The ACP Advocate Blog
by Bob Doherty
Tuesday, March 10, 2009
Do FPs do it better than internists?
A study in this month's issue of Health Affairs finds that Medicare spending by general internists and subspecialists is significantly higher than for family physicians.
The article's abstract says the following:
"Based on analyses of data from the 2001 - 2004 Medical Expenditure Panel Surveys, we found significant differences in annual spending, especially for adults. Use of and spending for subspecialists were similar to those for general internists, and both were significantly higher than those for family physicians. Variation in spending might be the result of training differences among primary care specialties." The article goes on to say that such "significant variation persisted after control variables and disease case-mix were adjusted for."
As a possible explanation for the variation, the authors cite another study, which concludes that "internal medicine resident training is not well suited for primary care populations." The article ends by saying, "Differences in the training of physicians who are serving as usual sources of care might account for different practice styles associated with greater and potentially avoidable spending, and thus it merits further investigation, particularly in light of current interest in the patient-centered medical home."
The study was conducted by the Graham Center, a research arm of the American Academy of Family Physicians.
I will leave it to others with more expertise than me to comment on the study's methodology and the suggestion that internal medicine training may not be well suited for primary care and the patient-centered medical home. I know that many internists will take issue with the study and the authors' discussion of the policy implications.
My concern is that at a time when family medicine, pediatrics and internal medicine are united on the need to institute policies to support primary care provided by all three disciplines, can there be anything more divisive than for each specialty to get into an argument over which one does the job better?
Vested interests who do not want to see primary care gain at their expense would love to see the primary care physician specialties get into a fight among themselves. Just like they would like to see primary care physicians and NPs battle over their respective roles.
This is not to say that we shouldn't do research to learn more about the impact of physician training on variations in effectiveness and cost of care. Such research should be subjected to critique and commentary, as I am sure the AAFP's Graham Center's study will be. But it will be regrettable if this article ends up creating a war of words on the value of family medicine versus internal medicine, when we should remain united on the essential contributions of both.
Today's question: What do you think of the Graham Center's finding that family physicians are less expensive than internists, and their suggestion that internal medicine training is not well-suited for primary care populations and the medical home?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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