Examining referral practices of primary care physician assistants

Various barriers to specialty referrals that are initiated by physician assistants (PAs) have been reported to limit a PA's ability to care for patients effectively when they have a medical problem that requires specialty intervention. To assist in evaluating this matter, we conducted a survey to assess referral practices and perceived barriers to referral among primary care PAs in the United States.

A cross-sectional, random sample of 500 primary care PAs from across the United States was surveyed to determine their referral practices and perceived barriers to referrals. Standard descriptive statistics and univariate analysis of variables were carried out using Pearson chi-squared tests.

Seventy-one percent of respondents identified barriers to referral of patients to specialists, although 86% were satisfied with their level of autonomy. The most frequently identified barrier (38%) was the patient's insurance company. This is not an unexpected finding, considering the managed care environment in which medicine is practiced in the United States. Of respondents who mentioned this barrier, the majority were in practice 5 years or less (P < .05) and lived in a community with 10,000 or more people (P < .05). Seventeen percent of respondents also identified refusal or reluctance of specialists to accept referrals from PAs as a barrier; of respondents who mentioned this barrier, the majority had been in practice 5 or fewer years (P < .05) and worked in a community of 10,000 or more people (P < .01). A reassuring finding was that the majority of PAs (86%) were satisfied with their level of autonomy in making referrals. This may reflect the level of confidence that supervising and specialty physicians have in a PA's ability to make appropriate decisions regarding referrals.

Further research is needed to determine whether these barriers affect a patient's access to cost-effective, high-quality care from specialist physicians.