Where a primary care physician completes his or her residency may be a good predictor of their Medicare expenditures in the early years of practice, according to a study published today in the Journal of the American Medical Association.
The study found physicians trained in high-spending regions continued to practice high-cost medicine for nearly 10 years after graduation, even if they move to a lower-spending region. Likewise, physicians trained in lower-spending regions continued to practice less expensive medicine, despite the practice spending environment.
Researchers analyzed 2011 Medicare claims data from a random sample of about 2,800 physicians. The physicians completed residences between 1992 and 2010 and served a minimum of 40 Medicare patients each. Using Dartmouth Atlas Hospital Referral Region files, researchers were able to match locations of practice and residency and categorize them into groups based on low-, average- and high-spending. The Dartmouth Atlas is a 20-year project that tracks Medicare expenditures geographically. It reveals possible discrepancies in healthcare spending in regions where patients' health status may not warrant the expense.
Data indicated physicians who both trained and practice in high-spending regions spend an average of $1,926 more in Medicare per beneficiary per year. Physicians who completed graduate medical education in a high-spending region, but currently practice in an average-spending region, spend $897 more in Medicare per beneficiary per year.
For those who trained in high-spending regions, there was a 7 percent difference in spending, which translates to an average increase of $522 more annually than physicians trained in less expensive regions.
The difference in spending was most pronounced early on in the physicians' careers; the effect diminished over time. In the first seven years of practice, data shows a 29 percent difference in spending across high- to low-spending regions. However, after 16 to 19 years, the difference was no longer significant, according to the report.
The study concludes, "Interventions during residency training may have the potential to help control future health care spending." Data suggest exposing physicians to a variety of spending environments during their residencies could begin to address nationwide discrepancies in healthcare spending.
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