July 2, 2015
Dr. Anupam Jena was recently promoted to Associate Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School. He is widely recognized as a creative scholar who tackles important questions of general interest to health economists, physicians, and health policy makers. In addition to his role at HMS, he is also an internist at Massachusetts General Hospital (MGH) and a Faculty Research Fellow at the National Bureau of Economic Research. At MGH, he focuses on the care of hospitalized patients.
Barbara J. McNeil, MD, PhD, Head of the Department of Health Care Policy, says that “We were excited when Bapu accepted our offer to join our faculty and we are thrilled now that he is moving up the academic ladder at HMS. His work is exciting and topical, and I expect that he will influence the way many of us think about important issues in health policy and medicine today; these include research on the study of physician behavior, physician responses to medical malpractice, and the productivity of health care.”
Dr. Jena’s research touches on many facets of health care, using novel empirical strategies to answer questions of broad policy importance. For example, it is well known that physician practice patterns are variable and that more care is not always associated with better outcomes (i.e., ‘flat of the curve’ medicine). However, nearly all studies are based on associations and lack ‘natural experiment’ study designs, which are far more informative about whether a particular set of care is effective or not. In a recent study, Dr. Jena approached the issue of how physician practice patterns influence care and outcomes by studying outcomes of patients hospitalized with acute cardiovascular conditions during dates of national cardiology meetings, a time when specific cardiologists are away. He counterintuitively showed that patients with cardiac arrest and high-risk heart failure have substantially lower mortality during meeting dates (nearly 20%), that AMI patients have no difference in mortality, and that rates of PCI are nearly a third lower. This study demonstrates the scope of mortality differences that can result from differences in physician behavior and opens a number of questions into how care can be better optimized in this area. The idea that ‘less is more’ in health care is frequently discussed, but supporting rigorous evidence has been lacking. This study complements Dr. Jena’s contributions to studying the productivity of hospital care and his exploration of the role of resident inexperience in July on patient outcomes.
In his attempts to understand physician behavior, Dr. Jena has emphasized that the training of physicians is a clear determinant of their quality, but little evidence exists on how training matters. For example, many have been concerned that as a result of reforms to duty hours (e.g., 2003 ACGME reforms which reduced resident work hours to less than 80 hrs/wk), physicians today are less well prepared for independent practice compared to earlier cohorts of physicians. This is perhaps the most hotly debated issue in medical education and is a distinct issue from whether patients treated in teaching hospitals have had better or worse outcomes after duty hour reforms. In the first and only study on this issue, Dr. Jena assembled unique data from Florida on hospital mortality of all patients treated by internists, linked to licensing information on when an internist completed residency. Dr. Jena showed that attending physicians who completed residency after 2003 had similar hospital mortality and length of stay compared to physicians not exposed to duty hour reforms during their own residency. This study is the first to indicate that at least in one state ACGME reforms did not harm patients when mortality is considered the endpoint.
These examples highlight what makes Dr. Jena unique among health policy researchers. He asks questions that are important to health policy but creatively answers them using the tools of economics, which emphasize the importance of well thought-out, natural experiments that reveal how various policies and practices actually affect outcomes.
Dr. Jena has received many accolades. His work related to societal benefits for treatment for HIV/AIDS was awarded the Eugene Garfield Award for article of the year from Research America. In 2013, he was awarded the NIH Early Independence Award from the Office of the Director. This highly competitive award, given to only 10-15 junior scientists annually, provides Anupam with $2.5 million in grant funding for the next five years to conduct ‘high-risk, high-reward’ research on physician behavior. Dr. Jena is the first social scientist to win this award. In 2014, Dr. Jena was appointed to the IOM Committee on Diagnostic Errors in Health Care. In 2015, he was awarded the Bernie J. O’Brien New Investigator Award from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Since 2010, nearly 20 of his published articles have been covered by prominent news outlets such as the New York Times, Boston Globe, Wall Street Journal, Washington Post, CNN, Reuters, and National Public Radio. Dr. Jena’s overall work was the recent feature of a Freakonomics podcast.
Dr. Jena joined the Department of Health Care Policy in July 2012 as an Assistant Professor. Previous to this, he received his B.S. from MIT, and his MD and PhD in Economics from the University of Chicago through its NIH Medical Scientist Training Program. He completed his residency in internal medicine at Massachusetts General Hospital.
Dr. Jena is excited for his new role and looks forward to continuing innovative and high impact collaborations with his colleagues in the Department of Health Care Policy. He says, “HCP is unprecedented in its combination of economists, physicians, and statisticians, all of whom are national leaders in health care policy. There is no other place I would rather be.”