Even many MDs think patients get too much treatment

A survey of US primary care physicians shows that many believe their patients are receiving too much medical care. Also, many feel that malpractice reform, realignment of financial incentives, and having more time with patients could reduce pressures on physicians to do more than they feel is needed, according to a recent report in the Archives of Internal Medicine, one of the JAMA/Archives journals.

“Per capita U.S. health care spending exceeds, by a factor of two, that of the average industrialized nation and is growing at an unsustainable rate,” the authors write as background information in the article. “A number of health care epidemiologists and economists, however, have suggested that a substantial amount of U.S. health care is actually unnecessary.” The authors also note that the opinions on rate of care of primary care physicians, whom they acknowledge are the “frontline of health care delivery,” are unknown.

Brenda E. Sirovich, MD, and colleagues from the VA Outcomes Group, White River Junction, Vt., and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, conducted a national mail survey of US primary care physicians identified from a random sample of the American Medical Association Physician Masterfile, between June and December 2009. Of the surveys mailed, 627 physicians participated, for a 70% response rate.

Nearly half (42%) of all survey respondents believe that patients in their own practice receive too much medical care, while only 6% believe their patients receive too little care. Just over half (52%) believe the amount of care received is just right. In addition, 28% of respondents said they personally were practicing more aggressively than they would like, and 29% felt that other primary care physicians in their community were practicing too aggressively.

Forty-seven percent of respondents reported that mid-level primary care clinicians (nurse practitioners, physician assistants) practice too aggressively, and 61% felt that medical subspecialists practice too aggressively. Almost all physicians in the survey (95%) believe that primary care physicians vary in their testing and treatment of patients, and most (76%) were interested in learning how their own practice compared to those of other physicians.

Study participants identified three factors they believe cause physicians to practice too aggressively: malpractice concerns (76%), clinical performance measures (52%) and inadequate time to spend with patients (40%). Eighty-three percent of physicians felt they could easily be sued for failing to order a test that was indicated, while 21% felt that they could be sued for ordering a test that was not indicated.

The authors conclude their results show “physicians are open to practicing more conservatively.” They also note that “physicians believe they are paid to do more and exposed to legal punishment if they do less. Reimbursement systems should encourage longer primary care physician visits and telephone, e-mail and nursing follow-up, rather than diagnostic intensity.”

In an invited commentary published in the same issue, Calvin Chou, MD, PhD, from the University of California and San Francisco Veterans Affairs Medical Center, noted: “implicit in these findings is a kind of trained helplessness – it seems that physicians know they are practicing aggressively but feel they have no recourse.”

SOURCES: Arch Intern Med. 2011;171[17]:1582-1586, Sept. 26, 2011.

Press Release, the American Medical Association.

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