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Endocr Pract. 2014 Jun 1;20(6):571-5. doi: 10.4158/EP13061.OR.

Referral patterns for endocrine surgical disease.

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  • 1Deparment of Surgery, Montefiore Medical Center, Bronx, New York.
  • 2Medicine-Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 3Department of Endocrinology, Montefiore Medical Center, Bronx, New York.
  • 4Department of Surgery, University of Michigan, Ann Arbor, Michigan.


Objective: Referrals between physician specialties are common practice, and clear patterns develop. The increasing availability of high-volume endocrine surgery subspecialists with better outcomes may change these patterns. This study aimed to determine what factors influence endocrinologists' referral patterns for the surgical treatment of endocrine disease.Methods: A national, cross-sectional, voluntary survey of members of the American Association of Clinical Endocrinologists examined physician demographics, physician's opinions on referral to endocrine surgery, preferred surgeon specialty, knowledge about surgeon characteristics, and how these factors influenced which surgeons they referred patients, as well as what changes in these factors would alter their referral patterns.Results: The survey response rate was 15% (73/500), and 97% were endocrinologists. On average, 0 to 5 patients/week were referred for surgery. Most respondents (91.8%) felt that endocrinologists should decide which surgeon to refer. General surgery was the preferred surgeon specialty (43.7%), and endocrine surgery was the preferred subspecialty (70.8%). The factors most often cited as very important in referral to a surgeon included surgeon outcome/complications (71%), familiarity with surgeon (65%), surgeon's communication with referring physician (61%), and surgeon volume (59%). The factors most often cited as likely to change physician referral patterns included patient satisfaction (62%), complication rates (57%), surgeon outcomes (54%), and surgeon volume (50%). The factors most often cited as unlikely to change referral patterns included new surgeon availability (70%) and hospital/surgeon advertising (58%).Conclusion: Referring physicians want experienced endocrine surgeons with high operative volumes and good outcomes whom they are familiar with. The promotion of referral to high-volume surgeons requires communication, good outcomes, and satisfied patients.

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