by Tony Chen

Has anyone else seen this article in the Atlantic? It claims that too many doctors lead to lower quality because the "coordination costs" outweigh the benefits. When every doc is responsible for one aspect of care, sometimes it gets unclear who is responsible for what (or at least, that's the theory)

From the article:

“Why would more doctors lead to worse care, and fewer doctors to better care? More tests and procedures always entail more risk, and for care that’s unnecessary, the ratio of benefit to risk is zero. What’s more, where numerous doctors, particularly specialists, are routinely involved in a patient’s case, the potential for miscommunication and confusion multiplies (bold mine). Modern medicine should be a team sport, but it is often practiced as if everybody is running a different play. Different doctors order duplicative tests, prescribe drugs that interact poorly with what the patient is already taking, and assume another physician will attend to a critical aspect of a patient’s care. A cardiologist can be a virtuoso at slipping a stent into the coronary artery of a patient in the throes of a heart attack, but if she leaves it to another physician to prescribe aspirin to her patient—one of the most effective treatments for preventing a second heart attack—that prescription might fall through the cracks.

“This is what appears to be happening in many hospitals, where the ratio of specialists to primary-care physicians is especially high. In one recent study, two Harvard economists—Katherine Baicker, of the School of Public Health, and Amitabh Chandra, of the Kennedy School of Government—examined how the quality of care in different states varied as the proportion of specialists rose. They found that measures of quality, like the percentage of heart-attack patients who received a prescription for aspirin, tended to fall in direct proportion to a rising ratio of specialists. The point, says Chandra, “is not that the specialist is inferior, but that the system is not accounting for the ‘coordination cost’ specialists are imposing.”

It's not hard to believe that this coordination isn't always done well. But it is hard to believe that this lack of coordination could outweigh the benefits of the tremendous expertise and advanced care provided by specialists.

I need to see more on this, but nonetheless, this further reinforces the notion that your hospital's organizational culture may be just as important as the organizational structure & processes.