High price tag linked to heavy testing by newer doctors

A RAND study says physicians with under 10 years of experience order more expensive tests and drive up costs for Medicare and private insurers.

By Jennifer Lubell — Posted Nov. 16, 2012

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Inexperienced physicians may be contributing to rising costs in the health care system by ordering more care that might not be necessary, but they also might be dealing with sicker patients, according to a RAND Corp. study that appeared in the November edition of Health Affairs.

In looking at the cost profiles of more than 12,000 doctors in Massachusetts, the study found that the overall costs incurred by doctors with less than a decade of experience was more than 13% higher than those of physicians who had been practicing medicine for 40 years or more. Cost profiles are used to identify doctors that account for higher spending than others. “By identifying the costliest physicians, health plans and Medicare hope to craft policy interventions to reduce total health care spending,” the study said (link).

The report’s researchers suggested that newer physicians may have more costly practice styles that would help drive up overall health care costs. “Recently trained physicians may be more familiar with, and therefore more likely to use, newer and more expensive treatment modalities,” the study said. They also may overcompensate for their lack of experience by employing more aggressive treatments.

Mark Smith, president of Merritt Hawkins, a physician search firm based in Irving, Texas, said many young doctors train in large, tertiary medical facilities “where there is a culture of abundance, including all the latest technologies and multiple subspecialists to refer to. That is the standard they are used to and are comfortable with.”

There are times, however, when consultation and observation are more effective tools, from a cost and quality perspective, than tests or procedures, Smith said. “It can take a few years of seasoning before they realize you don’t need a Ferrari to win every race.”

Inexperienced doctors also may be treating higher numbers of sicker patients with more complex medical problems than seasoned doctors, “and the risk adjustments used in cost profiles may not adequately adjust for this difference,” the study’s authors stated.

The cost differences between less experienced and veteran doctors don’t translate into a conclusion that newer doctors are providing better medical care, the study’s researchers said. In addition, there was no association between costs and other factors, such as whether a doctor was board-certified or had incurred a disciplinary action or medical liability claim. The size of a physician’s practice wasn’t a significant driver, either.

While telling, the findings warrant further research “and need to be affirmed by additional studies,” said the study’s lead author, Ateev Mehrotra, MD, MPH, an associate professor at the University of Pittsburgh School of Medicine and a researcher at RAND. The researchers noted that the practice of using physician cost profiles is being refined.

“Our findings cannot be considered final, but they do underscore the need to better understand physician practice patterns and what influences that behavior,” Dr. Mehrotra said in a statement.

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