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maintaining your referral patterns

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Through the years I have developed a group of subspecialists that I like.
I trust them to take care of my patients and  they get timely consultations
back to me.  They also know me and don't mind giving me phone advise
without having to see every patient.  They accept both Medicaid and
non-Medicaid  kids and on occasion I have asked them to help a family out
that is struggling.  I could not do my job as well without them and I truly
appreciate their wisdom.  So how come managed care has to mess up my
beautiful referral pattern and ask me to use physicians that I don't know
well and don't know me?  Instead of referring to a couple of allergists I
now refer to 5 or 6. the same with ENT, dermatology etc. Sorry- just needed
to vent.  Kim Burlingham, MD