‘Cause for concern’: Physicians in the same health system make vastly different choices for identical patients
Physicians practicing in the same geographic area (and even health system) often provide vastly different levels of care during identical clinical situations, including some concerning variations, according to a new analysis.
Clinical and policy experts assessed care strategies used by more than 8,500 doctors across five municipal areas in the U.S., keying in on whether they utilized well-established, evidence-backed guidelines. They found significant differences between physicians, including some working in the same specialty and hospital.
The study results were published Jan. 28 in JAMA Health Forum.
“In some of the cases we looked at, physicians who made the most clinically appropriate decisions were 5 to 10 times more likely to use the recommended standard of care than peers in the same specialties and cities whose decisions tended to be the least appropriate,” lead author Zirui Song, MD, PhD, associate professor of healthcare policy and a general internist at Massachusetts General Hospital, said in a statement. “The differences we found are a cause for concern.”
The researchers pored over nationwide insurance data spanning 2016 to 2018, which incorporated 8,788 physicians from seven specialties who made care decisions in 14 clinical situations. Song et al. maintained they analyzed “straightforward” scenarios, rather than complex clinical cases.
Additionally, doctors were separated into five groups based on how likely they were to abide and use guidelines. And patients with similar clinical and demographic traits were included to avoid patient-level variations driving results rather than physicians’ individual decisions.
One practice difference the authors found surprising was in arthroscopic knee surgery rates. In these cases, the top 20% of surgeons performed surgery on 2%-3% of their patients, while the bottom 20% chose this invasive option for 26%-31% of patients with the same condition being treated in the same city.
Surgery has proven to provide no additional benefits for those with new osteoarthritis compared to no surgery or placebo treatments, the authors noted.
While more evidence is needed, the findings back long-held beliefs that wasteful spending on healthcare is tied, in part, to inappropriate decision making.
“Researchers have long suspected that much of that waste lies in the variation of the appropriateness of care from one physician to another,” Song added. “This study offers evidence that this problem is large and widespread across specialties.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.