Why Do Some Doctors Use More Resources Than Others?

It is well known that some doctors use more resources than others. Up to now, that was an interesting observation. Now, however, it has become a major challenge for ACOs and those participating in risk-based payment schemes. One of the first steps in "rehabilitating" medical wastrels, is understanding what drives the behavior and creating ways to modify or eliminate it. Here are some possible reasons:

1. Variations in availability of resources in a given location.

2. Differing technology adoption patterns.

3. Differences between urban care vs. rural care.

4. Different practice patterns and habits learned during residency training.

5. Patient preferences.

6. Financial incentives.

7. Attitudes about best practices and clinical guidelines.

8. Systems that prevent change and that are built to reinforce old habits.

9. Lack of incentives to change behavior.

10. Lack of a sense of urgency to change.

In 1990, I co-authored a book on Cost Effective Otolaryngology. It was not exactly a New York Times best-seller. I guess my timing was off.

Maybe I should write a second edition, since generalists are increasingly being pressured to refer to cost-effective specialists because 45.7% of visits to office-based physicians in 2009 were to primary care physicians in general practice, family practice, internal medicine, or pediatrics, they accounted for only 30.4% of spending.

Getting into the heads of docs has never been easy. Getting into their wallets is even harder.