Referral Patterns for Endocrine Surgery Depend on Operative Volumes

In the past few decades, it has become clear that doctors can improve surgical outcomes for specific procedures like bariatric surgery and hip and knee replacement by referring patients to high-volume surgical centers.

Nevertheless, high-volume endocrine surgeons in the United States perform less than 10% of all endocrine surgeries. Conversely, low-volume surgeons perform more than three-quarters of all endocrine surgeries.

However, a team of researchers from the University of Michigan, Montefiore Medical Center, and Memorial Sloan-Kettering Cancer Center believe the increasing availability of high-volume endocrine surgery sub-specialists could change those patterns.

For their work published in the January 2014 issue of Endocrine Practice, the researchers examined the factors that influence endocrinologists' referral patterns for endocrine surgery. Employing a national cross-sectional voluntary survey of members of the American Association of Clinical Endocrinologists (AACE), they gathered a variety of demographics to establish those patterns.

Approximately 15% of the 500 physicians surveyed responded, and all but 3% were endocrinologists. The survey respondents referred an average of 5 patients per week to a surgeon, and most believed endocrinologists were capable of selecting an appropriate surgeon, which indicated that there might be some resistance to change.

Almost half of the physician respondents preferred referring patients to a general surgeon. If a sub-specialist was needed and available, 70.8% said they would refer patients to an endocrine surgeon.

The survey participants identified several factors that are very important in making a referral. Those included the surgeon’s outcome/complication rate (71%), the referring physician’s familiarity with the surgeon (65%), the receiving surgeon's communication with the referring physician (61%), and the surgeon’s volume (59%).

While the physicians noted patient satisfaction (62%), complication rates (57%), surgeon outcomes (54%), and surgeon volume (50%) could change their referral patterns, they said new surgeon availability (70%) and hospital/surgeon advertising (58%) would not.

The researchers concluded that physicians are apt to refer patients to experienced endocrine surgeons with high operative volumes who are known to them and have good outcomes. To improve the referral rates to high-volume surgeons, healthcare organizations must communicate with physicians, achieve good outcomes, and satisfy patients.