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Clinical Decisionmaking

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Risk-aversion may lead internists to spend more than family physicians to confirm medical diagnoses

Family physicians tend to spend less than internists on patient care, perhaps because the internists tend to be more risk-averse. This higher level of discomfort with risk-taking may lead internists to order more tests, refer patients more often to consultants, and generally spend more to confirm diagnoses or treatments than family physicians. A recent study supported by the Agency for Healthcare Research and Quality (HS09397) found that after adjusting for differences in patient case mix, a one-standard-deviation increase in a doctor's risk-aversion score was associated with a 3 percent increase in expenditures. None of the other physician demographic, practice, or psychological characteristics were significantly associated with expenditures.

These findings suggest that interspecialty differences in costs may be related to the greater risk-aversion of internists, concludes Peter Franks, M.D., of the University of Rochester. Lead author Kevin Fiscella, M.D., M.P.H., Dr. Franks, and their colleagues surveyed 61 family physicians and 112 internists within a large local New York managed care organization about their demographic, practice, and psychological characteristics. The researchers then used claims data to identify patient case mix and physician costs per enrollee.

Attitude toward risk-taking was the only psychological factor that differed among the two specialties. Family physicians reported less anxiety generated by uncertainty and were less risk-averse than internists. For example, internists were more likely than family physicians to agree that the uncertainty of patient care often troubled them and that they usually felt anxious when they were not sure of a diagnosis. They were more apt to disagree that in their personal life they enjoyed taking risks.

See "Risk aversion and costs: A comparison of family physicians and general internists," by Drs. Fiscella, and Franks, Jack Zwanziger, Ph.D., and others, in the January 2000 Journal of Family Practice 49, pp. 12-16.

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