Journal of General Internal Medicine

, Volume 22, Issue 6, pp 794–798 | Cite as

Factors Affecting Influential Discussions Among Physicians: A Social Network Analysis of a Primary Care Practice

  • Nancy L. KeatingEmail author
  • John Z. Ayanian
  • Paul D. Cleary
  • Peter V. Marsden
Original Article



Physicians often rely on colleagues for new information and advice about the care of their patients.


Evaluate the network of influential discussions among primary care physicians in a hospital-based academic practice.


Survey of physicians about influential discussions with their colleagues regarding women’s health issues. We used social network analysis to describe the network of discussions and examined factors predictive of a physician’s location in the network.


All 38 primary care physicians in a hospital-based academic practice.


Location of physician within the influential discussion network and relationship with other physicians in the network.


Of 33 responding physicians (response rate = 87%), the 5 reporting expertise in women’s health were more likely than others to be cited as sources of influential information (odds ratio [OR] 6.81, 95% Bayesian confidence interval [CI] 2.25–23.81). Physicians caring for more women were also more often cited (OR 1.03, 95% CI 1.01–1.05 for a 1 percentage-point increase in the proportion of women patients). Influential discussions were more frequent among physicians practicing in the same clinic within the practice than among those in different clinics (OR 5.03, 95% CI 3.10–8.33) and with physicians having more weekly clinical sessions (OR 1.33, 95% CI 1.15 to 1.54 for each additional session).


In the primary care practice studied, physicians obtained information from colleagues with greater expertise and experience as well as colleagues who were accessible based on location and schedule. It may be possible to organize practices to promote more rapid dissemination of high-quality evidence-based medicine.


consultation and referral primary care communication physician behavior 



This work was funded by the Brigham and Women’s Hospital Primary Care Research and Education Fund.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Nancy L. Keating
    • 1
    • 2
    Email author
  • John Z. Ayanian
    • 1
    • 2
  • Paul D. Cleary
    • 3
  • Peter V. Marsden
    • 2
    • 4
  1. 1.Division of General Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  3. 3.Yale School of Public HealthNew HavenUSA
  4. 4.Department of SociologyHarvard UniversityCambridgeUSA

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