A University of Newcastle study has found a link between high pathology test rates and trainee doctor supervision

AUSTRALIAN patients might be over-tested, over-diagnosed and over-treated because registrars in their final training years in clinical practice need greater support from supervisors, a University of Newcastle study released on Monday has found.

A study of pathology test rates of 876 registrars between 2010 and 2014 found an 11 per cent increase in test ordering for each additional term within their final two years of training.

The additional pathology test ordering coincided with a “marked decrease” in supervision by more senior doctors over the two years.

University of Newcastle Professor Parker Magin, who led the study, said the result was contrary to expectations, and the increase “causes concerns about overtesting”.

“An 11% increase in test ordering per term of training has implications for health care costs,” Professor Magin said.

“It may also have implications for patient wellbeing and safety if, as seems likely, higher pathology testing rates entail increased inappropriate testing, elevating the probability of overdiagnosis and overtreatment.”

The study used data from the Registrar Clinical Encounters in Training (ReCEnT) study, which is an on-going, multi-centre study of general practice registrars – doctors in their final years of training – in Australia.

The study assessed data from 114,584 consultations involving 876 registrars to find that contrary to expectations, pathology test ordering by general practice registrars increased significantly during their first two years of clinical practice. 

The study found no tests were ordered in 76 per cent of consultations, but one test was ordered in 10 per cent of consultations, and up to 12 tests were ordered in 1577, or 1.4 per cent, of consultations.

The study acknowledged that registrars in their final years of vocational training were likely to see more complex cases, but the results showed “test ordering (and, potentially, over-ordering) may peak during late vocational training and early career practice”.

“Registrars need support through this difficult period in the development of their clinical practice patterns,” the study found.

The university launched the study in response to increasing pathology testing rates in Australia. Most pathology test ordering is initiated in general practice.