Variations in practice patterns among internists has been demonstrated in the past, but it is currently unknown whether or not the ranking, as determined by the US News and World Report, of a physician’s medical school has an effect on patient outcomes or healthcare spending. In this observational study of a random sample of Medicare fee-for-service beneficiaries age 65 years or older, 996,212 admissions treated by 30,322 general internists were followed for patients’ 30-day mortality and re-admission rates. Additionally, the internists’ Medicare Part B spending, adjusted for the patient, physician, and hospital characteristics, was documented. Researchers found that physicians from the top 10 ranked schools, as based on primary care US News and World Report rankings, had lower 30-day re-admission rates, as compared to schools ranked 50 or above (adjusted risk difference 0.4%, 95% CI 0.1% to 0.8%, p=0.005 for trend). Additionally, the physicians from the top 10 schools from primary care rankings spent significantly less through Medicare Part B (adjusted difference $36, 95% CI $20 to $52, p<0.001 for trend). No differences were observed in mortality among patients treated by these groups of physicians. When using US News and World Report research rankings, as opposed to primary care, no significant trends were observed for patient mortality or re-admission, though the lower spending among physicians from top 10 schools was again observed. Investigators therefore concluded that the ranking of a physician’s medical school has no effect on 30-day mortality and little effect on 30-day readmission, although physicians from top-ranked medical schools did account for less healthcare spending.
Click to read the study in BMJ
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