Harmful medical practices, like inappropriate prescribing of opioids and racial and income-based discrimination in clinical settings, can vary across medical practices and individuals. Patients may find that even common primary care health services, like getting a chest x-rays or a referral to a heart or lung specialist, can differ widely depending on your doctor or clinic location. These variations in medical practice can have serious consequences for the quality, equity and cost of one's health care; however, it's unclear whether these disparities can be attributed to individual differences, from one doctor to another or to changes in your doctor's individual practice over time, perhaps in response to shifts in clinical guidelines or advancements in diagnostic technologists. Is it person-to-person variation or variation over time? A group of Israeli researchers sought to answer this question in a retrospective cohort study using a decade of data from the largest health care provider in southern Israel. This study shows variations between physicians' practice patterns to be significantly more pronounced than variations within an individual physician's practice patterns over a decade. Researchers assessed the medical practice patterns of 251 primary care physicians, including their rates of imaging tests, cardiac tests, laboratory tests, and specialist visits. After adjusting for different patient and clinic characteristics, practice pattern variations remain high, while individual physicians' patterns over time appear stable. The authors propose that medical practitioners' personal behavioral characteristics might help explain variations across practice patterns.
Medical Practice Variation Among Primary Care Physicians: 1 Decade, 14 Health Services, 3,238,498 Patient-Years
Victor Novack, MD, PhD, et al
Ben-Gurion University of the Negev, Soroka University Medical Center, Be'er-Sheva, Israel