It can be difficult enough in a rural area to get patients to see a specialist, but one doctor is frustrated that they often end up being seen by a nonphysician.
When she refers patients to a specialist, she wants them to be seen by physician, but increasingly that’s not the case, wrote Kimberly Becher, M.D., who practices at a rural federally qualified health center in Clay County, West Virginia.
“Regardless of resources, I often send people long distances for higher levels of care, and when they get there they expect to see a doctor, not a nurse practitioner or physician assistant,” writes Becher in a blog post for the American Academy of Family Physicians. “But increasingly, I either get a call from a disappointed patient or parent, or a consult note signed by an independently practicing nurse practitioner, or both.”
Although she knew that it would be a challenge to refer patients for subspecialty care or diagnostic workups since they often require traveling a distance, Becher didn't expect that nonphysicians would provide subspeciality care. It’s not a problem when fellowship-trained subspecialists have nurse practitioners working side by side with them as part of a physician-led team, she says. What she is seeing, however, is patients being seen by a nurse practitioner practicing independently for their initial visit, with no engagement by the physician.
Specialists trying to nurture referrals may want to pay attention to Becher’s complaint. As FierceHealthcare reported, specialists may not receive future referrals if patients have complained about long wait times for appointments or the need to continuously call for results from a consultation.
However, the value of referrals to specialists was recently confirmed by a Mayo Clinic study that found more than 20% of patients who sought a second opinion from specialists were misdiagnosed by primary care providers.