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The Cost and Efficiency of Hospital Care Provided by Primary Care Physicians and Medical Subspecialists

Department of Medicine, Loyola University Medical Center, Maywood, Ill, Veterans Integrated Service Network 12, Hines, Ill

Frank A. Piontek, MA

Holy Cross Health System Corporation, South Bend, Ind

Rajiv Kohli, PhD

Holy Cross Health System Corporation, South Bend, Ind

James Carrier, MPA

Holy Cross Health System Corporation, South Bend, Ind

There is a perceived excess of subspecialists compared with primary care doctors, but there are few severity-adjusted data that characterize the care provided by these physician groups. In a nationwide hospital network, we studied outcomes of 17,185 patients who were hospitalized for 1 of 9 common internal medicine illnesses. For 4 of 9 conditions, the subspecialists treated more severely ill (P < .001) patients. The raw total charges for their care were higher (P < .002) for 4 of 9 conditions and longer stays were required for 2 conditions. After adjusting for severity of illness, differences between the physician groups became minimal. In nine-severity adjusted medical illnesses, subspecialists and primary care physicians provide care that produces similar results for length of stay, charge, and mortality. Health care manpower projections should be re-evaluated in light of this information.

American Journal of Medical Quality, Vol. 14, No. 5, 197-201 (1999)
DOI: 10.1177/106286069901400502


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