Reasons for practice variation

In view of the reaction to Atul Gawande’s recent New Yorker article I thought it would be interesting to explore some of the many reasons for practice variation. A popular perception is that it’s a lot about greed, and Gawande provided some extreme anecdotes which suggest, on first glance, that this is the case. Objective evidence, however, suggests otherwise. Here’s a run down.

Physicians with risk averse personality profiles order more tests.

Malpractice fear drives referrals to specialists.

Internists have higher utilization than FPs according to multiple studies, attributable to being more risk averse.

I have found no study looking at greed as a driver of utilization.