severe disease that needs to be treated. It's just a matter of connecting to an AML expert in the region. I would say it's variable depending on where you are. Also don't forget that there are actually rural places that just don't have a big university or a tertiary center around and they have to treat the patients. They actually do sometimes get better at treating leukemia because they have to. They don't have a choice of sending the patient anywhere. But I think what my advice to patients is always ask. When you're dealing with a disease that is aggressive, always ask is there another opinion we should be seeking? Are there places we should be going? That usually leads to answers and referrals.