As a single physician practice, obviously all services cannot be provided. In addition, San Luis Obispo is a relatively small community with limited cardiac, vascular and cardiac surgical services. As such, we have established consultation and referral programs in place for both electrophysiology and complex cardiac surgical procedures unavailable in the region with multiple centers of excellence. Dependent on patient needs, we have referred patients to the Community Hospital of the Monterey Peninsula, Sequoia Hospital, Stanford, UCLA, and Mayo Clinic with excellent results.