What Happens To A Family Practice Doctor When He Or

What happens to a family practice doctor when he or she refers a patient to see a specialist? Does the doctor incur some financial cost? Perhaps it is a social cost like embarrassment or damage to their reputation. Maybe they just get punched in the face. I'm really curious to know why doctors will concede that a patient has an issue beyond their scope of expertise and yet refuse to refer a patient. Any insight you can offer would be much appreciated. Thank you.