Decision on SIG-2026-0050
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MSOM Conference
May 8, 2026, 5:14:29 PM (7 days ago) May 8
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08-May-2026
Re: SIG-2026-0050, "Reimagining Primary Care Continuity: Evidence from Tiered Physician Teams"
SIG Day Decision: Reject
Dear Author (this is to ensure anonymity):
We received many excellent submissions for the Healthcare Operations Management SIG-Day Conference. Unfortunately, we could not accept all of them to be included in the program, and we are sorry to say that your paper was not accepted to the SIG-Day conference.
If you also submitted an extended abstract of your paper to the main MSOM Conference, a decision on that submission will be made separately.
Sincerely,
Healthcare Operations;SIG Co-Chairs
MSOM Healthcare Operations Management SIG-Day Co-Chair
---------------------
Referee: 1
Strengths SIG Only: The manuscript tackles an important and timely problem (i.e., the erosion of continuity of care under workforce fragmentation) and proposes a novel and intuitively appealing solution in the form of tiered physician teams. The idea of assigning both a primary and a secondary physician is conceptually elegant and directly addresses real operational constraints in primary care, making the paper highly relevant for both scholars and practitioners. The study also offers clear evidence that secondary physicians retain a meaningful share of continuity benefits, which is a practically important and policy-relevant insight.
A second key strength lies in the paper’s theoretical contribution to the literature on team familiarity. By conceptualizing the team as comprising two physicians and a patient, and by distinguishing between patient–physician and physician–physician familiarity, the authors introduce a nuanced and original framework. The identification of a “familiarity paradox”, with beneficial effects for one type of familiarity and an inverted U-shaped effect for another, extends prior work in operations management.
Finally, the empirical analysis is a strength. The use of a large-scale, longitudinal dataset, combined with a well-executed identification strategy and multiple robustness checks, lends credibility to the findings. The counterfactual analysis further enhances the contribution by translating empirical results into system-level implications, demonstrating the potential for substantial cost savings and improved care delivery.
Referee: 2
Strengths SIG Only: The paper has several notable strengths. First, it examines important issues—continuity of care and team familiarity—that are both theoretically and practically relevant. Second, it leverages a large and comprehensive dataset covering all primary care practices in the UK over more than a decade.
Referee: 3
Strengths SIG Only: The paper examines the impact of care continuity on physician productivity within a tiered physician–patient interaction framework. It distinguishes continuity with respect to both primary and secondary physicians and investigates how their familiarity with the patient—as well as with each other—affects productivity. Overall, the paper is well written, leverages a granular dataset, addresses an important research question, and employs rigorous analyses.
Referee: 1
Limitations: One limitation concerns the measurement of clinical productivity. The use of inter-arrival times as a proxy for “getting it right the first time” is reasonable and consistent with prior literature, but it may also capture alternative mechanisms such as patient preferences, access constraints, or unmet care needs. While the authors provide some supporting analyses, the interpretation would benefit from additional validation or a more explicit discussion of these alternative explanations.
A second limitation relates to identification. Although the instrumental variable strategy is carefully constructed and supported by institutional features, the exclusion restriction remains difficult to fully verify. In particular, physician availability may correlate with unobserved aspects of practice operations or patient demand that could also influence outcomes.
Finally, while the paper offers rich empirical insights, the managerial implications could be more fully developed. In particular, the inverted U-shaped relationship between physician–physician familiarity raises important practical questions about how organizations can monitor and manage familiarity levels in practice. More concrete guidance on implementation, including potential trade-offs and operational constraints, would enhance the paper’s impact for practitioners and policymakers.
Referee: 2
Limitations: The primary limitation of the paper lies in the empirical analysis. The main identification strategy relies on an instrumental variables (IV) approach, largely motivated by Kajaria-Montag et al. (2024, Management Science).
First, it is important to establish the strength and relevance of the instrument. At a minimum, the paper should report standard first-stage diagnostics, such as weak identification tests, as Kajaria-Montag et al. (2024) report in their appendix. These results are currently not reported. While the instrument is adopted from prior work, it is still necessary to demonstrate its validity and strength in the present empirical setting.
Second, several basic but important empirical details are missing. In particular, the paper does not report summary statistics for control and moderator variables, nor does it present the first-stage regression results. Including these elements would improve transparency and help readers better assess the empirical strategy.
Third, one of the paper’s central contributions is the concept of “physician–physician familiarity.” However, the current empirical measure raises some concerns regarding interpretation. The measure appears to rely on physicians treating the same patient, but physician assignment is largely driven by patient choice and physician availability (p. 10). As a result, it is not clear that this mechanism reflects meaningful collaboration or interaction between physicians. If this definition follows prior literature, appropriate references should be provided and discussed.
Finally, the literature review section would benefit from a more comprehensive discussion of related work on continuity of care from the healthcare OM and medical literature, which is missing in the current manuscript. See Kajaria-Montag et al. (2024)’s literature review section.
Referee: 3
Limitations: The contribution of this work relative to the following work appears incremental and somewhat marginal.
Kajaria-Montag H, Freeman M, Scholtes S (2024) Continuity of care increases physician productivity in primary care. Management Science 70(11):7943–7960.
In that study, the authors show that visiting one's primary care physician leads to longer revisit intervals. The current paper documents a similar pattern but extends it to interactions involving both primary and secondary physicians. However, the underlying mechanism—greater continuity leading to increased familiarity between patients and providers, and consequently improved outcomes—is already well established. In this context, the paper's main findings—that the effect is stronger for the primary physician than for the secondary physician, and stronger for the secondary physician than for a third physician—are largely expected and do not yield substantially new insights.
More broadly, the distinction between primary and secondary physicians may not be essential for the analysis. The concept of continuity could be reframed as a continuous measure of familiarity: greater familiarity leads to longer revisit intervals, regardless of the provider’s designation. From this perspective, the current framework may add complexity without delivering commensurate conceptual gains.
Another fundamental concern is that the paper does not clarify whether follow-up visits are related to the initial appointment. If revisit intervals span different episodes of care, the interpretation of continuity and its effect on productivity becomes less clear.
Minor comments:
I suggest presenting summary statistics for the revisit interval variable in its original scale, rather than only reporting its natural logarithm, to improve interpretability.
The hypothesis regarding patient complexity could be removed. Although currently placed under the physician–patient familiarity subsection, it does not align well with that theme. The corresponding results can still be presented without a formal hypothesis.
The exposition across sections makes it unclear whether primary and secondary physicians are assigned by the health system or constructed by the authors. This distinction should be clarified early and described consistently throughout the paper.
The presentation of results in Tables 2 and 3 is difficult to follow. I recommend adopting a more standard format, where each row corresponds to a variable and each column corresponds to a model.
Referee: 1
Comments to the Author
(There are no comments.)
Referee: 2
Comments to the Author
(There are no comments.)
Referee: 3
Comments to the Author
(There are no comments.)
Re: SIG-2026-0050, "Reimagining Primary Care Continuity: Evidence from Tiered Physician Teams"
SIG Day Decision: Reject
Dear Author (this is to ensure anonymity):
We received many excellent submissions for the Healthcare Operations Management SIG-Day Conference. Unfortunately, we could not accept all of them to be included in the program, and we are sorry to say that your paper was not accepted to the SIG-Day conference.
If you also submitted an extended abstract of your paper to the main MSOM Conference, a decision on that submission will be made separately.
Sincerely,
Healthcare Operations;SIG Co-Chairs
MSOM Healthcare Operations Management SIG-Day Co-Chair
---------------------
Referee: 1
Strengths SIG Only: The manuscript tackles an important and timely problem (i.e., the erosion of continuity of care under workforce fragmentation) and proposes a novel and intuitively appealing solution in the form of tiered physician teams. The idea of assigning both a primary and a secondary physician is conceptually elegant and directly addresses real operational constraints in primary care, making the paper highly relevant for both scholars and practitioners. The study also offers clear evidence that secondary physicians retain a meaningful share of continuity benefits, which is a practically important and policy-relevant insight.
A second key strength lies in the paper’s theoretical contribution to the literature on team familiarity. By conceptualizing the team as comprising two physicians and a patient, and by distinguishing between patient–physician and physician–physician familiarity, the authors introduce a nuanced and original framework. The identification of a “familiarity paradox”, with beneficial effects for one type of familiarity and an inverted U-shaped effect for another, extends prior work in operations management.
Finally, the empirical analysis is a strength. The use of a large-scale, longitudinal dataset, combined with a well-executed identification strategy and multiple robustness checks, lends credibility to the findings. The counterfactual analysis further enhances the contribution by translating empirical results into system-level implications, demonstrating the potential for substantial cost savings and improved care delivery.
Referee: 2
Strengths SIG Only: The paper has several notable strengths. First, it examines important issues—continuity of care and team familiarity—that are both theoretically and practically relevant. Second, it leverages a large and comprehensive dataset covering all primary care practices in the UK over more than a decade.
Referee: 3
Strengths SIG Only: The paper examines the impact of care continuity on physician productivity within a tiered physician–patient interaction framework. It distinguishes continuity with respect to both primary and secondary physicians and investigates how their familiarity with the patient—as well as with each other—affects productivity. Overall, the paper is well written, leverages a granular dataset, addresses an important research question, and employs rigorous analyses.
Referee: 1
Limitations: One limitation concerns the measurement of clinical productivity. The use of inter-arrival times as a proxy for “getting it right the first time” is reasonable and consistent with prior literature, but it may also capture alternative mechanisms such as patient preferences, access constraints, or unmet care needs. While the authors provide some supporting analyses, the interpretation would benefit from additional validation or a more explicit discussion of these alternative explanations.
A second limitation relates to identification. Although the instrumental variable strategy is carefully constructed and supported by institutional features, the exclusion restriction remains difficult to fully verify. In particular, physician availability may correlate with unobserved aspects of practice operations or patient demand that could also influence outcomes.
Finally, while the paper offers rich empirical insights, the managerial implications could be more fully developed. In particular, the inverted U-shaped relationship between physician–physician familiarity raises important practical questions about how organizations can monitor and manage familiarity levels in practice. More concrete guidance on implementation, including potential trade-offs and operational constraints, would enhance the paper’s impact for practitioners and policymakers.
Referee: 2
Limitations: The primary limitation of the paper lies in the empirical analysis. The main identification strategy relies on an instrumental variables (IV) approach, largely motivated by Kajaria-Montag et al. (2024, Management Science).
First, it is important to establish the strength and relevance of the instrument. At a minimum, the paper should report standard first-stage diagnostics, such as weak identification tests, as Kajaria-Montag et al. (2024) report in their appendix. These results are currently not reported. While the instrument is adopted from prior work, it is still necessary to demonstrate its validity and strength in the present empirical setting.
Second, several basic but important empirical details are missing. In particular, the paper does not report summary statistics for control and moderator variables, nor does it present the first-stage regression results. Including these elements would improve transparency and help readers better assess the empirical strategy.
Third, one of the paper’s central contributions is the concept of “physician–physician familiarity.” However, the current empirical measure raises some concerns regarding interpretation. The measure appears to rely on physicians treating the same patient, but physician assignment is largely driven by patient choice and physician availability (p. 10). As a result, it is not clear that this mechanism reflects meaningful collaboration or interaction between physicians. If this definition follows prior literature, appropriate references should be provided and discussed.
Finally, the literature review section would benefit from a more comprehensive discussion of related work on continuity of care from the healthcare OM and medical literature, which is missing in the current manuscript. See Kajaria-Montag et al. (2024)’s literature review section.
Referee: 3
Limitations: The contribution of this work relative to the following work appears incremental and somewhat marginal.
Kajaria-Montag H, Freeman M, Scholtes S (2024) Continuity of care increases physician productivity in primary care. Management Science 70(11):7943–7960.
In that study, the authors show that visiting one's primary care physician leads to longer revisit intervals. The current paper documents a similar pattern but extends it to interactions involving both primary and secondary physicians. However, the underlying mechanism—greater continuity leading to increased familiarity between patients and providers, and consequently improved outcomes—is already well established. In this context, the paper's main findings—that the effect is stronger for the primary physician than for the secondary physician, and stronger for the secondary physician than for a third physician—are largely expected and do not yield substantially new insights.
More broadly, the distinction between primary and secondary physicians may not be essential for the analysis. The concept of continuity could be reframed as a continuous measure of familiarity: greater familiarity leads to longer revisit intervals, regardless of the provider’s designation. From this perspective, the current framework may add complexity without delivering commensurate conceptual gains.
Another fundamental concern is that the paper does not clarify whether follow-up visits are related to the initial appointment. If revisit intervals span different episodes of care, the interpretation of continuity and its effect on productivity becomes less clear.
Minor comments:
I suggest presenting summary statistics for the revisit interval variable in its original scale, rather than only reporting its natural logarithm, to improve interpretability.
The hypothesis regarding patient complexity could be removed. Although currently placed under the physician–patient familiarity subsection, it does not align well with that theme. The corresponding results can still be presented without a formal hypothesis.
The exposition across sections makes it unclear whether primary and secondary physicians are assigned by the health system or constructed by the authors. This distinction should be clarified early and described consistently throughout the paper.
The presentation of results in Tables 2 and 3 is difficult to follow. I recommend adopting a more standard format, where each row corresponds to a variable and each column corresponds to a model.
Referee: 1
Comments to the Author
(There are no comments.)
Referee: 2
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Referee: 3
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