Measuring Changes in the Economics of Medical Practice

Interest in technology among medical students early in their clinical experience

BACKGROUND

The world is in the midst of the "digital" revolution characterized by the ascendency of computerization, information systems and artificial intelligence with an emphasis on innovation and creativity. This revolution has affected current medical practice and promises to significantly impact it in the future. This requires physician's understanding and participation in adopting such technology. This study aimed to explore the role technology plays in the future career plans of medical students.

METHODS

A questionnaire examining selection criteria for medical specialty choice, criteria for choosing a post-residency job and demographic data was completed by a convenience sample of 5th-year Israeli medical students.

RESULTS

Two-hundred forty-two students (51 % men) completed the questionnaire, an 84 % response rate. Only a third (35 %) rated the specialty selection criterion "provides mechanical/ technological challenges" as important, while only 7% considered as important that a specialty requires skills in computer science. Few students were interested in post-residency positions requiring much technological knowledge (25 %) and requiring much skill with computerized information systems (13 %). Male students were significantly more interested than females in such positions and these students more often reported that they were considering careers in surgery and its subspecialties. This surgical bent was confirmed by the 42 % of students interested in post-residency positions that include time in the operating room having more interest in positions requiring much technological knowledge than the students not interested in operating room time.

CONCLUSIONS

This preliminary study demonstrated that as a group the students' expressed relatively little interest in medical specialties and post-residency positions involving technological challenges and knowledge of information (computer) science. Yet, the sub-group interested in the surgical specialties had such interests. These findings were perplexing since the students belong to Generations Y and Z who are steeped in the use of smartphones and social media. Therefore, we failed to support our hypothesis that Generation Y and Z students would be attracted to specialties and positions that provide them with technological challenges. Furthermore, medical educators need to explore this apparent lack of interest in technology in order to insure that the future physician workforce is ready to face future "digital" challenges.

Gender Differences in Physician Service Provision Using Medicare Claims Data

OBJECTIVE

To determine differences in the provision of Medicare services based on physician gender in the United States.

PATIENTS AND METHODS

Participants included all 2013 Medicare fee-for-service physicians and their patients, a population that is predominantly older than 65 years. The 2013 Medicare Provider Utilization and Payment Data for services rendered between January 1, 2013, and December 31, 2013, were combined with the 2015 Physician Compare National Downloadable files and 2015 Berenson-Eggers Type of Service classification files. Total fee-for-service Medicare payments and Healthcare Common Procedure Coding System procedure codes for all fee-for-service beneficiaries were aggregated according to physician gender, specialty, years since medical school graduation, and type of service classifications.

RESULTS

Excluding drug reimbursement, the mean total Medicare payments per female physician, compared with those for male physicians, were 41% in surgical specialties, 72% in hospital-based specialties, and 55% across all specialties (P<.001). The mean overall number of unique beneficiary visits per female physician was 59% of that for male physicians (P<.001). By using the Berenson-Eggers Type of Service classification, procedures and other services by female physicians were of 54% lower overall average intensity (allowed payments/number of unique patients) compared with those of male physicians. These differences persisted irrespective of years since medical school graduation (P<.001).

CONCLUSION

Female physicians had smaller average total Medicare payments and fewer unique beneficiary visits than male physicians in the care of fee-for-service Medicare beneficiaries in 2013. The differences persisted across specialty types and years in practice. These data can identify variation but cannot determine causation or explain the reasons behind gender differences. These findings suggest, but do not prove, that female physician Medicare payments are lower due to different practice patterns, consisting of fewer patients cared for and lower intensity of care.