Decisions regarding referrals between health care levels are strongly influenced by a health care practitioner‘s qualifications. This cross–sectional study at King Abdul–Aziz hospital (KAH) evaluated referrals by family medicine (FM) department physicians to other specialists and assessed the relationship between qualification and referral criteria. Data of 1590 patients referred from various KAH clinics during March 2017 were collected via electronic system review and structured questionnaires To assess the differences between board–certified and non–board–certified FM physicians. Referral rate was 23.4%. Board–certified physicians tended to refer patients to dentistry and obstetrics/gynecology departments, whereas non–board–certified physicians more frequently referred to medicine and surgery (P=0.047). The referral rejection rate was 11.8%. Board–certified physicians reported more frequent patient follow–up (odds ratio [OR]: 0.39, P=0.001), discharged more referred patients (OR: 0.37, P=0.001) and were more likely to have accepted referrals (OR: 2.3, P=0.002). We conclude that qualification affects referral decisions.