1385. Differential Patterns of Referral to Neurosurgery: A Comparison of Allopathic Physicians, Osteopathic Physicians, Nurse Practitioners, Physician Assistants, and Chiropractors

Award: First Place Socioeconomic Eposter Award

Authors: Aaron Gelinne, BS; Raj Thakrar, MD; Bruce Tranmer, MD; Susan Durham, MD; Ryan Jewell, MD; Paul Penar, MD; Scott Lollis, MD (South Burlington, VT)


Rising cost and limited resources remain major challenges to U.S. health care and neurosurgery in particular.  To ensure an efficient and cost-effective health care system, it is important that referrals to neurosurgery clinics are appropriate, and that referred patients have a reasonably high probability of requiring surgical intervention or, at a minimum, ongoing neurosurgical follow-up. This retrospective study tests the null hypothesis that the probability of a referred patient requiring surgery is independent of referring provider credentials and referring service specialty.


A database of all patients referred to the neurosurgery clinic from 2015 through 2018 (n=5677) was reviewed; the database included referring provider, referring provider specialty, number of subsequent clinic visits, and outcome of surgery or no surgery. Associations between categorical variables were tested using a chi-squared analysis with post-hoc relative risk (RR) calculations and binary logistical regression.


Compared to patients referred by allopathic physicians, patients referred by osteopathic physicians (RR .63, 95% CI .48-.84), and those referred by nurse practitioners (RR .66, 95%, CI .51-.86) were significantly less likely to require surgery. Probability of surgical intervention also varied by referrer specialty.  Patients referred by neurologists required surgery 35% of the time, while patients referred by family practitioners required surgery 19% of the time and patients referred by pediatricians required surgery only 7% of the time (p<0.01).  Binary logistic regression revealed that referrals from nurse practitioners and osteopathic physicians were independently associated with a decreased probability of surgical intervention.


Our data strengthens the concept of having interdisciplinary teams led by physicians at the primary care level to ensure appropriate referrals. Training and adherence to guidelines must continually be reinforced in order to prevent the unnecessary referral of patients.