Researchers at The Johns Hopkins University School of Medicine surveyed physicians between January 22, 2014 and March 8, 2014, and on September 6, 2017 published their findings from the responses from 2,106 physicians. The researchers found that those physicians believe that unnecessary medical treatment is fueled by fear of medical malpractice claims, patient demand for unneeded medical care, and some profit motives.
The physician respondents were among 3,318 physicians invited to participate in the survey about health care practices from a continuing education subgroup of the American Medical Association’s Physician Masterfile (the AMA’s Masterfile is a database of more than 1.4 million physicians in the United States). Of the total number of respondents included in the study’s findings, 47.9% were attending physicians. Of the attending physicians included in the study’s findings, 46.0% had at least ten years of experience. Specialists represented 42.4% of the overall sample (general internal medicine: 40.9%; specialized internal medicine: 10.8%; and family medicine/general practice: 10.0%). Most of the respondents who were included in the study’s findings worked in a hospital: 66.6% of the hospitals were non-profit; 74.3% of the hospitals were academic; and 67.6% of the hospitals were urban.
The majority of the respondents (64.7%) believed that at least 15% to 30% of medical care is unnecessary.
The physicians’ responses indicated that 24.9% of unnecessary medical care involved medical tests, 22% of unnecessary medical care involved prescription medications, 20.6% of overall medical care delivered was unnecessary medical care, and 11.1% of unnecessary medical care involved medical procedures. The researchers also found that the median response for physicians who performed unnecessary procedures for profit was 16.7%, and 28.1% of the respondents believed that at least 30% to 45% of physicians do so (physicians with ten or more years of experience following their residencies, and medical specialists, were more likely to believe that physicians perform unnecessary medical procedures when they profited from the unnecessary medical procedures). 70.8% of the respondents believed that physicians provide unnecessary procedures when they profit from them. Source
One of the authors of the study stated, “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.”
The researchers found that the top three reasons given for the overuse of healthcare resources were fear of medical malpractice claims (84.7% of the respondents), patient pressure or patient request (59%), and difficulty accessing prior medical records (38.2%). The study’s authors stated that perceptions on the prevalence of medical malpractice lawsuits may be greater than the reality of the problem: only 2% to 3% of patients harmed by medical negligence pursue litigation, of whom about half receive compensation, and paid medical malpractice claims have declined by nearly 50% in the last decade. Source
The respondents suggested solutions for eliminating unnecessary medical care, the top three of which are training medical residents of appropriateness criteria for medical care (55.2%), easy access to outside health records (52%), and more evidence-based practice guidelines (51.5%).
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