Patterns of diagnostic testing in the academic setting: the influence of medical attendings' subspecialty training

Internists with subspecialty training (subspecialists) constitute the majority of the medical faculty members and the test-ordering behavior of these subspecialists influences how house officers and students solve clinical problems. To assess whether test-ordering patterns are influenced by the ward attendings' subspecialty status, we identified the number of gastrointestinal endoscopic procedures, bone marrow procedures and exercise stress tests that were ordered on 9608 patients admitted to a medical service during a 3 year period. The patient management was supervised by attendings, 8 of whom were generalists and 37 of whom were subspecialists. House officers supervised by generalists ordered 23% fewer gastrointestinal procedures, 47% fewer bone marrow procedures, 43% fewer exercise stress tests and 29% fewer total procedures than house staff supervised by subspecialists (P--not significant, P less than 0.001, P less than 0.05 and P less than 0.01, respectively). House officers perceive a difference between the test-ordering patterns of subspecialists and generalists. They attribute this difference to post-residency training and believe that the use of more tests indicates a greater compulsion toward an exhaustive evaluation.