AIM: Do U.S. patients receive too much care?

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Many primary care physicians in the U.S. believe their own patients are receiving too much medical care, according to the results of a survey published in the Sept. 26 issue of the Archives of Internal Medicine.

Physicians believe that malpractice reform, realignment of financial incentives and more time with patients could remove pressure on physicians to do more than they feel is needed, according to the survey report, written by Brenda E. Sirovich, MD, and colleagues from the VA Outcomes Group in White River Junction, Vt., and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

“Per capita U.S. healthcare spending exceeds, by a factor of two, that of the average industrialized nation and is growing at an unsustainable rate,” wrote the authors. “Many worry that controlling medical costs inevitably would lead to the rationing of effective services. A number of healthcare epidemiologists and economists, however, have suggested that a substantial amount of U.S. healthcare is actually unnecessary.”

The survey was conducted through the mail between June 2009 and December 2009. A total of 627 physicians were randomly selected from the American Medical Association Physician Masterfile, with 70 percent responding.

Of the physicians who responded, 42 percent believe patients in their own practice receive too much medical care, while 6 percent believe their patients receive too little care. Just over half believe the amount of care received is just right. Additionally, 28 percent of respondents said they personally were practicing more aggressively than they would like, and 29 percent felt that other primary care physicians in their community were practicing too aggressively.

Study participants identified three main factors contributing to over-aggressive practice styles: malpractice concerns (76 percent), clinical performance measures (52 percent) and inadequate time to spend with patients (40 percent).

When it came to the question of financial incentives, physicians downplayed the effect they had on their own practice, while saying it did contribute to aggressive practice in colleagues. Just 3 percent thought financial considerations altered their own decisions, but 39 percent believed other primary care physicians would order fewer tests if they did not generate extra revenue. Nearly two-thirds said medical subspecialists would cut back on testing if financial incentives were removed.

“There needs to be a fundamental realignment of financial incentives and reform of the malpractice system,” wrote the authors. “Physicians believe they are paid to do more and exposed to legal punishment if they do less.”

The authors concluded on an optimistic note by pointing out that most physicians acknowledge the problem and are willing to make changes in their own practice. Almost all (95 percent) of the physicians in the survey believe that care varies across communities, and 76 percent said they were interested in learning how their own practice compared to those of other physicians.