title: The cost and efficiency of hospital care provided by primary care physicians and medical subspecialists.
abstract: 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.
authors.affiliation: Department of Medicine, Loyola University Medical Center, Maywood, Ill., USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Zarling
authors.forename: F A
authors.initials: FA
authors.lastname: Piontek
authors.forename: R
authors.initials: R
authors.lastname: Kohli
authors.forename: J
authors.initials: J
authors.lastname: Carrier
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004470:Economics, Medical; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D012720:Severity of Illness Index; D013038:Specialization; D016896:Treatment Outcome