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PCPs, Specialists Who Train Together See Better Patient Experience

Co-training among PCPs and specialists can be the difference between a median patient experience score and ranking in the 91st percentile, researchers found.

Reputation is everything in an increasingly consumer-centered healthcare industry, and new data in JAMA Network Open has illuminated one critical area for providers: reputation among their peers. According to the study, specialists perform better on patient experience measures when one of their peers is the patient’s primary care provider.

Particularly, the study showed that when specialists and PCPs know each other—even if the PCP did not refer the patient to the specialist—the specialist demonstrates better patient-provider communication and shared decision-making. The researchers posited that this is because the specialist wants to maintain a good reputation among her peers.

“The influence of peer observation and approval is likely to be powerful in medicine and could be more productively deployed,” the researchers explained. “Physicians are motivated to demonstrate their competence to other physicians not only for financial gain (eg, to earn favorable evaluations as trainees or to attract referrals), but also because they may derive professional satisfaction from upholding standards when observed.”

As it turns out, physicians care what their peers may think of them, which may have motivated many to practice stronger patient-centered care.

The researchers looked at patient experience scores between 2016 and 2019 to assess the level of patient-centered care delivered during a specialist appointment. Using information from the Massachusetts Board of Registration in Medicine, the researchers identified PCPs and consulting specialists who overlapped at the same institution for at least one year of medical school, residency, or fellowship.

Training together wasn’t exactly common, the researchers found, with only 3 percent of PCP-specialist dyads having some training overlap.

But when that happened, the changes in patient experience were notable. The researchers observed a 9 percentage-point higher adjusted composite patient rating of specialist care when specialists and PCPs had trained for at least one year together. That’s around the same as improving from median patient experience scores to the 91st percentile, the team said.

Unsurprisingly, this trend was more pronounced when the specialist and PCP had complete temporal overlap, meaning they were in the same medical school or residency class.

Moreover, these improvements were apparent across nine of the 10 patient experience items explored in the study, including clarity of communication and shared decision-making.

The researchers controlled for several variables, like nonrandom selection bias and PCP testimony offered during direct referrals, by examining indirect referrals. Additionally, the team found that the same specialist could have different patient experience scores depending on whether they had trained with the referring PCP.

That all indicates that higher patient satisfaction scores for specialists who trained with a PCP are specific to that relationship rather than PCP, specialist, or patient factors, the team posited.

The researchers posited that better patient satisfaction scores for PCPs and specialists who trained together could result from peer reputation. The specialist knows the PCP and therefore wants to maintain that good reputation.

“Taken together, these findings are consistent with the notion that peer relationships can motivate physicians to deliver improved care through peer or audience effects23-26; when physicians believe their work may be scrutinized or recognized by peers, they may aspire to higher standards,” the researchers said.

Additionally, the specialist and PCP may have shared values, prompting a higher level of peer accountability, the team said.

Co-training among PCPs and specialists brings about more remarkable clinical quality improvement than other initiatives—even public reporting. The researchers said this could have policy implications for an industry striving for quality improvement.

But it’s unrealistic that every PCP and specialist dyad would have some previous training relationship, the researchers said, giving credence to calls for more team-based care and similar models.

“The present study’s findings, and extensions thereof, could have major implications for the organization of care delivery, as they suggest potentially large quality gains from models encouraging peer interactions—such as team-based care, digital consultations that foster direct communication, peer coaching, and multispecialty case discussions,” the researchers said.

“More generally, our study suggests that nonfinancial strategies to harness physician professionalism, including the pressure to live up to the expectations of colleagues, could generate gains over many dimensions of care without requiring decision-specific interventions that risk erosion of intrinsic motivation when deployed in aggregate,” they concluded.

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