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Physicians' Experiences and Beliefs Regarding Informal Consultation
Nancy L. Keating, MD, MPH;
Alan M. Zaslavsky, PhD;
John Z. Ayanian, MD, MPP
JAMA. 1998;280:900-904.
Context.— Efforts to control medical expenses by emphasizing primary care and limiting specialty care may influence how physicians use informal or "curbside" consultation.
Objective.— To understand physicians' use of and beliefs about informal consultation.
Design.— Survey mailed in July 1997.
Participants.— Of a random sample of Massachusetts general internists, pediatricians, cardiologists, orthopedic surgeons (n=300 each), and infectious disease specialists (n=200) surveyed, 1225 were eligible and 705 (58%) responded.
Main Outcome Measures.— Self-reported use of and beliefs about informal consultation.
Results.— Generalist physicians requested more informal consultations than specialists (median, 3 vs 1 per week; P <.001) and were asked to provide fewer (2 vs 5 per week; P <.001). In multivariate analyses, physicians in a health maintenance organization, multispecialty group, or single-specialty group requested more informal consultations than those in solo practice (82%, 40%, and 28% more, respectively; all P<.001) and were more often asked to provide them (43%, 63%, and 14% more, respectively; all P<.05). Physicians with at least 30% of their income from capitation requested 38% more and were asked to provide 46% more informal consultations than those with little or no income from capitation (both P<.001). Generalists' overall approval of informal consultation was greater than specialists' (mean 5.9 vs 5.1 on a 7-point Likert scale; P<.001), and approval was strongly associated with beliefs about how informal consultation affects quality of care (P<.001).
Conclusions.— Use of informal consultation is common, varies by specialty, practice setting, and capitation, and therefore may increase with current trends toward group practice and managed care. Because overall approval of informal consultation is strongly associated with beliefs about how it affects quality of care, this issue should be carefully considered by physicians who participate in informal consultation.
From the Division of General Internal Medicine, Section on Health Services and Policy Research, Department of Medicine, Brigham and Women's Hospital (Drs Keating and Ayanian), and the Department of Health Care Policy (Drs Keating, Zaslavsky, and Ayanian), Harvard Medical School, Boston, Mass.
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