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Surgeon Attitudes Toward Nonphysician Screening of Low Back or Low Back–Related Leg Pain Patients Referred for Surgical Assessment: A Survey of Canadian Spine Surgeons

Busse, Jason W. DC, PhD*,†; Riva, John J. DC†,‡; Nash, Jennifer V. DC§; Hsu, Sandy BA; Fisher, Charles G. MD, FRCSC**,¶¶; Wai, Eugene K. MD, FRCSC††; Brunarski, David DC, MSc, FCCS (C)‡‡; Drew, Brian MD, FRCSC[BULLET OPERATOR]; Quon, Jeffery A. DC, PhD, FCCS (C)**,§§,¶¶; Walter, Stephen D. PhD; Bishop, Paul B. DC, MD, PhD**,¶¶; Rampersaud, Raja MD, FRCSC[BULLET OPERATOR][BULLET OPERATOR]

doi: 10.1097/BRS.0b013e318286c96b
Health Services Research

Study Design. Questionnaire survey.

Objective. To explore spine surgeons' attitudes toward the involvement of nonphysician clinicians (NPCs) to screen patients with low back or low back–related leg pain referred for surgical assessment.

Summary of Background Data. Although the utilization of physician assistants is common in several healthcare systems, the attitude of spine surgeons toward the independent assessment of patients by NPCs remains uncertain.

Methods. We administered a 28-item survey to all 101 surgeon members of the Canadian Spine Society, which inquired about demographic variables, patient screening efficiency, typical wait times for both assessment and surgery, important components of low back–related complaints history and examination, indicators for assessment by a surgeon, and attitudes toward the use of NPCs to screen patients with low back and leg pain referred for elective surgical assessment.

Results. Eighty-five spine surgeons completed our survey, for a response rate of 84.1%. Most respondents (77.6%) were interested in working with an NPC to screen patients with low back–related complaints referred for elective surgical assessment. Perception of suboptimal wait time for consultation and poor screening efficiency for surgical candidates were associated with greater surgeon interest in an NPC model of care. We achieved majority consensus regarding the core components for a low back–related complaints history and examination, and findings that would support surgical assessment. A majority of respondents (75.3%) agreed that they would be comfortable not assessing patients with low back–related complaints referred to their practice if indications for surgery were ruled out by an NPC.

Conclusion. The majority of Canadian spine surgeons were open to an NPC model of care to assess and triage nonurgent or emergent low back–related complaints. Clinical trials to establish the effectiveness and acceptance of an NPC model of care by all stakeholders are urgently needed.

Level of Evidence: 1

Supplemental Digital Content is Available in the Text.A 28-item survey was completed by Canadian spine surgeons, identifying core requirements for the assessment of low back and low back–related leg pain. Most surgeons were interested in working with nonphysician clinicians to improve triaging efficiency of these patients.

*Department of Anesthesia

Department of Clinical Epidemiology and Biostatistics

Department of Family Medicine

§Faculty of Health Sciences

Department of Oncology

[BULLET OPERATOR]Department of Surgery, McMaster University, Hamilton, Ontario, Canada

**Department of Orthopaedics, University of British Columbia, Combined Neurosurgical and Orthopaedic Spine Program, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada

††Ottawa Hospital, Ottawa, Ontario, Canada

‡‡Ontario Chiropractic Association, Toronto, Ontario, Canada

§§School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

¶¶International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada

[BULLET OPERATOR][BULLET OPERATOR]Department of Surgery, Divisions of Orthopedic Surgery and Neurosurgery, University of Toronto, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Jason W. Busse, DC, PhD, Department of Anesthesia, McMaster University, HSC-2U1, 1200 Main St. West, Hamilton, Ontario, Canada, L8S 4K1; E-mail:

Acknowledgment date: November 28, 2012. Revision date: January 2, 2013. Acceptance date: January 4, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, royalties, board membership, expert testimony.

© 2013 Lippincott Williams & Wilkins, Inc.