Increasing physicians in hospital staff does not improve quality of care, US study suggests

The proportion of hospitals employing physicians in the United States has increased sharply, but the switch to the physician-employment model has not been associated with improved quality of care, a study has found.1

Researchers looked at quality measures in 803 hospitals that switched from the traditional hospital-physician business model, in which the hospitals and hospital staff physicians are largely independent of each other, to an arrangement in which at least some of the physician staff are hospital employees.

The quality metrics considered were: risk adjusted hospital level mortality rates; 30 day readmission rates; length of stay; and patient satisfaction scores for common acute myocardial infarction, congestive heart failure, and pneumonia. The hospitals were matched with 2085 hospitals that did not make the switch. The study was published in the Annals of Internal Medicine.1

The researchers found that the proportion of US hospitals employing physicians rose markedly during the study period, from just 29% in 2003 to 42% in 2012—surpassing the proportion with the traditional unaffiliated hospital-physician arrangements, which fell from 44% to 38%. The proportion of hospitals whose contractual relationships with physicians fell short of employment also decreased during this period, from 27% to 19%. Large hospitals, teaching hospitals, and non-profit hospitals were more likely to make the switch, the study found.

However, hiring physicians as employees did not significantly change the quality of care. For example, the composite 30 day mortality rate was 11.2% among hospitals that switched, compared with 11.4% in those that kept the traditional model—a non-significant difference. The estimated changes in mortality during the two years after conversion were also non-significant: –0.4% in those that switched and –0.5% in those that did not.

The researchers concluded, “Although many advocates have suggested that hospital employment of physicians likely will result in much better care, we have found no substantive evidence to date to support this notion.

“As hospital systems continue to acquire physician practices and employ physicians, a focus on true clinical integration, as well as a renewed focus on improving the quality of patient care and clinical outcomes, will be essential.”