3 ms·

Could it be that older (more experienced) physicians are more likely to get assigned to patients with more complex or serious conditions? (I don't mean to stat

Could it be that older (more experienced) physicians are more likely to get assigned to patients with more complex or serious conditions? (I don't mean to state the obvious but this wasn't made explicitly clear enough to me.) Edit: My initial comment here is probably wrong based on the detailed section "Adjustment variables": > Patient characteristics included age in five year increments, sex, race or ethnic group (non-Hispanic white, non-Hispanic black, Hispanic, other), primary diagnosis (diagnosis related group), 27 comorbidities (Elixhauser comorbidity index22), median household income of zip code (in 10ths), an indicator for dual Medicare-Medicaid coverage, day of the week of the admission date (to account for the possibility that severity of illness of patients could be higher on specific days of the week), and year indicators.

olvar_ 9y ago
They do say that they adjust for "patient characteristics", although they don't go into much detail. Also it's important to note that physicians that have a large volume of patients don't have a higher mortality rate on their patients. It looks like a real effect, maybe from "staying behind" or maybe simply not being on the "top of their game".
- dhfhduk 9y ago
  It's difficult to really say for certain what's going on. The adjustments I'm sure are very crude compared to what case assignment decisions are actually based on, for example, so I'm sure they're adjustments wouldn't really account very well for patient illness severity or other subtleties along those lines. Another possibility is that younger staff are more likely to be questioned about things. "Have you thought about X?" causes them to rethink something and make a revision. If older staff are just assumed to know what they're doing, they might be questioned less. The fact that differences weren't present among physicians with a large volume also makes me wonder if this is just a fishing expedition that wouldn't replicate. Not to cast aspersions on the authors; just to say that if you slice up any dataset enough you can find something. Finally, the differences aren't huge...
npv 9y ago
Patient assignment to physicians (at least in internal medicine) is based upon either a rotated call schedule or, in the case of hospitalists, who tend to admit every day that they are on service, is done randomly to keep the different providers' patient load balanced in size.

olvar_ 9y ago

They do say that they adjust for "patient characteristics", although they don't go into much detail. Also it's important to note that physicians that have a large volume of patients don't have a higher mortality rate on their patients. It looks like a real effect, maybe from "staying behind" or maybe simply not being on the "top of their game".

dhfhduk 9y ago
It's difficult to really say for certain what's going on. The adjustments I'm sure are very crude compared to what case assignment decisions are actually based on, for example, so I'm sure they're adjustments wouldn't really account very well for patient illness severity or other subtleties along those lines. Another possibility is that younger staff are more likely to be questioned about things. "Have you thought about X?" causes them to rethink something and make a revision. If older staff are just assumed to know what they're doing, they might be questioned less. The fact that differences weren't present among physicians with a large volume also makes me wonder if this is just a fishing expedition that wouldn't replicate. Not to cast aspersions on the authors; just to say that if you slice up any dataset enough you can find something. Finally, the differences aren't huge...

npv 9y ago

Patient assignment to physicians (at least in internal medicine) is based upon either a rotated call schedule or, in the case of hospitalists, who tend to admit every day that they are on service, is done randomly to keep the different providers' patient load balanced in size.