Do doctors use less heathcare than non-doctors?

A lot of the debate surrounding healthcare reform seems to revolve around the ability or inability to make informed decisions regarding needed treatment. Many (I think, correctly) assume that the average person is not knowledgeable enough to know the best or most cost-effective course of action. It would seem doctors themselves would be more knowledgeable, but does that knowledge actually translate to cost savings wrt to they types of insurance they buy, or the medical expenditures they incur? Does anyone know of a study that has examined this?

Your theory might be true if doctors were “knowledgeable enough to know the most cost-effective course of action.” But do they know anything about the costs of various treatment options?

This is more on the anecdotal side, but you might want to check out this essay discussing why doctors tend to use less end-of-life care. In a nutshell, doctors are more realistic about the chances of a positive outcome and the quality of life thereafter – they’ve seen many patients suffer from “futile care”. Also, in discussions of this topic, I’ve seen this study cited, which surveyed doctors on their preferences for end-of-life-care. It’s not quite what you’re looking for, addressing preferences for aggressive treatment instead of costs, but it might be a start.

Well, it’s not really a theory, but I think it’s logical to assume they do given that they are presumably billing people for a vast number of things.

My point was that, in my experience, doctors typically don’t get involved in the billing side of things. They prescribe treatments and medications with often little idea as to the cost. (Now if you complain to your doctor that the co-pay on your new prescription is exorbitant, he might prescribe something else, but aside from that, I think they have no clue.)

In my experience, in having doctors send my wife to get imaging and other types of procedures done, they don’t really seem all that knowledgeable as to how much some of this stuff really costs. They may be aware of how much stuff costs in their own practice (and even then, they have staff who deals with the nuts and bolts of billing), but when they send you to a specialist, they’re only rarely able to give you an estimate of how much those services will end up costing. If you tell them you want to go somewhere that’s fairly inexpensive, they probably wouldn’t have any idea where to send you.

Now, part of the problem is that insurance policies will have varying deductibles, co-pays, etc., so what you end up paying depends largely on what type of insurance you have. But they can’t even really tell you “this costs x, but if you do this or go there instead, you’ll end up paying this much less.”

:confused: What?

Every doctor I know, and this includes a wide range of general practitioners, medical specialists, and surgeons, is intimately aware of the details of their coding and billing. If they are in private practice there is a one to one correlation between their billing practices and the check they take home every month. They can usually quote you codes for diagnosis, treatment, their contracted rates, usual adjustments, modifiers, accounts receivable, largest outstanding claims, etc at the drop of a hat. Those that are employed by someone else usually have a salary/bonus structure. If nothing else they prove to whoever pays their salary that they are being productive through their coding. It’s also an important part of proper medical documentation. It’s also a nontrivial part of medical training these days. Hell there are questions on the board exams on coding now.

Now, it’s hard to give a price on someone else’s services outside of a very rough ballpark. For services a doctor refers to commonly (i.e. OR or anesthesia fees for a surgeon. Radiology fees for an orthropod, etc) I’m willing to bet they know in a good deal of detail regarding the costs. For the test/referral ordered once in a blue moon it’s a lot harder. And honestly, patient’s don’t usually care. What they care about is what they will be paying, and that’s heavily dependent on their insurance.

Anecdotally, doctors use much less health care for several reasons: They often feel they can deal with minor problems themselves. This is a lot easier when you can write prescriptions for yourself/get your partner/buddy to do it. If they need a specialist consult they call up their friend Dr. X and have them check them out during lunch instead of making an appointment. And when it comes to end of life issues, opinions vary obviously, but they tend to be much less aggressive about it. Part of this is because they have a detailed understanding of what it entails, and also because quite often their friends and family also have some medical knowledge, so they can clearly and calmly explain what they do and do not want. I have yet to meet a doctor who would accept getting a trach/PEG and being shipped of to an LTAC (I don’t doubt there are some out there of course), but most people faced with that decision have no idea what that really means, and even if they do they haven’t discussed it in detail with their family.

IAAD and want to state that aux203 has said it (above) better than I ever could. I agree with everything s/he said.

thanks.
very informative. And useful. I really didn’t know how much doctors know about the billing.

My own anecdotal experience under UHC (that is, a system where costs are managed very differently) matches this: healthcare professionals are a lot more likely to self-medicate, the best trigger to drag one to the doctor is “if it was Patient Smith and not you, would you send them to the doctor?” and they use available medical services under the table (or, as you put it, during lunch break) a lot. During her first pregnancy, my sister in law was doing her residency: she didn’t have a single ObGyn appointment, but she was getting ultrasounds done much more frequently than Patient Smith; this is quite typical IME.

As for “end of life”, they’re the same as everybody else. Over 90% of people in Spain claim they don’t want a trach or to use a wheelchair; over 90% get one when they find themselves unable to breathe/walk and able to give consent. What you think you want when the problems are theoretical and what you accept when they’re real are different things.

I can imagine that doctors would also use a lot less diagnostic care. For example, I imagine this sort of exchange:

Doctor 1: This lump is funny. I should ask a specialist about it.
Doctor 2: Don’t worry, it’s totally ordinary. There’s a tiny chance it could be cancerous.
Doctor 1: If you’re not worried I’m not. I’ll come back if it grows a mouth and starts talking to me.

as compared to:

Patient: I’ve got a scary lump!
Doctor: It’s totally ordinary, but there’s a small chance it could be cancerous.
Patient: OMG cancer! Do every test to be sure it’s not cancer, and then remove it just to be safe!

The doctor-patient, at most, “consumed” an office visit. The overly-cautious patient, on the other hand, has “consumed” four or five figures worth of health care, perhaps including a CT scan and a biopsy and a minor surgery.

In my personal experience just volunteering in an ER, I have to agree this is pretty accurate. Patients who come to the ER come for a variety of reasons, not realizing that by calling the ambulance, and by going to the ER instead of waiting a few days to have minor problems checked out by their primary care (if they have one).

It’s called an EMERGENCY room for a reason. Most people would be surprised at the random stuff that show up, but I think a lot of it has to do with patient education and knowing “what’s serious/scary” vs. “what’s expected/normal course of an illness”.

If I have a fever, if it’s not over 100.5, I’m not even thinking about going to my PCP much less the ED, I’m going to be hydrating myself, and waiting a few days to see if I get better rather than seeking antibiotics immediately for a ‘fever’ of 99.1 or something like that.

But at the same time, I know I don’t know everything, and it’s nice sometimes to make sure you get checked out, and get a second opinion.
Physician heal thyself is just not a good idea in the long run in my opinion.
-R

People with health insurance don’t concern themselves with the cost-effectiveness of their treatment. If you aren’t paying for it, why wouldn’t you want the most effective treatment, regardless of cost?

A doctor also knows she’s unlikely to sue herself for malpractice if she didn’t order additional tests for herself. A disgusting amount of medical costs and time spent on healthcare comes from CYA tests done to better defend oneself in the event of a lawsuit.

There is also an element of selection bias to consider with this question. Getting through medical school takes a lot of time and effort, and someone with draining chronic illness, or who is prone to getting sick a lot, or accidentally hurting themselves a lot, is a lot less likely to make it through med school in the first place. So doctors probably start out healthier than people of the same age group.

My grandfather was a doctor (mainly epidemiological research, but an MD nonetheless), and he was notoriously resistant to bringing any of his five children “to the doctor” unless it was a real emergency. This lackadaisical attitude also extended to himself; long after he retired and couldn’t walk very well, he actually lit himself on fire (briefly – it tutned out he was fine) lighting his pipe, but he refused to have himself checked out by a doctor afterwards.

This would just be a single data point, and so not very valuable to the OP, except that, according to my mother, such an attitude was known to be TYPICAL among doctors. (Doesn’t mean it statistically *was *typical, but at least there was that reputation, likely based on something real.)