Effects of Physician Experience, Specialty Training, and Self-referral on Inappropriate Diagnostic Imaging

Abstract

BACKGROUND: Although previous research has demonstrated high rates of inappropriate diagnostic imaging, the potential influence of several physician-level characteristics is not well established. OBJECTIVE: To examine the influence of three types of physician characteristics on inappropriate imaging: experience, specialty training, and self-referral. DESIGN: A retrospective analysis of over 70,000 MRI claims submitted for commercially insured individuals. Physician characteristics were identified through a combination of administrative records and primary data collection. Multi-level modeling was used to assess relationships between physician characteristics and inappropriate MRIs. SETTING: Massachusetts PARTICIPANTS: Commercially insured individuals who received an MRI between 2010 and 2013 for one of three conditions: low back pain, knee pain, and shoulder pain. MEASUREMENTS: Guidelines from the American College of Radiology were used to classify MRI referrals as appropriate/inappropriate. Experience was measured from the date of medical school graduation. Specialty training comprised three principal groups: general internal medicine, family medicine, and orthopedics. Two forms of self-referral were examined: (a) the same physician who ordered the procedure also performed it, and (b) the physicians who ordered and performed the procedure were members of the same group practice and the procedure was performed outside the hospital setting. RESULTS: Approximately 23% of claims were classified as inappropriate. Physicians with 10 or less years of experience had significantly higher odds of ordering inappropriate MRIs. Primary care physicians were almost twice as likely to order an inappropriate MRI as orthopedists. Self-referral was not associated with higher rates of inappropriate MRIs. LIMITATIONS: Classification of MRIs was conducted with claims data. Not all self-referred MRIs could be detected. CONCLUSIONS: Inappropriate imaging continues to be a driver of wasteful health care spending. Both physician experience and specialty training were highly associated with inappropriate imaging.

The age‐old question: Thematic analysis of focus groups on physician experiences of aging in emergency medicine

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Physician practice migration and changes in practice style: An empirical analysis of inappropriate diagnostic imaging in primary care

“…Patient‐level characteristics included age, gender, type of health plan (i.e., health maintenance organization/point of service; preferred provider organization, indemnity), type of clinical condition (i.e., lower back, knee, shoulder), and the median income for residential zip code (proxy for a patient's financial resources for covering deductibles and copays). We also accounted for physician experience (i.e., number of years since graduation from medical school), as this is nontime invariant and has been linked to physicians’ judgments about the appropriate use of clinical services (Young et al., 2020). In addition, we accounted for whether the physician was employed at a practice site that was owned by a hospital system.…”

“…To conduct the investigation, we focused on referrals for inappropriate diagnostic imaging by primary care physicians (PCPs). Previous research has shown that rates of inappropriate imaging vary substantially among physician organizations and among individual physicians within the same community (Young et al., 2020). We examined whether physicians who migrated to new work environments changed their referral behavior for diagnostic imaging in a manner that conformed to the referral behavior in their new work environment.…”

Costs of Specialist Referrals From Employer-Sponsored Integrated Health Care Clinics Are Lower Than Those From Community Providers

“… 13 Unfortunately, there have been very few published studies of referral management among commercially insured populations and none on referral management from employer-sponsored health centers. 14 – 16 …”