Certification and Specialization

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Abstract
To learn whether there are differences among certified and self-designated cardiologists, internists, and family practitioners in terms of the mortality of their patients with acute myocardial infarction (AMI). Data on all patients admitted with AMI were collected for calendar year 1993 by the Pennsylvania Health Care Cost Containment Council and analyzed. Certified and self-designated family practitioners, internists, and cardiologists (n = 4,546) were compared with respect to the characteristics of their patients' illnesses. In addition, a regression model was fitted in which mortality was the dependent measure and the independent variables were the probability of death, hospital characteristics (location and the availability of advanced cardiac care), and physician characteristics (patient volume, years since graduation from medical school, specialty, and certification status). On average, cardiologists treated more patients than did generalists, and their patients were less severely ill. In the regression analysis, all variables were statistically significant except the availability of advanced cardiac care. Holding all other variables constant, treatment by a certified physician was associated with a 15% reduction in mortality among patients with AMI. Less patient mortality was associated with treatment by physicians who were cardiologists, cared for larger numbers of AMI patients, were closer to their graduation from medical school, and were certified.