Access to specialty care can be challenging for patients, often involving multiple
evaluations, laboratory tests, and referrals. To better understand the different pathways
to specialty care, we examined the outcomes of patients evaluated for surgical thyroid
disease at a single tertiary referral clinic.
We reviewed 691 patients seen in the endocrine surgery clinic for thyroid disease
(2018-2021). Patient demographics, referral source, referral reason, and reason for
not receiving an operation were collected. The number of days from referral to initial
clinic visit and from initial clinic visit to an operation were also collected. The
Chi-square test, the independent t-test, the Kruskal–Wallis test, the Dunn-Bonferroni post hoc test, and multiple logistic
regression tests were performed using SPSS.
The top reasons for referral were thyroid nodules (54.4%), hyperthyroidism (26.5%),
and multinodular goiter (10.3%). Specialty clinic referrals came from endocrinologists
(56.0%), self-referrals (15.5%), and primary care physicians (PCP; 14.4%). Self-referred
patients had a shorter waiting time for an appointment than those referred by endocrinologists
and PCPs. [median (IQR) (days) 12 (6-17) versus 16 (9-24) versus 16 (9-25), P < 0.001]. Overall, 450 (72.7%) patients underwent thyroid surgery. For those who
underwent thyroidectomy, self-referred patients had a shorter time between initial
clinic visit and the operation compared to those referred by endocrinologists and
PCPs [median (IQR) (days) 2 (1-19) versus 19 (8-33) versus 16 (1-48), P < 0.001]. Patients referred for hyperthyroidism (odds ratio [OR] = 2.2, 95% confidence
interval [CI] 1.3-10.5, P = 0.012 were more likely to undergo an operation than those referred for other reasons.
Access to specialty care for thyroid disease is facilitated and optimized when self-referrals
are permitted. Reducing or eliminating the requirement for a provider referral may
improve patients’ access.