Survey: Physicians Consider One-Fifth of All Medical Care Unnecessary

Findings from a survey of more than 2100 physicians published in PLOS One indicated that providers consider overtreatment a relatively common occurrence with roots in malpractice fears and patient expectations.

Overtreatment, or the delivery of unnecessary medical services, has been highlighted as a target for reduction in order to improve patient outcomes and control costs. Estimates suggest that overtreatment accounts for $210 billion in excess health spending each year and is directly linked to patient harm due to complications.

Despite the unique perspectives offered by physicians, few studies have directly asked them to assess the occurrence of overtreatment and identify its causes and possible solutions. The current study invited providers by e-mail to take a survey about practice patterns and gathered responses from 2106 physicians. More than 57% were primary care providers, while the rest practiced a wide array of specialties.

The survey asked the following questions, with some follow-ups seeking further detail:

• In your specialty, what percent of overall care do you think is unnecessary?
• Nationally, what do you think are the top reasons for overutilization of resources, if any?
• In your opinion, what can decrease overutilization?
• What do you think is the percentage of physicians who perform unnecessary procedures when they profit from them?
• If physician compensation were to change to de-emphasize fee-for-service bonus pay, what do you think would be the impact on utilization and national healthcare costs?

Physicians reported that a median of 20.6% of overall medical care was unnecessary; tests (24.9%) or prescription drugs (22%) were more likely to be seen as unnecessary, compared with procedures (11%). More than one-fourth of physicians responded that at least 30% to 45% of all medical care is unnecessary, while just 4.6% thought that none of the medical care delivered is unnecessary.

The most commonly cited reason for overtreatment was “fear of malpractice” at 84.7%, followed by “patient pressure/request” (59%) and “difficulty accessing prior medical records” (38.2%). Of all respondents, 71% believed that physicians are more likely to perform unneeded procedures when they profit from them; this belief was strongest among those with at least 10 years of experience and specialists. The median estimate for the proportion of physicians performing unnecessary procedures with a financial motive was 16.7%.

Over three-fourths (76%) reported that moving away from a fee-for-service reimbursement system would decrease unnecessary medical utilization, and 70.8% said it would lower national expenditures on healthcare. The top 3 potential solutions to overtreatment indicated by physicians were “training residents on appropriateness criteria,” “easy access to outside health records,” and “more practice guidelines.”

These findings represent “a significant opportunity to reduce waste in health care,” according to the study authors. They suggested incorporating guidance on overutilization early on in the medical education curriculum and emphasized the importance of physician buy-in to change wasteful practice patterns.

“Training on appropriateness criteria and practice guidelines should be a priority for the future,” they wrote. “The effectiveness of these interventions warrants further study as they are not yet well known to increase appropriateness of medical care.”