Patterns of family doctor decision making in practice context. What are the implications for medical practice variation and social disparities?

► Clinical decision making (CDM) is assumed to influence medical practice variation (MPV) and health disparities. ► We investigate the role of practice context in mediating this relationship in primary care. ► We perform a multi-level analysis of clinical activity in a representative sample of New Zealand family doctors and their patients. ► Despite little difference in activity level, MPV was greater for disadvantaged patients and fee-for-service practices. ► CDM may be influenced both by how doctors view patients from different social groups and by the practice context.