P4P Physician Compensation

Are young physicians better than old ones?

I can’t answer that. But I can tell you that young physicians are more likely to favor more costly medical intervetions. At least this is the conclusion of a recent study by Ateev Mehrotra and colleagues. They find:

We found that physicians with fewer than ten years of experience had 13.2 percent higher overall costs than physicians with forty or more years of experience. We found no association between costs and other physician characteristics, such as having had malpractice claims or disciplinary actions, board certification status, and the size of the group in which the physician practices. Although winners and losers are inevitable in any cost-profiling effort, physicians with less experience are more likely to be negatively affected by policies that use cost profiles, unless they change their practice patterns.

Why is this the case? One likely reason is that younger physicians have been more recently trained and are more familiar with how to use more advanced, high-cost technology. Research by Pham et al. found that less-experienced physicians are more likely to order unnecessary imaging when seeing a patient with back pain than their more-experienced physician peers. Even if new physicians are equally adept at new and old techniques, new physicians often have a smaller patient panel. Thus, they may feel the need to over-treat patients in order to increase their income nearer to their more senior, busier colleagues.


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