Residency Has Lasting Effect on Spending Habits of Doctors

Residency has a long-lasting effect on spending patterns during a physician’s career, according to a new study. Researchers at George Washington University found that physicians who trained in a part of the country with higher healthcare expenditures will continue to practice that type of medicine even if they move to a region with lower spending habits.

Physicians who trained in high-spending regions and continue to practice in a high-spending region had an annual mean spending per Medicare beneficiary that was $1926 higher than those trained in low-spending regions, according to the study, which appears in JAMA.

“Communities that recruit physicians who have trained in areas where more healthcare services are the norm will practice more expensive medicine but not necessarily produce better health outcomes,” lead author Candice Chen, MD, MPH, who did the research while an assistant research professor at Milken Institute School of Public Health at the George Washington University, said in a statement. “Doctors trained in an environment where health services are used judiciously may ultimately be providing better value for patients and cost savings for the system.”

The authors found there was a 7% difference in patient expenditures between low- and high-spending training regions. The difference was more noticeable between physicians just one to 7 years in practice, with a $2434 mean difference in spending per beneficiary. Meanwhile there was no significant difference for those practicing for 16-19 years.

However, the authors reported that a difference in spending could persist for up to 15 years after residency training.

“Evidence suggests that there is wide variation in Medicare spending, with higher spending associated with more inpatient-based and specialist-oriented care,” says Fitzhugh Mullan, MD, the Murdock Head Professor of Medicine and Health Policy at Milken Institute SPH and senior author of the paper. “A number of studies also show that higher spending for healthcare doesn’t necessarily lead to better outcomes.”

Even when the researchers adjusted for patient, physician, and community factors that could affect spending, physicians who trained in areas of higher expenditures still spent an average of $522 more per Medicare patient compared with their counterparts trained in areas of lower expenditures.

“Interventions during residency training may have the potential to help control future health care spending,” the authors concluded.