A new study from the Robert Graham Center examined the rate of low-value care services across the country. A LVC service could be a number of things, but the recent wave of research in this area is based off the Choosing Wisely campaign, which asked the major medical societies to come up with at least five tests or treatments that it felt its members might order too often. Examples include antibiotics for colds and routine chest x-rays for pre-op evaluations.
In this study, several large national data sets were combined to look at the rate of LVC services ordered by primary care physicians as a function of the physician supply. It found that decreased LVC services (the good outcome) were associated with allopathic (M.D. instead of D.O.) training, smaller Medicare patient panel, practiced family medicine (as opposed to general internists), practiced in the Midwest region, were a recent graduate, or practiced in rural areas.
The difference between the family physicians and internists was small, smaller than the association between allopathic degree, Medicare panel size, and graduation year. The major weakness of this study is that it could tell how many tests were ordered in a defined geographical area, but not precisely who ordered the test.
But this is yet another study showing that family physicians aren’t watered-down internists, that we have a different culture and a different set of patient care priorities. The only evidence that primary care delivers better care at a lower cost is in family physicians, not internists, not pediatrician, not any other kind of clinician.
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