How residency programs are training doctors to waste money | Vox

(It’s difficult to link to an article with such a ridiculous title, but here we are.)

An interesting piece written about a new JAMA study that shows residency impacts and continues to impact costs of care for physicians once they are practicing.

I initially read through the Vox article, then read the abstract from the JAMA [1] and came to the conclusion that training in a high-spending region seems to mean that you will have higher costs of care when you go out in practice (regardless of spending patterns in your region).

From the Vox article:

Residents who train in regions with high health care costs (that is, the places that err on the side of more scans and specialists) continue to practice expensive medicine decades beyond graduation — even if they move to low-cost parts of the country.

While proofing my original post, I realized that this is not what the paper says at all [2]. There is never a direct comparison made among residents trained in high-spending areas versus residents trained in low-spending areas. The comparisons (summarized in Table 2) are all made within the training spending levels.

The data (as presented) actually shows the opposite of what Vox concludes. For residents trained in regions with high health costs, their average cost patient expenditure is $9,482 when practicing in a high-spending region versus $7556 when practicing in a low-spending region [3].

The comparison we want to look at is between the high-spending trainees and low-spending trainees and their costs within their specific practice spending strata. So, for a resident trained in a high-spending region who goes to practice in a low-spending region, his average cost is $7,556 (as mentioned above). For a resident trained in a low-spending region who goes to practice in a low-spending region, his average cost is $6,882. This represents a difference of $674—not chump change—but no direct statistical comparison is made, so it is difficult to say if this is a real difference.

This data is correlational and speculative at best. It’s hard to tell the direction of the effect.

Vox concludes:

The JAMA paper suggests a tantalizingly easy way to save money in American health care: train more residents in low-cost areas of the country.

While I don’t think that is a bad idea, I wouldn’t base huge programs to shift residency training to lower-cost regions based on this paper.


  1. I have to jump through about 27 hoops to get a full-text article from JAMA through my institution while at home.  ↩

  2. Which subsequently had to be pulled because it was all sorts of wrong.  ↩

  3. P < 0.001  ↩

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