Study finds that physicians working outside their specialty may provide lower-quality care

Background: Studies show that subspecialists can provide better quality care than primary care physicians when working within their subspecialty for patients with some medical conditions. Recent studies have suggested there may be a surplus of subspecialists and a greater need for general internists. This surplus of subspecialists may result in such physicians caring for patients outside their chosen subspecialty.

Study:
The study compared the quality of care provided by three groups: 1) subspecialists practicing outside their speciality; 2) general internists; and 3) subspecialists practicing within their specialty. Using adjusted mortality rates and adjusted length of hospital stay as indexes of quality of care, researchers examined 5,112 hospital admissions from six hospitals in the greater Cleveland, Ohio area.

Results:
The study found that subspecialists working outside their subspecialty cared for 25% of hospitalized patients. When comparing patients cared for by subspecialists outside their subspecialty, adjusted length of hospital stay were longer for patients than those cared for by subspecialists practicing within their subspecialty, specifically the length of stay was 23% longer for patients with congestive heart failure and 22% longer for patients with bleeding ulcers. Patients also seen by subspecialists practicing outside their subspecialty had an average of up to 18% longer length of stay than patients cared for by general internists.

Conclusions:
Subspecialists commonly care for patients outside of their subspecialty, despite the fact that their patients may have longer lengths of stay in the hospital than those cared for by subspecialists practicing in their specialty or by primary care physicians. In addition, such patients have slightly higher mortality rates than those cared for by subspecialists practicing within their subspecialty.

Authors:
Scott R. Weingarten, M.D., M.P.H., Cedars-Sinai Health System, Zynx Health, Inc.; Lynne Lloyd, M.B.A.; Chiun-Fang Chiou, Ph.D., Cedars-Sinai Health System, Zynx Health, Inc.; Glenn D. Braunstein, M.D., Cedars-Sinai Medical Center

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