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Are quality measures for general internists related to market outcomes?

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Gray B, Holmboe ES, Lipner RS. — American Board of Internal Medicine

Reschovsky J. — Center for Studying Health Systems Change

Presented: AcademyHealth Annual Research Meeting, June 2011

Objective: To examine how more or less visible measures of physician quality affect market outcomes.

Data Sources: General internal medicine (GIM) physicians observations from the 2000-01 and 2004-05 Community Tracking Study Physician Surveys linked with residency program and board certification information from the American Board of Internal Medicine (N=2,315).

Study Design: We regressed seven market outcomes covering income, practice type, patient case-mix, location and career satisfaction on two sets of physician quality measures—interactions between initial attempt at board certification exam score and current board certified status and interactions between residency program quality and residency director evaluations—plus control variables.

Principal Findings: Except for non-certified physicians, who earn 15% less, physician quality was not associated with income. Quality indicators visible to physicians/employers help sort physicians into more/less desirable practice situations which are persistent over physicians' careers. Consequently, disadvantaged patients tend to be treated by lower quality physicians. Higher board scores were associated with greater career satisfaction.

Conclusions: The GIM market fails to reward physicians monetarily for better quality, above minimal standards and therefore may provide insufficient motivation for quality improvement. Results support reforms that reward physicians for delivering better care (e.g., public reporting, pay-for-performance), although policies such as these could exacerbate disparities in access to high-quality physicians.

For more information about this presentation, please contact Research@abim.org.