What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?

J Gen Intern Med. 2004 May;19(5 Pt 1):395-401. doi: 10.1111/j.1525-1497.2004.30298.x.


Objective: To examine the effects of internal medicine specialty and physician experience on inpatient resource use and clinical outcomes on an academic general medicine service.

Design: A 1-year retrospective cohort study.

Setting: The University of Michigan Hospitals, Ann Arbor, Michigan.

Patients: Two thousand six hundred seventeen admissions to the general medicine service from July 2001 to June 2002, excluding those for whom data were incomplete (n = 18).

Measurements and main results: Length of stay (LOS) and total hospital costs were used to measure resource utilization. Hospital mortality and 14-day and 30-day readmission rates were used to measure clinical outcomes. Adjusted mean LOS was significantly greater for rheumatologists (0.56 days greater; P =.002) and endocrinologists (0.38 days greater; P =.03) compared to general internists. Total costs were lower for general internists compared to endocrinologists ($1100 lower; P =.01) and rheumatologists ($431 lower; P =.07). Hospitalists showed a trend toward reduced LOS compared to all other physicians (0.31 days lower; P =.06). The top two deciles of physicians stratified by recent inpatient general medical experience showed significantly reduced LOS compared to all other physicians (0.35 days lower; P =.04). No significant differences were seen in readmission rates or in-hospital mortality among the various physician groups.

Conclusions: General internists had lower lengths of stay and costs compared to endocrinologists and rheumatologists. Hospitalists showed a trend toward reduced LOS compared to all other physicians. Recent inpatient general medicine experience appears to be a determinant of reduced inpatient resource use.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers / standards
  • Academic Medical Centers / statistics & numerical data*
  • Economics, Medical*
  • Female
  • Hospital Costs / statistics & numerical data
  • Hospitalists / classification
  • Hospitalists / standards*
  • Hospitalization*
  • Humans
  • Internal Medicine / economics*
  • Internal Medicine / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Medical Staff, Hospital / classification
  • Medical Staff, Hospital / standards*
  • Medicine / statistics & numerical data
  • Michigan
  • Middle Aged
  • Outcome and Process Assessment, Health Care / economics*
  • Patient Care Team
  • Retrospective Studies
  • Specialization*