Context.— Efforts to control medical expenses by emphasizing primary care and
limiting specialty care may influence how physicians use informal or "curbside"
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