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Residency and the hidden curriculum

Posted by Ishani Ganguli November 26, 2012 07:00 AM
It’s that time of year: Amtrak is hiking up its travel fares. "All I Want for Christmas" is reclaiming its rightful place on mall playlists. And fourth year medical students are starting the interview process to match into a residency program - their next and potentially final stage of training. 

Over the next few months, these students will rank the programs they visit based on features such as geography, research funding, and hospital affiliations. But there's another factor to consider - one that gets little attention but that probably matters more for the kind of doctors they’ll become. You might call it the institution's culture or practice style. For trainees, it comprises the "hidden curriculum" - informal lessons about the delivery of health care that are learned through observation and cemented by repetition

A recently published report from the Dartmouth Institute for Health Policy and Clinical Practice quantifies some of these cultural differences between hospitals and suggests that prestige and optimal care are not always aligned.

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Younger doctor, bigger spender?

Posted by Ishani Ganguli November 14, 2012 07:00 AM
We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders? 

A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairs earlier this month, looked at insurance claims filed by more than 12,000 doctors in Massachusetts between 2004 and 2005. The researchers found that those with fewer than 10 years of experience generated 13.2 percent higher costs for comparable "episodes of care" (say, a series of appointments to diagnose and treat a breast lump) than doctors with 40 or more years of experience. Doctors between 10 and 40 years of experience fell somewhere in the middle. When they broke down the costs by types of care, the trend went in the opposite direction for preventative care (as opposed to care for acute or chronic illnesses): less experienced doctors spent less on prevention. Surprisingly, factors such as prior malpractice claims, practice group size, or whether or not the doctor was board certified had no significant impact on the cost profiles.

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Stuck in the Emergency Room

Posted by Ishani Ganguli November 1, 2012 07:00 AM
The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system and for one presidential candidate, an acceptable alternative to expanding health insurance under Obamacare.

In the wake of Hurricane Sandy, the visual has become more familiar than we'd like - the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish in the ED for hours to days until beds are available for them upstairs. This last group of patients - so-called ED boarders - has become a new focus of efforts to mitigate ED overcrowding. One way to address the issue? Assign a doctor whose only job is to take care of them.

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About the author

Ishani Ganguli, MD, is a journalist and a second-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her More »

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