11 Physician Training and Practice Environment
11.1 Motivation
As highlighted in our discussion of physician learning, there is an element of healthcare variation that is due to a physician’s “initial conditions” or the prior. Something that leads one physician to treat patients from another, not because of differential experience in medical practice, but because of some other underlying differences. The purpose of this chapter is to discuss a few of these sources of heterogeneities.
11.2 Training
One source of such a difference is their medical training. This encompasses various aspects crucial to shaping the competencies and practices of medical professionals. These areas include medical education and the selection of specialization. The significance of these facets cannot be understated, as they collectively mold the approach and conduct of physicians in their practice. Medical education forms the foundation upon which physicians build their knowledge and skills. It involves a standardized curriculum that aims to provide a consistent level of training to medical students. This training equips future physicians with the requisite medical knowledge, diagnostic abilities, and clinical skills needed to effectively address patient needs. Selecting a specialization represents a critical juncture in a physician’s career path. The decision to pursue a particular specialty can significantly impact the trajectory of a physician’s practice. Specializations encompass distinct areas of medicine, each with its unique set of challenges, patient populations, and treatment paradigms.
In addition, while not a formal component of training, personal biases can play a subtle yet influential role in a physician’s practice. These biases, stemming from individual beliefs and experiences, can unconsciously affect diagnosis, treatment decisions, and patient interactions. Recognizing and addressing these biases is crucial to ensuring equitable and evidence-based healthcare delivery.
Several studies shed light on the dynamics of physician training and its implications on practice patterns and patient outcomes. Chan (2021) delves into the team dynamics and influences that shape physicians’ practice during their residency. The study highlights the significance of collaborative decision-making and its impact on the development of treatment approaches. A recent working paper by Maximilian Pany and co-authors also explores the phenomenon of physicians adhering to treatment patterns of advisors during their residency. The study uncovers how mentorship and guidance during training can shape a physician’s approach to patient care, with implications for long-term practice habits. Similarly, Kravitz and Greenfield (1995) examine the training of primary care physicians (PCPs) and its association with healthcare utilization. The study suggests that PCPs’ training influences their practice patterns, potentially leading to more efficient healthcare resource allocation.
11.3 Practice environment and peer effects
Physician location and practice patterns also play a significant role in determining healthcare delivery and utilization patterns within a given region. Peer effects, which refer to the influence of colleagues and peers on individual decisions, have been extensively studied in various contexts. However, the applicability of peer effects to physicians’ treatment decisions remains an intriguing question.
Molitor (2018) examines the extent to which physicians adopt the practice patterns of their peers when transitioning to new practices. Focusing on cardiologists, the study explores the role of practice environment in influencing treatment decisions and highlights the prevalence of peer effects in shaping physician behavior.
Molitor’s study delves into the evolution of physician practice styles, particularly among cardiologists who migrate to new practices. The research emphasizes the substantial impact of the practice environment on physician behavior, accounting for a significant portion of the observed variation in practice patterns.
A recent working paper from Badinski et al. offers a new study of geographic variation in healthcare utilization and its correlation with physician-related factors. The study consolidates prior approaches, revealing substantial heterogeneity across physician types. The findings suggest that for cardiologists, practice environment plays a central role in determining treatment patterns, overshadowing individual physician practice style. Conversely, for primary care physicians (PCPs), individual practice style gains prominence in explaining variations in healthcare utilization.
11.4 Summary
Addressing inefficiencies in healthcare delivery requires understanding the sources of variation in physician practice and its impact on healthcare utilization. The persistence of significant variations in healthcare utilization across different markets raises a pertinent concern. These variations cannot be solely attributed to patient need or variations in the quality of care provided. Rather, they point toward potential inefficiencies within healthcare systems.
Several factors contribute to the observed inefficiencies in healthcare utilization. As physicians continuously learn and adapt to evolving medical knowledge, disparities in their access to information and varying learning curves can lead to disparate treatment decisions. The practice environment, including the influence of peers and colleagues, can contribute to the diffusion of specific treatment patterns. Peer effects may lead physicians to adopt practices that are popular within their professional networks. Furthermore, physician training and prior beliefs can inadvertently influence treatment decisions. Unconscious biases, rooted in individual experiences and training, may impact diagnoses and care plans.
Addressing inefficiencies in physician practice patterns and healthcare utilization requires multifaceted solutions. Enhancing information transparency, through mechanisms such as FDA regulations and healthcare rating systems, can empower patients and providers to make more informed decisions. Integrating best practices, such as the use of checklists and electronic health records (EHRs), can standardize care processes and minimize variation. However, efforts to change practice patterns may encounter resistance from physicians accustomed to certain routines. Balancing the integration of new tools and approaches with physician preferences is a critical challenge.
In conclusion, understanding the dynamics of physician training, practice patterns, and their impact on healthcare utilization is paramount to addressing inefficiencies in healthcare systems. Through a combination of evidence-based policies and collaborative efforts, healthcare stakeholders can work towards achieving more consistent and efficient healthcare delivery.