Where Doctors Train May Affect Whether They Practice Expensive Medicine

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Doctors who were trained in high-cost areas of the United States may be more likely to practice expensive medicine, a new study suggests.

However, that effect gradually decreases over time.

Researchers from George Washington University analyzed Medicare claims data from doctors who completed their residencies between 1992 and 2010. They found that those who did their medical training in more expensive regions of the country spent an average of 29 percent more on patient care than those who did their training in less expensive regions.

“Evidence suggests that there is wide variation in Medicare spending, with higher spending associated with more inpatient-based and specialist-oriented care,” study senior author Dr. Fitzhugh Mullan, professor of medicine and health policy at the Milken Institute School of Public Health at George Washington, said in a university news release.

“A number of studies also show that higher spending for health care doesn’t necessarily lead to better outcomes,” Mullan added.

In the study, the unadjusted average spending of doctors who trained in high-spending areas was $1,847 more per Medicare patient. When adjusted for patient, doctor and community factors, the spending was about $522 more per patient.

The difference in spending was strongest among doctors who had recently completed their residency program. Within seven years after completing training, doctors trained in high-spending regions spent an average of $2,434 more per patient than those who trained in lower-spending regions.

Spending differences linked to doctors’ training locations were no longer evident 16 to 19 years after completing their residency, according to the researchers.

Study author Dr. Candice Chen said, “Communities that recruit physicians who have trained in areas where more health care services are the norm will practice more expensive medicine but not necessarily produce better health outcomes.” Chen conducted the research while an assistant research professor at Milken, which is based in Washington, D.C.

“Doctors trained in an environment where health services are used judiciously may ultimately be providing better value for patients and cost savings for the system,” she added in the news release.

The study was published in the Dec. 9 issue of the Journal of the American Medical Association.

More information

The Kaiser Family Foundation has more on U.S. health care costs.

Source: HealthDay

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