The Base of the Spine "Consultation Chain" - Primary Care Physicians

According to national surveys, PCPs are the leading source for spine referrals, followed by word-of-mouth referral and advertising, respectively. My experience across the country is that PCP’s still have an overwhelming preference for referring to a surgeon. The PCP does not have the time to make a diagnosis, only to triage for symptoms. With more than 90% of patients with back and neck pain needing non-surgical care, this can be problematic. It is not uncommon that patients will be referred to a neurosurgeon or orthopedic spine surgeon, wait for between 2-6 weeks and, after evaluation, be told they need to be treated with non-surgical interventions, frustrating the patient and PCP. While this is so, in speaking with dozens of surgical and non-surgical spine specialists across the country, they say they would prefer referral earlier in the symptom cycle.

PCP’s are the foundation of the “consultation chain” and loyalty to spine specialists is driven by a combination of factors;

  • ease of access
  • clinical competence
  • advanced / fellowship training
  • real-time communication about treatments for referred patients
  • specialist’s support for PCP’s clinics
  • referral reciprocity
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  • satisfying patient experience
  • realistic options for chronic pain management

The PCP is often directing a referral coordinator or nurse to manage the referral for back and neck pain. Capturing PCP referrals will require addressing and enhancing the referral factors cited above. Regardless; convenience, responsiveness and service from the consulting spine specialist drive the referral pattern.

Additionally, the advent of hospitalists has distanced the spine specialist and PCP. Ten years ago, it was a frequent occurance to personally interact at hospitals while now, only infrequent personal contact occurs. For younger physicians, both spine and primary care doctors, they may rarely meet face to face. This emphasizes the need for the spine expert to connect with the primary care doctor to establish a personal relationship, demonstrate their knowledge and comfort with a range of patient presentations and share the latest in treatment options. One compelling model that affords an exceptional level of access and service to PCP’s is when the spine specialist can provide regularly scheduled hours in the PCP practice, providing a predictable schedule and fostering consultation and co-management of the patient. This model, of course, requires that such clinic hours be viable clinically and administratively.

Once the referral relationship has been established it is critical to support the transition of care and ongoing treatment for back and neck pain with surgical care and referral to non-surgical interventions. Both hospitals and physician practices have begun to turn to phone-based intake, triage and navigation functions that support the primary care physician, patient and other care providers. Such a navigation system offers coordination of care reduces duplication of services and expedites referral to providers that most closely match patient’s needs.

For the spine surgeon, creating and sustaining a predictable and satisfying patient and referring physician experience is central to building and fostering loyalty with primary care practices. Understanding the clinical and referral needs of PCP’s is key to supporting them with ready access, evaluation and expert consultation. The purpose of the intake process is to expedite access, better prepare the patient for evaluation and treatment, coordinate and communicate care for the PCP. To maximize coordination, all stakeholders in the process; patient, PCP, office staff, spine specialist, etc. should use the intake Center as the preferred point of access.

In closing, spine specialists are wise to go beyond just treating the referred patient and deliberately develop and maintain a professional relationship with primary care physicians that is characterized by excellent care, support for their practices and real-time communication regarding treatment options and suggested course of care.

PATRICK VEGA, M.S., Principal for Vega Healthcare writes, speaks and consults in neurosciences, musculoskeletal services, orthopedics, and spine in the areas of: assessment, strategy, service launch and center of excellence development. Patrick is also a partner in LRV-CyKsupport, a firm specializing in Market Assessment and Operational consulting for prospective and current Stereotactic Radiosurgery (SRS) users.

Phone: 301 730-2595

Written by Patrick Vega, M.S