Less than 37 percent of physicians surveyed by the Dartmouth Institute for Health Policy & Clinical Practice reported having an understanding of “the cost of tests and procedures to the health system.”

The study, coauthored by Carrie Colla, PhD, and published in the American Journal of Managed Care, aimed to measure physicians’ awareness of Choosing Wisely, an initiative created by the American Board of Internal Medicine to help medical professionals identify and avoid low-value health services. The survey, which also included broader questions on the overuse of tests and procedures, was answered by 584 clinicians practicing at Massachusetts-based Atrius Health.   

Most of the respondents (59 percent) were unaware of the Choosing Wisely campaign, but their answers on the broader questions matched with previously identified factors leading to overuse.

Among the notable responses:

• The vast majority of respondents agreed physicians should limit unnecessary tests (96.8 percent) and have responsibility to control costs (92.2 percent), but only 20.7 percent felt others in their specialty share a commitment to reducing unnecessary treatment;
• Patient pressure or actual needs outweighed cost concerns: 74.5 percent said “I should be devoted to patients’ interest, even if expensive," and 67.7 percent felt pressured by patients to order more tests;
• Malpractice concerns affected some decisions: 69.5 percent said they’re worried about a malpractice suit in next 10 years, and 49.2 percent reported seeking consultant opinions to avoid getting sued;
• Some expressed frustration with cost concerns: 33 percent said it’s “unfair to ask physicians to be cost-conscious and concerned with patient welfare,” and 30.7 percent said there’s too much emphasis on cost.

When it came to knowledge of costs, more medical specialty physicians reported an understanding (41.3 percent) than surgical specialists (39.1 percent) and primary care physicians (34.2 percent).

While admitting the results may not reflect how physicians feel nationwide, the study argued the findings show doctors are willing to forego low-value services, but want some assurances in other areas when it comes to addressing the underlying causes of overuse.

“Reduction of overuse will require more than just engaging physicians, as the behavior of patients, regulators, and other stakeholders also contributes to the consumption of low-value services, “ Colla and her coauthors wrote. “Improving the value in the US healthcare system will require a multi-faceted approach in which all stakeholders’ beliefs and objectives are taken into consideration so that incentives are aligned for the elimination of the use of low-value services across stakeholder groups.”