Less Experienced Providers Higher Spenders?

With all the recent press surrounding health care costs, everyone wants to know why medical care in the United States is so expensive.  A recent study published in Health Affairs gives us one piece of the health care spending puzzle.  The study shows that less experienced doctors spend more treating patients than those with more time in practice.

Just how much more do less experienced physicians spend?

The study found that physicians with 10 or fewer years of experience had 13.2 percent overall higher costs in treating similar patient 'episodes of care' (for example evaluating and treating a lung nodule) than physicians with 40 or more years of experience.  Doctors with 10-19 years of experience had cost profiles 10 percent higher than those with 40 years experience while doctors with 20-29 years of experience had cost profiles 6.5 percent higher.  Based on the results of this study, as physicians gain years in practice, they spend proportionally less treating their patients. 

Why do experienced doctors spend less on health care?

Researchers have several theories as to why less experienced doctors spend less treating their patients.  Recently trained doctors may have greater knowledge of cutting-edge treatments and be more likely to use them than older doctors.  Lack of experience may lead to ordering more tests and more aggressive treatment regimens among less experienced physicians.  Researchers are uncertain if as newer doctors progress throughout their careers their spending will remain elevated or if it will decreased as they foster relationships with their patients and gain experience.

How will these findings affect health care?

The knowledge that less experienced physicians spend more may lead insurance companies, both private and government programs to contract with more experienced physicians.  Insurers may begin to reimburse physicians with less experience at lower rates.  As insurers look for ways to cut costs, reward systems for providers with lower costs of care will likely emerge.

What about nurse practitioners?

Although this study exclusively examined the spending habits of physicians, I believe research findings surrounding NP's would prove similar.  As a nurse practitioner I personally order fewer tests and imaging studies the more experience I gain.  I have become more familiar with how certain diagnoses present and can therefore work a patient up for a complaint in a more efficient manner.