Report: Cost-consciousness Must Begin in Residency

Medical doctors surveyed cited "fear of malpractice" as the top reason for unnecessary care. Researchers suggest that aspiring MDs learn about overtreatment well before it becomes a concern.

Despite years of industry emphasis on curbing costly and potentially harmful unnecessary care, physicians believe that overtreatment remains an ongoing problem, according to a research from Johns Hopkins University School of Medicine published this week in the journal PLOS ONE.

The findings, based on a survey of more than 2,000 physicians, revealed that most physicians surveyed (64.7%) believe that at least 15% to 30% of medical care is unnecessary. Those surveyed were from a subgroup of the American Medical Association’s Physician Masterfile.

The top three culprits cited include:

Prescription medications (22%)
Tests (24.9%)
Procedures (11.1%)

“Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American,” says Martin Makary, MD, MPH, professor of surgery and health policy at the Johns Hopkins University School of Medicine and the paper’s senior author.

Makary and colleagues also collected physicians’ opinions as to why overtreatment occurs.

Fear of malpractice (84.7%)
Patient pressure/request (59%)
Difficulty accessing medical records (38.2%)

In addition, most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. And most respondents believed that de-emphasizing fee-for-service physician compensation would reduce healthcare utilization and costs.

The top three selected potential solutions for eliminating unnecessary services were training medical residents on appropriateness criteria for care (55.2%), easy access to outside health records (52%) and more evidence-based practice guidelines (51.5%).

“Addressing overtreatment can have a major impact on rising healthcare costs in the US,” the authors wrote. “Using the IOM’s estimate of excess costs arising from overtreatment, a 50% reduction in ‘unnecessary services’ would result in $105 billion in savings each year, or about 4% of total national healthcare spending.

While initiatives such as such as Choosing Wisely and Improving Wisely, which aim to reduce unnecessary tests and procedures, have raised awareness about overtreatment, future work should focus on the most high-volume over-utilized tests and procedures by specialty, wrote Makary and colleagues.

Finally, physicians should be taught about appropriateness early, beginning in medical school and continuing in residency, the authors urged, noting that healthcare utilization by physicians may be influenced by the cost environment in which they trained as residents.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.