When to refer to specialist?

I am a resident in midwest unopposed program, small town. We have specialists in some areas (cardiology) but not others (endo) and it has shaped our referral patterns and training for common stuff pretty heavily. For example, folks in my program don't touch cardiac meds in chf patients because "cardio is already on board." There isn't an endo for hours out, so we tend to take on some of the more challenging diabetes cases because of lack of access. I'm not 100% convinced we do a great job... When to refer to specialist?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Family Medicine Source Type: forums