Consultant Services to Kansas Family Physicians

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Cora Laurel O’Connor’
6 years ago
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1 Consultant Services to Kansas Family Physicians The purpose of this study is to track the use of consultants. An survey was sent to 114 Kansas family physicians The survey was launched on 11/25/2009 and closed 12/31/2009 The total response rate was 45% (51/114) Age Years in Practice Average Range Average Range Average Range Male (n=33) Female (n=18) Size of community in which you practice Count Percent <5, % 5,000-24, % 25,000-75, % >75, % AGE Size of practice community Median Average Range <5, ,000-24, ,000-75, >75, Years in Practice Size of practice community Median Average Range <5, ,000-24, ,000-75, >75, I make a personal call to the consultant My office staff works with the consultant s office staff to schedule a visit I send a note or to the consultant I admit the patient to the hospital and ask for in-patient consultation Usually Occasionally Rarely Not answered 12% 51% 33% 4% 84% 10% 4% 2% 47% 25% 22% 6% 8% 20% 67% 6% 1

2 What percentage of your patients are seen by consultants in a timely fashion (meeting the patient s needs and appropriate for the nature of the problem) Size of practice 5,000-25,000- Total community <5,000 24,999 75,000 >75,000 >90% of the time 33% 13% 67% 41% 37% >75% of the time 53% 75% 36% 43% >50% of the time 13% 13% 17% 23% 18% Other 17% 2% In your geographic service area, specialties that are usually very timely in doing consultations Specialty # % of physicians n=51 Cardiology 43 84% General surgery 34 67% Orthopaedics 33 65% ENT 16 31% Urology 15 29% Gastroenterology 9 18% Ob/gyn 8 16% Oncology 7 14% Nephrology 6 12% Dermatology 5 10% Pulmonary 5 medicine 10% Pediatrics 4 8% Neurology 3 6% 2 Specialty # % of physicians n=51 Gynecology 2 4% Neurosurgery 2 4% Ophthalmology 2 4% Breast surgery 1 2% Dental 1 2% Endocrinology 1 2% Eye 1 2% Hospitalists 1 2% Internal medicine 1 2% Pain management 1 2% Physiatry 1 2% Psychiatry 1 2% Radiology 1 2% Renal 1 2% Specialty <5,000 n=15 5,000-24,999 n=8 25,000-75,000 n=6 >75,000 n=22 Cardiology 87% 88% 50% 91% General Surgery 80% 75% 67% 55% Orthopedics 67% 75% 67% 59% ENT 27% 13% 50% 32% Urology 33% 13% 50% 27% Gastroenterology 7% 17% 32% OB/GYN 20% 13% 33% 9% Oncology 7% 38% 17% 9% Nephrology 33% 18% Pulmonology 7% 25% 14% Dermatology 7% 25% 9% Pediatrics 20% 17% Neurology 7% 9% Gynecology 13% 5% Neurosurgery 13% 17% Ophthalmology 17% 5% Dental 17% 0%

3 Specialty <5,000 n=15 5,000-24,999 n=8 25,000-75,000 n=6 >75,000 n=22 Endocrinology 5% Endoscopy 5% Eye 17% Hospitalists 5% Internal Medicine 17% Pain management 5% Physiatry 7% Psychiatry 7% Radiology 5% Renal 13% Surgery-breast 13% In your geographic service area, specialties that are often difficult for patients to access in a timely fashion Specialty # % of physicians n=51 Neurology 37 73% Rheumatology 22 43% Dermatology 20 39% Psychiatry/ 16 31% Psychology Neurosurgery 11 22% Endocrinology 8 16% Gastroenterology 8 16% Pulmonary medicine 7 14% Pain management 6 12% Orthopaedics 5 10% Developmental pediatrics 3 6% ENT 2 4% 3 Specialty # % of physicians n=51 Peds subspecialties 2 4% Plastic surgery 2 4% Urology 2 4% Allergy/immunology 1 2% Cardiology 1 2% Child psych 1 2% Gynecology 1 2% Infectious disease 1 2% Internal medicine 1 2% Neonatal 1 2% Nephrology 1 2% Ob/gyn 1 2% Ortho spine specialist 1 2% Pediatrics 1 2% Specialty <5,000 n=15 5,000-24,999 n=8 25,000-75,000 n=6 >75,000 n=22 Neurology 87% 100% 17% 73% Rheumatology 53% 38% 50% Dermatology 47% 38% 50% 32% Psychiatry 27% 25% 50% 27% Neurosurgery 13% 25% 17% 27% Endocrinology 13% 27% Gastroenterology 33% 13% 9% Pulmonology 13% 13% 33% 9% Orthopedics 7% 25% 17% 9% Pain Management 7% 13% 0% 14% Developmental pediatrics 17% 9% ENT 9%

4 Specialty <5,000 n=15 5,000-24,999 n=8 25,000-75,000 n=6 >75,000 n=22 Pediatric subspecialties 17% 5% Urology 7% 13% Allergy and immunology 5% Cardiology 17% Child psychiatry 7% General Surgery 5% Gynecology 7% Infectious disease 5% Internal medicine 13% Neonatal 5% Nephrology 13% OB/GYN 7% Otologists 5% Pediatric neurology 5% Pediatrics 17% Plastic surgery 5% Specialties in both categories Timely Difficult Cardiology 43 84% 1 2% Dermatology 5 10% 20 39% EENT 16 31% 2 4% Endocrinology 1 2% 8 16% Gastroenterology 9 18% 8 16% Gynecology 2 4% 1 2% Internal medicine 1 2% 1 2% Nephrology 6 12% 1 2% Neurology 3 6% 37 73% Neurosurgery 2 4% 11 22% Ob/gyn 8 16% 1 2% Orthopaedics 33 65% 5 10% Pain management 1 2% 6 12% Pediatrics 4 8% 1 2% Psychiatry 1 2% 16 31% Pulmonary medicine 5 10% 7 14% Urology 15 29% 2 4% 4

5 For specialty you ranked in that are often difficult for patients to access in a timely fashion, rank the s to the problem. Allergy and immunology n=1 Cardiology n=1 Child Psychology n=1 5

6 Dermatology n= timely access Consultants seem aloof... hard to get in contact with problems uninsured) ENT n=2 1 timely access 2 Consultants aren t interested in a high patient volume 2 Consultants seem aloof... hard to get in contact with 2 1 uninsured) 2 Endocrinology n=6 Inadequate specialist resources for the need problems 2 4 uninsured)

7 Gastroenterology n=3 Inadequate specialist resources for the need problems 3 2 General Surgery n=1 Internal medicine n=1 7

8 Nephrology n=1 Neurology n=37 Inadequate specialist resources for the need timely access Consultants aren t interested in a high patient volume Consultants seem aloof... hard to get in contact with problems uninsured) Neurosurgery n=10 Inadequate specialist resources for the need 8 2 timely access Consultants seem aloof... hard to get in contact with 5 4 problems 7 2 uninsured)

9 OB/GYN n=10 Orthopedics n=4 Inadequate specialist resources for the need uninsured) 2 2 Otologist n=1 9

10 Pain management n= uninsured) 2 Developmental pediatrics n=2 Inadequate specialist resources for the need Neonatal n=1 10

11 Pediatric neurology n=1 Pediatric subspecialties n=2 Inadequate specialist resources for the need uninsured) 2 Pediatrics n=1 11

12 Psychiatry n=1 0 4 timely access Consultants seem aloof... hard to get in contact with problems Pulmonology n=6 Inadequate specialist resources for the need 3 3 timely access 3 3 Consultants aren t interested in a high patient volume 3 3 Consultants seem aloof... hard to get in contact with 2 4 problems 3 3 uninsured) 3 3 Rheumatology n=6 5 3 timely access Consultants aren t interested in a high patient volume problems

13 Urology n=2 Inadequate specialist resources for the need 2 1 Consultants aren t interested in a high patient volume 2 Consultants seem aloof... hard to get in contact with 2 problems 2 uninsured) 2 How frequently do you encounter these problems in consultations you arrange for your patients? The consultant < once a < once a < once a week month year rarely Does not discuss consultation findings with the patient or family. 22% 29% 22% 24% Does not call you or send you a report of the consultation 20% 33% 18% 24% Keeps your patient and doesn t send him/her back to you for ongoing care 2% 27% 24% 43% Sends the patient on to another consultant without discussing it with you 12% 39% 18% 25% Suggests to your patient that you were not doing a good job in your medical 2% 27% 63% care Suggests or says that the consultation was not worthwhile or inappropriate 14% 27% 53% Ignores the question of the consultation and takes off in a different direction 12% 33% 49% Doesn t pay attention to the background letter, labs, tests, or my thoughts on the case 10% 22% 24% 39% On reflection, when I seek a consultation I feel I Generally provide a clearly stated concern and give solid background information 35% Could sometimes do a better job of presenting the issue and providing background information 63% Often fall short in how I present the problem and provide background material 2% Other 13

I-1 TIME SERIES - MOST RECENT FIVE YEARS Field of post-m.d. training and source of funding

I-1 TIME SERIES - MOST RECENT FIVE YEARS Field of post-m.d. training and source of funding Family Medicine Emergency Medicine (CFPC) Care of the Elderly (CFPC) Enhanced Skills: Fam. Med. Training FAMILY MEDICINE SUBTOTAL Anesthesiology Critical Care (Anes.) Pain Medicine (Anes.) Public Health