Healthcare becoming an overdrive model feel half of the primary physicians

By Dr. Ananya Mandal, MDSep 27 2011

In a new poll of primary care physicians, nearly half of them said their patients received too much medical care and more than a quarter said they were practicing more aggressively than they'd like to. This could mean ordering more tests, prescribing more drugs or diagnosing people with diseases, although they would never have experienced any symptoms. On the other hand, just six percent of doctors believed their patients were getting too little care.

Dr. Brenda Sirovich of the VA Medical Center in White River Junction, Vermont, who worked on the survey said, “Physicians at the frontline of medical care are telling us that their patients are getting too much care. And we don't think we are just talking about the 627 physicians that we surveyed.”

The findings come at a time when the healthcare budget is already overstretched and many fear it is about to spiral out of control. “We spend a lot on healthcare in this country, more than anywhere else…We realize that this is unsustainable,” Sirovich, also at the Dartmouth Medical School.

According to Organization for Economic Cooperation and Development (OECD), the U.S. spent $7,960 per capita on healthcare in 2009. That's $2,608 more than Norway, the runner-up, shelled out.

Dr. Lisa Schwartz and Dr. Steven Woloshin, who also worked on the new study, were two of the three authors of a book called “Overdiagnosed: Making People Sick in the Pursuit of Health.”

Dr. Calvin Chou of the University of California (San Francisco) and San Francisco Veterans Affairs Medical Center said better communication might help. “Implicit in these findings is a kind of trained helplessness – it seems that physicians know they are practicing aggressively but feel they have no recourse,” he wrote in a commentary in the same journal.

The question asked is why are doctors ordering tests that they themselves believe are excessive. Three reasons stood out in the survey, which is based on a random sample of U.S. doctors: fear of malpractice lawsuits, performance measures and too little time to just listen to patients.

Four in 10 also believed that other primary care physicians would order fewer tests if those tests didn't provide extra income. Of course, just three percent thought that financial considerations influenced their own practice style.

“I'm not saying that physicians do tests in order to make money - there is a potential to be a real cynic here - but I think that the reimbursement model for most healthcare encourages utilization in a variety of ways,” Sirovich said. “It's a time for us to reflect about what incentives we have built into our healthcare system, and what directions they are taking us in,” she said.

The Obama administration has tried to tackle the issue of fee-for-service incentives. Last month, the Centers for Medicare and Medicaid Services said it would start offering so-called bundled payments, in which a medical practice is paid for a course of treatment as opposed to piecemeal tests, visits and procedures.