Physician survey: Unneeded medical care is common, driven by fear of malpractice

Over 80 percent of surveyed physicians cited fear of malpractice as the top reason for medical overuse. A new national survey of more than 2,000 physicians across multiple specialties finds that physicians believe overtreatment is common and mostly perpetuated by fear of malpractice, as well as patient demand and some profit motives.

A report on the findings, published in PLOS ONE, highlights physicians' perspectives on unnecessary healthcare 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, M.D., M.P.H., 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 healthcare 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 healthcare organizations have focused on campaigns to address the unnecessary medical care issue. Initiatives such as Choosing Wisely and Improving Wisely, which focus on reducing unneeded tests and procedures and are endorsed by multiple physician societies, have increased awareness of appropriateness in testing and treatment. 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 from a continuing education subgroup of the American Medical Association's Physician Masterfile, a database of more than 1.4 million physicians in the United States, to complete a survey about healthcare practices.

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, M.D., 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, or 1,783 of 2,106 respondents), patient pressure/request (59 percent, or 1,242 of 2,106 respondents) and difficulty accessing prior medical records (38.2 percent, or 804 of 2,106 respondents).

The top three selected potential solutions for eliminating unnecessary services were training medical residents on appropriateness criteria for care (55.2 percent, or 1,163 of 2,106 respondents), easy access to outside health records (52 percent, or 1,096 of 2,106 respondents) and more evidence-based practice guidelines (51.5 percent, or 1,084 of 2,106 respondents).

"Most doctors do the right thing and always try to, 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," says Makary.