Consultant Services to Kansas Family Physicians The purpose of this study is to track the use of consultants. An e-mail 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 51.5 20.9 Range 33-81 2-56 Average Range Average Range Male (n=33) 54.9 33-81 24.9 2-56 Female (n=18) 45.3 36-60 21.2 6-29 Size of community in which you practice Count Percent <5,000 15 29% 5,000-24,999 8 16% 25,000-75,000 6 12% >75,000 22 43% AGE Size of practice community Median Average Range <5,000 44 47 34-65 5,000-24,999 57 55 33-72 25,000-75,000 55 57 38-81 >75,000 55 52 40-64 Years in Practice Size of practice community Median Average Range <5,000 11 16 2-40 5,000-24,999 28.5 21 4-40 25,000-75,000 22 27 11-56 >75,000 23 24 10-32 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 e-mail 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
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%
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%
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
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
Dermatology n=15 1 4 1 timely access 2 7 7 5 9 Consultants seem aloof... hard to get in contact with 3 6 6 problems 3 5 7 uninsured) 6 5 5 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 4 2 3 2 5 5 problems 2 4 uninsured) 2 1 3 6
Gastroenterology n=3 Inadequate specialist resources for the need 3 2 2 2 problems 3 2 General Surgery n=1 Internal medicine n=1 7
Nephrology n=1 Neurology n=37 Inadequate specialist resources for the need 28 8 1 timely access 4 16 17 Consultants aren t interested in a high patient volume 9 12 15 Consultants seem aloof... hard to get in contact with 5 9 22 problems 4 12 20 uninsured) 4 18 14 Neurosurgery n=10 Inadequate specialist resources for the need 8 2 timely access 2 4 4 4 5 Consultants seem aloof... hard to get in contact with 5 4 problems 7 2 uninsured) 4 2 3 8
OB/GYN n=10 Orthopedics n=4 Inadequate specialist resources for the need 3 1 1 2 3 1 2 2 1 uninsured) 2 2 Otologist n=1 9
Pain management n=1 1 1 1 1 1 uninsured) 2 Developmental pediatrics n=2 Inadequate specialist resources for the need 2 1 1 1 1 Neonatal n=1 10
Pediatric neurology n=1 Pediatric subspecialties n=2 Inadequate specialist resources for the need 2 1 1 1 1 uninsured) 2 Pediatrics n=1 11
Psychiatry n=1 0 4 timely access 8 6 10 3 Consultants seem aloof... hard to get in contact with 2 7 5 problems 3 3 8 6 7 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 2 8 8 Consultants aren t interested in a high patient volume 3 7 8 2 5 problems 3 9 5 10 5 12
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