Health Affairs reported this week something most of us sort of “knew”; the more experience a physician has, the lower their patients’ health care costs are.
Here’s the money quote:
“…physicians with fewer than ten years of experience had 13.2 percent higher overall costs than physicians with forty or more years of experience. [emphasis added] We found no association between costs and other physician characteristics, such as having had malpractice claims or disciplinary actions, board certification status, and the size of the group in which the physician practices.”
CWCI performed an analysis ten years ago [Does Practice Make Perfect?] that looked at the volume of workers comp cases handled by physicians over an eight year period. Alex Swedlow and Laura Gardner MD’s research clearly showed a strong correlation between experience and outcomes. The more workers’ comp patients a doc had, the lower the litigation rate, disability duration, indemnity and medical expense; pretty much every indicator was better. While the two studies aren’t directly comparable, the overarching lesson is the same:
The more experience a provider has, the better the outcomes are.
Of course, this is a generalization; there are older docs who are quite costly, and younger docs with terrific outcomes. That said, if you’re looking to identify providers associated with better outcomes, those of us with grey hair (or little hair) may be a good place to start.
And yes, the older I get, the more accurate I find this correlation!
Based on my 20 plus years in WC, it seems the older docs aren’t as likely to practice “defensive medicine” and/or seek numerous consultations as their younger counterparts are. I’m sure that I’m not the only one who has noticed this trend. It’s been my experience that if you want to send a claim “south” just get multiple drs involved or keep doing diagnostics until you find the slightest abnormality that could explain the continuing pain complaints.
This is commonly accepted by physicians which is why, they opine, there are no health care cost savings by replacing physicians with unsupervised NPs and PAs. PAs and NPs tend to order lab and imaging tests, so I am told, in the same way that young inexperienced practitioners might, for a multitude of reasons.
Joe,
Joan’s comment regarding the use of “physician extenders” does not bode well for developing an “experience track” for physicians to reach the forty years in practice plateau.
Forty years + schooling puts many of these physicians in their late 60s at least! Having not yet read the report, what is the trend for those physicians in the 30 years in between?
How does the industry develop doctors to that point? Comp is not taught in medical school and I believe there is a trend for new doctors to seek employment in a medical group rather than develop a private practice. The system itself leaves a lot to be desired from the perspective of administrative overhead and the knowledge needed to understand reporting and other specific nuances. The graying of this specific workforce is a big problem. What are your ideas?
Steve – read the report.