Physician-Peer Relationships and Patient Experiences With Specialist Care

Abstract

Importance: Peer relationships may motivate physicians to aspire to high professional standards but have not been a major focus of quality improvement efforts. Objective: To determine whether peer relationships between primary care physicians (PCPs) and specialists formed during training motivate improved specialist care for patients. Design, Setting, and Participants: In this quasi-experimental study, difference-in-differences analysis was used to estimate differences in experiences with specialist care reported by patients of the same PCP for specialists who did vs did not co-train with the PCP, controlling for any differences in patient ratings of the same specialists in the absence of co-training ties. Specialist visits resulting from PCP referrals from 2016 to 2019 in a large health system were analyzed, including a subset of undirected referrals in which PCPs did not specify a specialist. Data were collected from January 2016 to December 2019 and analyzed from March 2020 to October 2022. Exposure: The exposure was PCP-specialist overlap in training (medical school or postgraduate medical) at the same institution for at least 1 year (co-training). Main Outcomes and Measures: Composite patient experience rating of specialist care constructed from Press Ganey's Medical Practice Survey. Results: Of 9920 specialist visits for 8655 patients (62.9% female; mean age, 57.4 years) with 502 specialists in 13 specialties, 3.1% (306) involved PCP-specialist dyads with a co-training tie. Co-training ties between PCPs and specialists were associated with a 9.0 percentage point higher adjusted composite patient rating of specialist care (95% CI, 5.6-12.4 percentage points; P