Introduction

Physicians are considered to be the most informed consumers in the use of medical services since they have more information about diseases or medical technology. Prior studies reported that female doctors had a higher prevalence of use of hormone replacement therapy than other women [1,2]. Another study by Dugowson & Holland also revealed that compared to non-physician families, physician families used more amniocentesis and had a higher rate of primary cesarean sections [3]. However, very few studies have attempted to explore issues of medical utilization behavior of physicians.

Christie & Ingstad indicated that when physicians are ill, they often have difficulty acting as patients [4]. Many studies also consistently found that instead of seeking care, many physicians perform self-treatment when they are sick [4–8]. Two studies even reported that office-based physicians were more likely to practice self-treatment than hospital-based physicians [7,8]. However, although plenty of researchers have suggested different medical seeking behaviors among physicians, very few empirical studies have been conducted to investigate differences in medical utilization between physicians and the general population. According to our knowledge, only one study by Lin et al. reported that physicians were at lower risk of hospitalization than the general population in Taiwan [9]. The literature on medical utilization by physicians is still very limited.

Therefore, in this study, we explored differences in the utilization of healthcare services between physicians and the general population using a population-based dataset. In addition, this study further compared differences in the utilization of healthcare services between hospital-based physicians and office-based physicians.

Materials and Methods

Results

Table 1 summarizes the descriptive statistics of the sociodemographic characteristics of the sample. The mean age was 44.5 ± 12.1 years of the 2852 study subjects, and were 44.4 ± 12.0 and 44.5 ± 11.9 years for physicians and comparison subjects, respectively (p = 0.711). After matching for gender and age group, there were significant differences in monthly incomes (p<0.001) between physicians and comparison subjects. Physicians were more likely to have a monthly income of ≥US$830 than were comparison subjects.

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Table 1. Demographic characteristics of physicians and comparison subjects (n = 2852).

https://doi.org/10.1371/journal.pone.0130690.t001

Table 2 presents the use and costs of healthcare services in the year of 2010 for physicians and comparison subjects. Wilcoxon-Mann-Whitney tests revealed that physicians had significantly fewer outpatient visits (13.2 vs. 15.7, p<0.001) and significantly lower outpatient costs (US$477 vs. US$680, p<0.001) than comparison subjects. Furthermore, physicians had fewer inpatient days (0.713 vs. 1.727, p<0.001) and lower inpatients costs (US$167 vs. US$386, p = 0.007) compared to comparison subjects. Correspondingly, physicians had lower total health service costs than comparison subjects (US$643 vs. US$1066, p<0.001). This indicates that the mean total health service costs in the year 2010 was1.66-fold greater for comparison subjects than physicians.

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Table 2. Use and costs (US$) of healthcare services in the year 2010 by physicians and comparison subjects.

https://doi.org/10.1371/journal.pone.0130690.t002

The use and costs of all healthcare services among office-based physicians, hospital-based physicians, and comparison subjects are presented in Table 3. Kruskal-Wallis tests indicated the existence of significant differences in the mean number of outpatient services (p<0.001), outpatient costs (p = 0.001), inpatients costs (p = 0.018), and total costs (p = 0.001) among office-based physicians, hospital-based physicians, and comparison subjects. Specifically, Scheffe contrast tests showed that office-based physicians had significantly more outpatient visits (19.3 vs.10.7, p<0.001) and significantly higher outpatient costs (US$656 vs. US$402, p<0.001) than hospital-based physicians. In other words, the mean number of outpatient visits was about 1.8-fold higher for office-based physicians than hospital-based physicians. However, differences in inpatient costs and total costs between office-based physicians and hospital-based physicians did not reach a significant level according to Scheffe contrasts tests.

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Table 3. Use and costs (US$) of healthcare services in the year 2010 by office-based physicians, hospital-based physicians, and comparison subjects.

https://doi.org/10.1371/journal.pone.0130690.t003

Discussion

Based on our knowledge, this is the first population-based study to compare utilization of healthcare services between physicians and the general population. We found that physicians consistently had lower outpatient and inpatient services and costs compared to the general population.

Our findings are in line with previous observations that physicians may perform self-diagnosis and treatment instead of seeking medical assistance from other health professionals [11–13]. In addition, Schneck outlined a number of possible factors influencing how physicians respond to illness [14]. These includes a fear of illness as equated to weakness, an inability to reverse roles to become a patient, concerns about loss of confidentiality and privacy, poor choices of personal physicians, and loss of self-esteem when ill. Another study by Steffen also reported that physicians had the following top 3 barriers to receiving healthcare: limited time, concerns about confidentiality, and costs of lost work time [15]. These perhaps explain why physicians have lower medical utilization than the general population.

Furthermore, we found that office-based physicians incurred higher outpatient services and costs than hospital-based physicians. Prior studies indicated that office-based physicians work independently and tend to treat themselves when they have minor health problems [7–8]. Therefore, it is possible that office-based physicians have a greater tendency to practice self-treatment in their own clinics than do hospital-based physicians.

Furthermore, the healthcare system in Taiwan is characterized as a closed-staff system, under which almost all physicians who practice in hospitals are employees of those hospitals, and physicians who practice in clinics do not have privileges at hospitals. Hospital-based physicians are compensated with highly variable combinations of salaries, bonuses, volume-driven fees, and teaching or research supplements. Therefore, their earnings do not fully exhibit a proportional relationship to their clinical efforts. However, incomes of office-based physicians are mainly based on patient volumes, so they have a strong financial incentive to provide more outpatient services including self-treatment in order to reach target incomes [16–18]. This is consistent with our findings that office-based physicians had higher outpatient services and costs than hospital-based physicians.

This study also found that compared to office-based physicians, hospital-based physicians had higher inpatient costs. One study found that hospital-based physicians had a slightly higher risk of hospitalization compared to community practitioners in Taiwan [11]. In contrast to office-based physicians, hospital-based physicians have greater access to inpatient services. This may explain the higher inpatient costs among hospital-based physicians. In addition, a previous study showed that the prevalence of burnout in hospital physicians was significantly higher than in family physicians [19]. Physicians in hospitals are faced with more-complex, more-stressful, and more-irregular patterns of life [20–22]. Burnout is highly prevalent among hospital-based physicians and is accompanied by poor health resulting in high inpatient costs.

A key strength of our study is the use of a population-based dataset to investigate differences in the use of medical utilization among hospital-based physicians, office-based physicians, and the general population in Taiwan. This feature afforded sufficient statistical power and an adequate sample size to detect differences in inpatient and outpatient services among the three groups after adjusting for confounders.

Nevertheless, there are several limitations of this study. First, the LHID2000 used in this study provides no information on working characteristics, lifestyles, health habits, or the disease severity of subjects. Second, most subjects included in our study were of Chinese ethnicity, so the ability to generalize the results to other ethnic groups is uncertain. Finally, this study only employed 1 year of data of healthcare utilization, and this might not fully represent long-term treatment-seeking behavior of the sampled subjects.

Despite these limitations, our population-based study found that physicians had less healthcare utilization than comparison subjects. Furthermore, hospital-based physicians had higher inpatient costs and less outpatient services and costs than office-based physicians. Further large-scale long-period epidemiological studies are suggested to explore differences in the utilization of healthcare services between physicians and the general population in other regions and countries.