Attitudes, beliefs, and referral patterns of PCPs to bariatric surgeons

J Surg Res. 2008 Jan;144(1):49-58. doi: 10.1016/j.jss.2007.01.038. Epub 2007 Jul 16.


Background: As severe obesity (BMI >40kg/m(2)) and its surgical treatment rise, primary care physicians (PCPs) will more frequently evaluate, refer, and oversee the long-term medical management of bariatric patients. A cross-sectional mail survey was conducted to assess the attitudes, knowledge, and bariatric referral practices among family and internal medicine physicians in North Carolina.

Materials and methods: Forty-seven percent of 611 randomly chosen PCPs returned a self-completed questionnaire. The effect of demographics, PCP attitudes, and PCP knowledge on referral practices was evaluated.

Results: Over 85% (221) of PCPs have treated operated bariatric patients within the last year and 76% (203) have referred patients for surgical evaluation. Thirty-five percent of practitioners felt unprepared to provide good quality long-term medical care to operated patients, and just 45% felt competent to address medical complications of bariatric surgery. Compared with nonreferring PCPs, referring physicians provided medical care to a greater number of severely obese (mean 9.9 versus 7.5, P < 0.001) and postoperative (mean 4.6 and 2.3, P < 0.001) bariatric patients. Referring providers were younger (46 versus 49, P = 0.02), had higher BMI (25.3 versus 23.5, P = 0.001), were more familiar with NIH guidelines (14.7% versus 3.0%, P = 0.02), and had completed more bariatric continuing medical education (49.8% versus 34.9%, P = 0.03). Also, they reported better resources (71.4% versus 35.4%, P < 0.001) and competency to provide good quality long-term care to postoperative bariatric patients (54.2% versus 15.4%, P < 0.001) than nonreferring peers.

Conclusions: Bariatric surgeons will optimize referrals and postoperative care for patients by working cooperatively with PCPs and by providing educational resources.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel*
  • Bariatric Surgery / statistics & numerical data*
  • Continuity of Patient Care / statistics & numerical data
  • Female
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Obesity / epidemiology
  • Obesity / surgery*
  • Postal Service
  • Postoperative Complications / therapy
  • Primary Health Care / statistics & numerical data*
  • Professional Practice / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data*
  • Surveys and Questionnaires