Missed steps in the diagnostic process, such as timely referral for surgical consultation, can lead to missed or delayed diagnoses. This large, retrospective cohort study using Medicare data identified disparities between Black and White patients in receipt of consults for emergency surgery. Findings show that Black patients had lower odds of receiving a surgical consultation after being admitted from the emergency department; these disparities remained after adjusting for medical comorbidities, socioeconomic factors, and individual hospital-level effects.