Your Doc Is Away? Substitute Doctors a Safe Option, Study Finds
TUESDAY, Dec. 5, 2017 -- When the regular hospital doctor is out, the white-coated physician treating you may very well be a "temp."
The good news: Patients cared for by substitute doctors don't have a higher risk of death.
But they do tend to have longer stays and higher costs, a new study finds.
"Our findings so far are reassuring," said study senior author Dr. Anupam Jena, an associate professor of health care policy at Harvard Medical School.
Traditionally, when a regular staff doctor was away or sick, hospitals relied on one of the doctor's colleagues to pitch in.
Today, hospitals in the United States increasingly turn to for-hire temporary physicians from anywhere in the country. But Jena said there has been little research into how that affects patient care.
In this study, investigators analyzed 1.8 million Medicare hospital admissions between 2009 and 2014. Nearly 40,000 involved care by substitute doctors. The researchers found that 1 in 10 regular staff doctors was replaced by a "sub."
Death rates within a month of hospital admission were nearly identical -- 8.8 percent among patients treated by substitute physicians and 8.7 percent among patients seen by regular staff doctors.
However, patients who received care from subs did have slightly longer hospital stays and somewhat higher costs, although the differences were small.
"Some of the trends we found demand that we look more closely at how the system works in a more granular way," Jena said in a Harvard news release.
Substitute doctors get hired in different ways. Some work at different hospitals in a single area, while others travel across the country to fill in at a hospital, Jena explained.
Generally, substitutes have no relationship with their patients and have little or no knowledge of the local community. Also, they may never have worked with the hospital's electronic health records system, hospital staff or local care facilities where patients may be sent after the hospital, the study authors noted.
One potentially concerning finding was that hospitals that used substitute doctors less often had somewhat higher patient death rates.
Remote location, tight finances and lack of support for temporary doctors might help explain that result, said study first author Dr. Daniel Blumenthal.
"As the market place shifts and employment patterns fluctuate, we owe it to our patients to make sure that the way we cover for doctors who are out of the office is safe and effective," said Blumenthal, a Harvard Medical School instructor in medicine at Massachusetts General Hospital.
The study was published Dec. 5 in the Journal of the American Medical Association.
Posted: December 2017