4 ms·

The title should be "hospital patients treated by low volume physicians are more likely to die". But that would have been less likely to get published. The "hig

The title should be "hospital patients treated by low volume physicians are more likely to die". But that would have been less likely to get published. The "high volume" group was also really NOT high volume: 200 patients per year is around 4 patients per week. So the study really tells us about very 'low volume' providers compared to slightly higher volume providers, it's interesting that that was enough to get rid of any age-related effect. That in turn suggests the effect was pretty small. Similarly, I'm pretty sure that "code written by programmers who don't program often is more likely to have bugs", and "pilots who don't fly often are more likely to crash". (Strictly speaking, you'd want to normalize the risk of bugs / crashes per some unit of output e.g. per hour flown for pilots.)

yequalsx 9y ago
Older docs don't have to take board exams every ten years. Incoming doctors all have to take board exams every 10 years for the rest of their working life. This may account for why high volume doctors don't have the higher mortality rate even for older physicians. Perhaps the higher volume makes them more likely to be current in their field.
MarkMc 9y ago
> So the study really tells us about very 'low volume' providers compared to slightly higher volume providers I don't think 'slightly higher' is accurate. The report says, "We classified physicians into thirds of patient volume: low (estimated number of total admissions <90 per year), medium (91-200 admissions), and high (>201 admissions)". So you have two-thirds of doctors whose median volume is 90 per year, and one third of doctors whose median volume is well above 201 per year. That seems to be a significant difference. > That in turn suggests the effect was pretty small. For two-thirds of doctors the effect is: "adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%)...and 12.1% for physicians aged ≥60 (11.6% to 12.5%)". I'd say that's a significant effect - certainly something that should be included in the title.
deleted 9y ago
[deleted]

yequalsx 9y ago

Older docs don't have to take board exams every ten years. Incoming doctors all have to take board exams every 10 years for the rest of their working life. This may account for why high volume doctors don't have the higher mortality rate even for older physicians. Perhaps the higher volume makes them more likely to be current in their field.

MarkMc 9y ago

> So the study really tells us about very 'low volume' providers compared to slightly higher volume providers I don't think 'slightly higher' is accurate. The report says, "We classified physicians into thirds of patient volume: low (estimated number of total admissions <90 per year), medium (91-200 admissions), and high (>201 admissions)". So you have two-thirds of doctors whose median volume is 90 per year, and one third of doctors whose median volume is well above 201 per year. That seems to be a significant difference. > That in turn suggests the effect was pretty small. For two-thirds of doctors the effect is: "adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% confidence interval 10.7% to 10.9%)...and 12.1% for physicians aged ≥60 (11.6% to 12.5%)". I'd say that's a significant effect - certainly something that should be included in the title.

deleted 9y ago

[deleted]