A national survey of more than 2,000 doctors across multiple specialties finds that physicians believe overtreatment is common and primarily perpetuated by fear of malpractice, as well as patient demand and some profit motives.
A report on the findings, published today in PLOS ONE, highlights physicians' perspectives on unnecessary health care practices and the potential causes and solutions.
"Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American," says Martin Makary, professor of surgery and health policy at the Johns Hopkins University School of Medicine and the paper's senior author.
Unnecessary medical services represent the majority of wasted health care resources and costs in the United States, accounting for an estimated $210 billion in excess spending each year, according to the National Academy of Medicine. Studies consistently show that overtreatment is also directly associated with preventable patient harm and, on a national scale, the issue represents a significant opportunity to improve patient safety and lower health care costs, Makary notes.
Increasingly, he adds, professional societies and other health care organizations have focused on campaigns to address the unnecessary medical care issue. Direct estimates by physicians themselves of unnecessary care, however, have been limited.
In an effort to hear from physicians about the magnitude of the "too much medical care" problem, the Johns Hopkins research team—part of a national consortium exploring ways to reduce unneeded care—invited 3,318 physicians to complete a survey about health care practices. The survey was conducted between Jan. 22 and March 8, 2014, and a total of 2,106 physicians' responses were included in the published research report.
The majority of the physicians who responded to the survey said they believed that at least 15 to 30 percent of medical care is not needed.
Breaking down the types of unnecessary medical care, survey respondents reported that 22 percent of prescription medications, 24.9 percent of medical tests, 11.1 percent of procedures, and 20.6 percent of overall medical care delivered is unnecessary. The median response for physicians who perform unnecessary procedures for profit motive was 16.7 percent.
Physicians with at least 10 years of experience after residency and specialists were more likely to believe that physicians perform unnecessary procedures when they profit from them.
"Interestingly, but not surprisingly, physicians implicated their colleagues (more so than themselves) in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level so that individual providers can see where they might improve," says Daniel Brotman, professor of medicine at the Johns Hopkins University School of Medicine and an author on the paper.
The top three reasons cited for overuse of resources were fear of malpractice (84.7 percent), patient pressure/request (59 percent), and difficulty accessing prior medical records (38.2 percent).
The top three selected potential solutions for eliminating unnecessary services were training medical residents on appropriateness criteria for care (55.2 percent), easy access to outside health records (52 percent), and more evidence-based practice guidelines (51.5 percent).
"Most doctors do the right thing and always try to," Makary says. "However, today 'too much medical care' has become an endemic problem in some areas of medicine. A new physician-led focus on appropriateness is a promising homegrown strategy to address the problem."