Physician division of labor impacts care

4/08/2014 09:30:00 AM
Health Affairs presents some evidence on how the type of attending physician has big effects on the type of care they provide for seemingly similar patients. From the abstract:
"Insertion rates were markedly lower when all of a patient's attending physicians were hospitalists (1.6 percent) or nonhospitalist generalists (2.2 percent), compared to all subspecialists (11.0 percent) or a mixture of physicians by type, which typically included a subspecialist (15.6 percent). The portion of patients seen by a mixture of attending physicians increased from 28.9 percent in 2001 to 38.3 percent in 2010."
This isn't an isolated finding. I'm reminded of this study from the Journal of Health Economics which similarly showed that the physician's background--in particular whether they worked in inpatient versus outpatient settings--also had big effects on the kinds of procedures they ordered.

We should, however, hesitate to call these relationships purely causal, however. One needs to also consider the physician-patient matching process works, and understand that certain types of patients may seek out certain kinds of physicians. However, we should worry about patient care coordination between physicians of different backgrounds, and we should be concerned about whether there's a lack of adequate standards for treating similar complications in similar patients.