Getting a new physician could be good for your health
Often when your physician closes or sells his or her practice to retire, you get a younger and more inexperienced physician, who looks at you with fresh eyes. This change could be both life-enhancing and life-prolonging, according to new research from Aarhus BSS.
When a physician closes his or her practice, it will often be a disadvantage to you as a patient. A good old family doctor will have followed you for many years and acquired substantial knowledge of you and your health as well as a familiarity with you as a person, which will be lost in the transition to a new physician. Even though your medical record will be passed on. So we have often thought. And some studies do point to the negative consequences of such a transition.
But new research from Aarhus BSS is turning that idea upside down. In a new study based on registry data from 877.547 Danish citizens (and an equally large control group), researchers examine how patients and their health are affected by a change of physician when their previous physician closes his or her practice, typically due to retirement or because he or she finds a new occupation.
The results are positive. The researchers find a very large increase in the uptake of medicine targeting type 2 diabetes, high blood pressure and high cholesterol. The likelihood of starting treatment with medicine targeted at these diseases increases with 30-60% following a practice closure. This corresponds to 25-100 more patients who enter treatment for these lifestyle diseases every time 10,000 changes of physicians have taken place.
These are diseases which are prevalent among elderly people in particular, and diseases which are generally underdiagnosed in the population. For this reason, the patient greatly benefits if these chronic diseases are identified and treated.
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”In fact, it can be a huge advantage for patients to change their physician.”
Niels Skipper, associate professor at Department of Economics and Business Economics, Aarhus BSS, Aarhus University.
So what is the reason lifestyle diseases are diagnosed and treatment initiated in connection with a change of physician?
According to the researchers, one of two things could be at work. Either the new physician treats his or her patients differently (difference in practice style), or the cause might be the change itself (discontinuity in care).
The latter turns out to be the most important cause. The explanation is simple: The previous physician is not sufficiently attentive to changes in the patients’ medical needs. To the old family doctor, you might be business as usual. Whereas a new physician looks at the patient from a fresh perspective while doing his or her routine check-up and thus identifies these diseases.
“The patient is being looked at with fresh eyes. Your previous physician may not have been fully aware of all the problems in his or her patient base. The new physician discovers that there are undiagnosed diseases at play,” says associate professor of health economics Niels Skipper from Aarhus BSS at Aarhus University. He is behind the new study together with fellow researchers Marianne Simonsen, Lars Skipper and Peter Rønø Thingholm from the Department of Economics and Business Economics at Aarhus BSS.
Old versus new physicians
The study also presents some interesting characteristics of old and new physicians respectively.
Usually, the previous physician is an older man (73 per cent of physicians who close their practice are men. 58 per cent are over the age of 60) with long experience (on average 30.3 years of experience). He often has a single-physician practice.
The likelihood that the new physician is female is 32 per cent. The new physician is often younger (at least under the age of 60) and slightly more inexperienced (though on average, with 24.8 years of experience). The new physician is more often a part of a joint clinic.
In both cases, the physician acts as a gatekeeper to further treatment by specialists. And the new physician is more likely to refer you – not because his or her practice style is more aggressive, but because it turns out there is a genuine need for further treatment as the patient suffers from lifestyle diseases.
Everyone has the right to a physician
“Our research shows that it might not be so bad for the patient to get a new physician,” says Niels Skipper.
And for this reason, we should not fear the coming wave of practice closures due to retiring physicians.
In Denmark, everyone has the right to a physician. And the results of this study are indeed based on the fact that people get a new physician following practice closures. What makes this study special is that the researchers have managed to move beyond an issue which often affects similar international studies: The patients risk not getting a new physician when their old one retires, which naturally leads to a subsequent decrease in the use of healthcare services.
"The reason is simply that there is no new physician to visit. We are not faced with this challenge in Denmark,” Niels Skipper explains.
“Having said that, we might genuinely worry whether there will also be enough physicians in the future. It is important that decision-makers ensure that we have access to physicians. This is something that needs political attention. So far, the authorities deserve top marks for how they have solved this task, because people do have access to physicians,” says Niels Skipper.
Positive or negative effects
The research is interesting because many people perceive the concept of continuity in care, which is a much-discussed topic in the field of medical research and economics, as a positive thing.
"Your old physician knows your complex medical history and the medicine you usually take. And on a personal level, there may be a sense of informal confidentiality between you and your physician,” says Niels Skipper and continues:
"For this reason, many believes that ‘discontinuity’ automatically presents a disadvantage to the patient, as there will undeniably be a loss of information in the transition from one physician to another. That is why it is so exciting that our study shows that this is not necessarily the case. In fact, it can be a huge advantage for patients to change their physician."
Facts about the study
The register-based study covering the period 1998-2015 examines the consequences of practice closures. For the period in question, the examination encompassed 877,547 people who were compared with similar people whose physician’s practice did not close until three years later.
The researchers find a very large increase in the uptake of medicine targeting type 2 diabetes, high blood pressure and high cholesterol. The likelihood of starting treatment with medicine targeted at these diseases increases with 30-60% following a practice closure. This corresponds to 25-100 more patients who enter treatment for these lifestyle diseases every time 10,000 changes of physicians have taken place.
By focusing on a change of physician due to retirement or due to the physician finding a new occupation, the study was able to rule out changes due to reasons in the specific patient-physician relationship or for individual purposes, e.g. because you think your old physician is incompetent and want a new one.
This is also the reason why the researchers do not outright recommend changing your physician based on these findings. That is simply not what they have examined in this study.
Following the transition to a new physician, there are no changes in your access to a physician and you do not visit the physician less than before.
Labelling of research
Population-based, register-based study covering the period 1998-2015 with 877.547 participants and an equally large control group, whose physician’s practice did not close until three years later. The research uses an event-study to examine the consequences of practice closures.
Read the scientific article ”Discontinuity in care: Practice closures among primary care providers and patient health care utilization”, which has been published in the Journal of Health Economics, in full here.