Assessing Correlations of Physicians' Practice Intensity and Certainty During Residency Training

Area of Science:

• Medical Education
• Health Services Research
• Physician Behavior

Background:

• Physician practice patterns vary, contributing to unnecessary healthcare spending.
• Modifiable determinants influencing these practice patterns are largely unknown.
• Identifying such factors could reduce unnecessary testing and clinical practice variation.

Purpose of the Study:

• To determine the relative importance of residency programs versus physician personality traits in explaining variations in practice intensity (PI).
• To assess the influence of these factors on the likelihood of ordering tests and treatments.
• To evaluate their impact on the certainty of physicians' intentions to order tests and treatments.

Main Methods:

• Surveyed 690 internal medicine interns and residents from 7 diverse residency programs.
• Utilized clinical vignettes to assess preferences for aggressive clinical care.
• Assessed physician personality traits and demographic characteristics.

Main Results:

• Residency program affiliation was the largest contributor to practice intensity variation (27.3% explained).
• No specific personality traits were independently associated with higher practice intensity.
• Personality traits accounted for 63.6% of the explained variation in certainty scores (17.1% explained).

Conclusions:

• Residency program affiliations significantly explain more variation in physician practice intensity than demographic characteristics, personality traits, or subjective norms.
• Understanding the impact of residency programs is crucial for addressing practice variation and healthcare costs.