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Comment & Response
July 2017

Limitations Concerning the Association of Physician Sex and Patient Outcomes—Reply

Author Affiliations
  • 1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 4Department of Medicine, Massachusetts General Hospital, Boston
  • 5National Bureau of Economic Research, Cambridge, Massachusetts
  • 6VA Boston Healthcare System, Boston, Massachusetts
JAMA Intern Med. 2017;177(7):1058-1059. doi:10.1001/jamainternmed.2017.2148

In Reply We agree with Maslove that there is no single rule to attribute patient outcomes to physicians.1 We used 3 different attribution rules: attributing patients to physicians who (1) accounted for the largest Part B spending, (2) derived the largest number of evaluation-and-management claims, and (3) derived the first evaluation-and-management claim. Our findings were similar in each approach. We also found that 51%, 22%, and 11% of Part B spending was accounted for the first, second, and third highest-spending physicians, respectively,2 suggesting that a single physician drives the majority of care rather than multiple physicians delivering care equally.

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