HEALTH CARE REFORM Associations Between Physician Characteristics and Quality of Care

Background: Information on physicians' performance on measures of clinical quality is rarely available to patients. Instead, patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures. Methods: We calculated overall performance scores on 124 quality measures from RAND's Quality Assessment Tools for each of 10 408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in 1 of 4 Massachusetts commercial health plans from 2004 to 2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression. Results: The mean overall performance score was 62.5% (5th to 95th percentile range, 48.2%-74.9%). Three physician characteristics were independently associated with significantly higher overall performance: female sex (1.6 percentage points higher than male sex; P<.001), board certification (3.3 percentage points higher than noncertified; P<.001), and graduation from a domestic medical school (1.0 percentage points higher than international; P<.001). There was no significant association between performance and malpractice claims (P=.26). Conclusions: Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures.