HealthDay News — According to a study published in the Annals of Family Medicine, spending patterns in training hospital service areas (HSAs) impact physician spending.

Robert Phillips Jr, MD, MSPH, from the American Board of Family Medicine Inc in Lexington, Kentucky, and colleagues conducted a secondary analysis of 2011 Medicare claims and American Medical Association Masterfile data.

They used a sample of family physicians and general internists who completed residency between 1992 and 2010 (3075 physicians providing care to 503,109 Medicare beneficiaries). Practice and training locations were matched with HSAs and classified as low-, average-, and high-cost spending groups; the differences in four diabetes quality measures were assessed in practice and training HSAs.

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The researchers found that for physicians trained in high- and low-cost HSAs, the unadjusted annual, per-beneficiary spending difference was $1644; after adjustment for patient and physician characteristics the difference remained significant.

There was no significant relationship for diabetes quality measures. Training in high-cost HSAs was more likely for general internists than family physicians. Lower-spending physicians came from institutions with more graduates in rural practice and primary care.

“The ‘imprint’ of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes,” the authors write.


Phillips RL, et al. “The Effects Of Training Institution Practice Costs, Quality, And Other Characteristics On Future Practice”. The Annals of Family Medicine. 2017;15(2). doi: 10.1370/afm.2044

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