Background

Bariatric surgery is a highly effective therapy for obesity and some primary care physicians are reluctant to refer patients for surgical evaluation. The primary objective of this study is to identify the attitudes, knowledge, and perceptions of primary care physicians regarding bariatric surgery and identify referral barriers.

Methods

A prospective cohort study was conducted through an anonymous survey of primary care physicians at two institutions. The intentionally constructed survey included 30 questions.

Results

In all, 55 of 81 surveys were completed (67.9%). Each responder reported having bariatric surgery patients in their practice. Although 74.5% are familiar with bariatric surgery indications, 92.6% reported referring less than 10% of their patients with BMI >35 for bariatric surgery consultation. For diabetes specifically, 49.1% rarely or never discuss bariatric surgery as a management option. Reasons for bariatric non-referral include concerns regarding psychosocial issues (60.4%), follow-up care (26.4%), complication risk (32.1%), lack of appointment time to discuss obesity (47.2%), and apprehension of offending patients (24.5%). Financial burden was also a perceived barrier by 84.9%. Overall, 40% of those surveyed do not feel competent to discuss bariatric surgery with patients and 70.9% would gain comfort in referring patients if they had more bariatric surgery education.

Conclusions

The perception of bariatric surgery amongst primary care physicians is variable. While the majority are familiar with bariatric surgery indications, several remain hesitant to provide discussion or referral. Reasons for non-referral are multifactorial. The results of this study encourage further quality education on bariatric surgery for primary care physicians.