Oct

19

From Pariah to Pioneer

In 1973, when John Wennberg published his first journal article on unwarranted variations in the delivery of healthcare, he was largely ignored. But over the past 40 years, Wennberg—the founder of the Dartmouth Atlas Project and the Peggy Y. Thomson Professor Emeritus in the Evaluative Clinical Sciences at Geisel—has helped to change the way physicians and patients approach medical decision making and shaped efforts to reform the nation's health-care system.

Over the course of two days at Dartmouth, Jack and his colleagues laid out the content of their work—leaving me to sort out its revolutionary implications. Elliott Fisher, David Goodman, and H. Gilbert Welch, all physicians, showed me data suggesting that in regions of the country and at individual hospitals that delivered the most medical services—as measured by days in the hospital, tests, procedures, and visits from multiple specialists—patients did not, on average, live longer. It also did not appear that regions whose patients were the sickest on average—and therefore potentially most in need of more treatment—were the ones where the most care was delivered. Jack and the others went on to show me that many patients were unwittingly getting elective surgeries (including cardiac bypass, mastectomy, and prostate surgery) that could cause side effects that patients did not know about or fully understand, raising the question of whether they would have wanted the surgeries had the pros and cons been explained to them in a way they could grasp.

Tracking Medicine: A Researcher's Quest to Understand Health Care, by John E. Wennberg.

Kim Zussman adds:

There are financial incentives to do procedures (both for drs and hospitals), creating moral hazard. I.e., it is more likely for an interventional cardiologist to recommend an angiogram than it is for a non-interventional to do so. Note the income difference in the table. Click on the image for full view or go to the article:

Cardiology salaries on the rise, how does yours compare?

According to Modern Healthcare’s 2017-2018 By the Numbers report, most physician specialties have seen an increase in average salary since 2015-2016. Interventional and non-invasive cardiology are no exception.


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