BACKGROUND:
The role of physicians of specific subspecialties in undervaccination for influenza among nonelderly adults has not previously been examined.

OBJECTIVE:
To characterize attitudes regarding influenza (flu) vaccination among cardiologists, endocrinologists, and pulmonologists, who provide care for the largest numbers of persons with indications for flu vaccine.

METHOD:
National random samples of subspecialists were drawn from the AMA Masterfile. We contacted each physician's office by telephone to determine whether flu vaccine was offered to patients during the 2002-03 season. "Offerers" and "non-offerers" were mailed tailored questionnaires that examined physicians' attitudes and practices about flu vaccine and barriers to patient vaccination. Likelihood ratio chi-square tests were used to compare physicians of different subspecialties, and to compare non-offerers to offerers as well.

RESULT:
Overall, 506 of 1473 subspecialists responded (395 offerers, 111 non-offerers; response rate=34%). 90% of pulmonologists (PM) were offerers, compared to 80% of endocrinologists (EN) and 53% of cardiologists (CD) (p<.001). Non-offerers reported a significantly lower proportion of patients with repeat visits than offerers, and smaller proportions of non-offerers than offerers worked in practices with more than 10 physicians (14% vs 30%; p=.001). 73% of offerers said they strongly recommend flu vaccine to their patients, compared to only 42% of non-offerers (p<.001). The proportion of offerers that strongly recommends influenza vaccination differed significantly by discipline: PM 81% vs EN 69% vs CD 52% (p<.005). Among offerers, PM were more likely than EN and CD to say that eligible patients did not receive flu vaccine because of illness at the time of a visit (71% vs 60% vs 41%; p<.001). In contrast, CD were more likely to acknowledge that eligible patients did not receive flu vaccine because they as physicians had overlooked the issue (41% vs EN 28% vs PM 14%; p<.001).

CONCLUSION:
Previously unappreciated variation in approaches to flu vaccination among physicians of different subspecialties may represent opportunities to improve vaccination rates among nonelderly adults. Coordination between generalists and subspecialists regarding flu vaccine remains to be elucidated further.

LEARNING OBJECTIVES:
1) Understand differences among medical subspecialists regarding influenza vaccine practices