How patients navigate specialist referral pathways in hand surgery: a cross-sectional survey study

BACKGROUND: Patients navigating specialist care are often presented with multiple options and information sources. In fragmented healthcare systems, understanding how individuals select specialists is important for optimizing referral pathways and access to care. This study examined factors influencing patient selection of hand surgeons, including the relative importance of primary care recommendations, surgeon characteristics, online information (such as physician rating websites and internet-based search resources), opinions of family and friends, as well as demographic differences in these preferences. METHODS: This cross-sectional survey study was conducted among adults residing in New England. A 30-item online questionnaire was developed with input from hand surgeons and researchers and refined through pilot testing in lay participants. The survey was built in REDCap and distributed via ResearchMatch to 3,000 registrants, of whom 868 responded (response rate 28.9%). A total of 739 fully completed surveys were analyzed. Associations between demographic variables and factors influencing specialist selection were evaluated using chi-square tests, t-tests, and multivariable logistic regression analyses adjusting for demographic covariates. Statistical significance was defined as p < 0.05. RESULTS: Primary care physician (PCP) recommendation (26%) and internet-based resources (24%) were the most frequently reported methods for identifying a hand surgeon. 83% of respondents reported that a PCP recommendation influenced their specialist selection. Increasing age was independently associated with decreased importance attributed to online physician ratings (p < 0.0001), opinions of family and friends (p < 0.001), and insurance-related factors (p < 0.0001). Most respondents reported a preference for orthopedic practice settings (77%) and orthopedic training backgrounds (90%). CONCLUSION: In this survey, PCP recommendations were the strongest reported influence on specialist selection, with age-related differences in the importance of online and interpersonal information sources. These findings suggest that primary care plays a major role in reported pathways to specialty hand care and that communication strategies may need to be tailored to different demographic groups within healthcare systems.