A recent survey of over 2000 U.S.-based physicians shows that doctors believe patients are being subjected to overtreatment on a regular basis, with the effect of driving up healthcare costs.
The survey was taken by doctors from the American Medical Association. Both Primary Care physicians and specialists were included in the survey respondents. For the purposes of this survey, “Primary Care” was defined as General Internal Medicine, Pediatrics, and Family Medicine, while specialists came from a variety of treatment areas, such as Gastroenterology, Cardiology, Critical Care, and Oncology. The survey is the first to gather input on overtreatment from physicians of various specialties nationwide; a 2011 survey included only Primary Care doctors.
The questions on the survey were about overtreatment of patients, including how common overtreatment is, possible causes and solutions, and what implications, if any, overtreatment has on healthcare in the United States. The results seem to clearly indicate that overtreatment is a significant problem, and that solutions—including moving away from fee-for-service care—should be found.
Most of the physicians surveyed believe that up to 30% of medical care is overtreatment. The most commons reasons cited for overtreatment were fear of malpractice, patient pressure, and difficulty getting medical records. The majority of physicians surveyed also believe that profit is another factor in overtreatment. The percentages from the study itself clearly indicate the seriousness of the problem:
“The top three cited reasons for overtreatment were “fear of malpractice” (84.7%), “patient pressure/request” (59.0%), and “difficulty accessing prior medical records” (38.2%). Seventy-one percent of respondents believed that physicians are more likely to perform unnecessary procedures when they profit from them.”
The surveyed physicians offered a number of possible solutions, such as better training for resident physicians and easier access to patient records. Most survey respondents also believe that moving away from fee-for-service and flat-salary models is an important part of solving the overtreatment problem and decreasing overall healthcare costs:
“Seventy-six percent of respondents believed that de-emphasizing fee-for-service bonus pay would reduce unnecessary utilization; 70.8% believed that it would reduce national healthcare spending.”
The study was published in PLOS One in September 2017, though the survey is comprised of data collected in 2014. While recent initiatives have been utilized regarding overtreatment, the survey authors believe their data is still extremely viable:
“Overtreatment continues to be a major contributor to excessive healthcare spending and this data remains relevant nationally. Finally, this study was conducted in the United States but overtreatment is a global issue and continues to be cited in the literature as such. A [2016] article in the BMJ from London cites a list of 40 unnecessary interventions chosen by the Academy of Medical Royal Colleges modeled after the Choosing Wisely Initiative.”
The results of this survey clearly indicate the the scope and extent of the problem of overtreatment in the United States. Costs to both patients and payers are higher than they should be, and fee-for-service is thought to be a large part of the problem. Better ways must be found to protect patients and reduce costs. Value-based healthcare, as evidenced by the Choosing Wisely Initiative, is part of the solution.