Physician‐reported barriers to referring cancer patients to specialists: Prevalence, factors, and association with career satisfaction

Abstract

Background Quality care for patients with cancer often requires access to specialty providers, but little is known about barriers to referring cancer patients for specialized care. Referral barriers may also lessen physician career satisfaction. We aimed to determine factors associated with these barriers and whether greater barriers are associated with low career satisfaction. Methods In this cross-sectional study, we studied 1,562 primary care physicians (PCPs) and 2,144 specialists responding to the multi-regional Cancer Care Outcomes Research and Surveillance Consortium Physician Survey. We assessed the prevalence of physician-reported barriers to referring cancer patients (restricted provider networks, pre-authorization requirements, patient inability to pay, lack of surgical sub-specialists, excessive patient travel time) for more specialized care. We averaged the five items to calculate a barrier score. We used multivariable linear regression to determine physician and practice setting characteristics associated with the barrier score, and multivariable logistic regression to analyze the association of the barrier score with physician career satisfaction. Results Three in five physicians reported always, usually, or sometimes encountering any barrier to cancer patient specialty referrals. In adjusted analyses of PCPs and specialists, international medical graduates, physicians practicing in solo or government-owned practices, or who had <90% patients in managed care plans had higher barrier scores than others (P<.05). High barrier scores were associated with lower physician career satisfaction among PCPs and specialists (P<.05). Conclusions Many physicians experience barriers to specialty referral for cancer patients. Uniform systems for providing and tracking timely referrals may enhance care and promote physician career satisfaction.

A survey of primary care practitioners' referral habits and recommendations of allergen‐specific immunotherapy for canine and feline patients with atopic dermatitis

“…Our survey of 827 recent and seasoned first‐opinion veterinarians from 17 countries illustrated that most participants discussed referral of atopic dogs and cats with clients, yet the method or avidity of recommendations may vary. In human medicine, investigators commonly perform studies to identify clinician and patient barriers to referral, as well as physician perceptions about referral and treatment options 20–26 . Similar to our findings, these studies have identified the following commonly noted referral barriers: perceived high cost, long travel times, delayed communication and disagreement over the specialist's role 20–26 .…”

Early Postoperative Mortality Among Patients Aged 75 Years or Older With Stage II/III Rectal Cancer

“…Efforts such as implementation of surgical quality improvement programs, care coordination, or streamlining referral systems to centers of excellence that improve access to high-quality care could lower early postoperative mortality in this group of patients. 13,25 In addition, patients with rectal cancer require specialized management, and centralizing care could improve postoperative outcome.…”

A pilot study to identify perceived barrier and motivating factors of primary veterinarians in the USA for specialty referral and management of atopic dermatitis with allergen‐specific immunotherapy

“…15,16,18 The human medical field has long recognized the need to scrutinize clinician and patient factors in order to smooth out the referral process and make certain therapies more readily available to patients. [12][13][14][19][20][21][22][23] Findings from studies such as these have been used to improve the specialist-generalist relationship, provide better continuity of care and ensure better patient outcomes.…”

“…12 In an effort to better support clients during diagnostic trials, one study investigated client factors associated with adherence to elimination diet trials based on the Health Belief Model commonly used in human medicine. 13 Physicians have long recognized the need to investigate perceived barriers to referral and specialized treatment which can include specialty services with restricted provider networks, inconvenient office hours, and difficulty in getting an appointment quickly. [14][15][16] To the best of the authors' knowledge, specific factors impacting referral to specialized veterinary medicine have not been evaluated in the veterinary dermatology subset.…”