Table 2

Themes that inform the decisions concerning choices and patterns of interactions between physicians

Themes	Subthemes	Description
Circumstances for external engagement	1. Community engagement	Activities that connected specialists with community hospitals and physicians in order to increase the awareness of the services and procedures offered at the AMC.
	2. Scientific engagement	Activities where specialists elevated their professional profile by reaching larger audiences through conferences and scientific publishing.
	3. Reputational value	Reputational value encompasses the functional and social expectations associated with the quality of care available at AMCs generally and from specific specialists.
	4. Experiential information	The sharing of personal experiences that influenced perceptions concerning the quality of care provided at the AMC generally and by specific specialists.
Clinical conditions for engagement	5. Professional identity	Situations where specialists define their identity by becoming experts within a clinical subspecialty.
	6. Self-awareness of competence	Scenarios where specialists opted to forward a referral to a colleague with more experience if they perceived a procedure was outside their area of expertise.
	7. Multidisciplinary programmes	Specialists with similar specialisations met to discuss and distribute complex patient cases.
	8. Situational factors	Factors that facilitated the timely arrangement of referrals with another physician such as spatial proximity.