Quality of referrals from PA/NPs vs Physicians

[Dr Francis DNP NP FNP ACNP]

Interesting study done by Mayo Clinic regarding the quality of patient referrals from PA/NPs vs physicians. (blind study)

 

Results:

Referrals from physicians were scored higher than were referrals from NPs and PAs for each of the following items: referral question clearly articulated (86.3% vs 76.0%), clinical information provided (72.6% vs 54.1%), documented understanding of the patient's pathophysiology (51.0% vs 30.3%), appropriate evaluation performed locally (60.3% vs 39.0%), appropriate management performed locally (53.5% vs 24.1%), and confidence returning patient to referring health care professional (67.8% vs 41.4%). Referrals from physicians were also less likely to be evaluated as having been unnecessary (30.1% vs 56.2%).

 

Seems like we still got a way to go!

 

I wish the study separated results from PAs and NPs.. I have a feeling the NP data weighed down the PAs..

 

http://www.ncbi.nlm.nih.gov/pubmed/24119364

[LT_Oneal_PAC]

I wish they had separated it as well, just to make the data more applicable, but that's mighty big of you to say that considering you're an NP. I'm a firm believer in the person matters more than the initials, though I think the more varied clinical experience may help PAs speaking with consultants.

[MedicalRN]

Oneal, surely you realize this person is a troll? They have one post, and purposely made their username a poke at the alphabet soup a lot of nurse practitioners carry. The only thing they have ever contributed to this board is how bad PA and NP referrals are compared to physicians?

 

Sad that so many in the medical community act so childish towards other professions.

[True Anomaly]

You could feed an entire homeless shelter with the alphabet soup in the OP's screenname

[LT_Oneal_PAC]

Oneal, surely you realize this person is a troll? They have one post, and purposely made their username a poke at the alphabet soup a lot of nurse practitioners carry. The only thing they have ever contributed to this board is how bad PA and NP referrals are compared to physicians?

 

Sad that so many in the medical community act so childish towards other professions.

Eh, you're probably right. 14 hour shifts have affected my judgement.

[andersenpa]

This is a retrospective study

I'm no sure how you could do a prospective RCT with this model

 

Why were PAs and NPs not included in the reviewing panel?

[MedicinePower]

Thank you for posting this article.

[PACdan]

I apologize if this sounds rude and I sincerely hope it doesn't, but the number of postnominals is truly astounding. Several of them seem to be duplicates of one another so I don't exactly understand the purpose of all of them. Thoughts?

Troll

[Acebecker]

An interesting concept for the study.  I don't have access to the full article, so of course I'm unable to give an accurate assessment of the quality of the study.  Anyone have a copy of it they can ethically share with me? 

 

Andrew

[treejay]

Is this surprising?  On a profession wide generalization which of course is all you can make discussing thing such as this, physicians have more experience than PAs and NPs..........   right ?

[Z PA-C]

An interesting concept for the study.  I don't have access to the full article, so of course I'm unable to give an accurate assessment of the quality of the study.  Anyone have a copy of it they can ethically share with me? 

 

Andrew

I can email it to you. The file is too large to upload.

[whoRyou]

Ace: Here is a copy ... Comparison of the Quality of Patient Referrals from Physicians, Physician Assistants & Nurse Practitioners Remove your personal email on here (too many weirdos and trolls)

[ventana]

flip side - it is not just the PA/NP who sometimes doesn't get it right....

 

new onset back pain in 80+ yr old male

 

3!!! ER visits

2 Admissions!!!

 

Hospital and ER just loads him up with meds(surprise his pain gets better with Dilaudid~!) then sends him home - no work up, single CT LS spine, nothing else.....  just drugs and DC - lots of other reasons this guy should be (and derserves to be worked up in patient) but, well i don't know where the problem is.... poor guy is suffering

 

 

[gbrothers98]

Several issues with this article.

First, at one institution and not several like institutions in different geographic areas.

Second, this was PAs, NPs and general physicians making referrals to general internists? For what conditions?

Third, objective of study rather vague. Something of real value such as: The study of acute back pain referrals to a spine center, a comparison of PAs, NPs and family physicians patterns, would give this study an actual focus.

Fourth, what conditions were referred other than 'complex medical problems'. The 7 items used to rate each referral are overly subjective, only one had some objectivity: the clinical information was provided. The rest all are judgements by the reviewers. The last item, I am confident sending the patient back to the referring provider is the definition of paternalism at its worst.

Fifth, the study was funded by the Division of General Internal Medicine at Mayo. The internists that did the review were the same internists at Mayo. The study was proposed by the same department. This isnt science, this is a group of people using money and station to influence an area of healthcare that they perceive a problem.

Last, the discussion clearly outlines what this study is all about. This department of Mayo thinks outpatient NPs and PAs outside their institution should be supervised closely and there should be physician involvement prior to a referral placed. 

This is not a study, this is an attempt to justify and set policy under the guise of scientific study. It is inflammatory and a stinking pile of dogsh&t.

G Brothers PA-C