Effect of Physician Specialty on Use of Necessary Coronary Angiography

Examines the effect of physician specialty on the receipt of necessary coronary angiography. Of 243 patients who had positive or very positive exercise stress tests and who met additional clinical criteria for the necessity of coronary angiography, 47 percent subsequently received coronary angiography within 3 months of exercise testing (61 percent received the procedure within 12 months). After adjustment for sociodemographic factors and clinical presentation, patients who named a cardiologist as their regular source of care were more likely than all other patients to have undergone necessary coronary angiography within 3 months (52 percent versus 38 percent) and 12 months (74 percent versus 44 percent). The article demonstrates that those who are offered a necessary procedure are more likely to be cared for by a specialist who performs the procedure. The issue for managed care is whether necessary care will decline as barriers between the general practitioner, the patient, and the specialist increase.