Too Little? Too Much? Primary care physicians' views on US health care: a brief report

Abstract

Background: Some believe that a substantial amount of US health care is unnecessary, suggesting that it would be possible to control costs without rationing effective services. The views of primary care physicians-the frontline of health care delivery-are not known.

Methods: Between June and December 2009, we conducted a nationally representative mail survey of US primary care physicians (general internal medicine and family practice) randomly selected from the American Medical Association Physician Masterfile (response rate, 70%; n=627).

Results: Forty-two percent of US primary care physicians believe that patients in their own practice are receiving too much care; only 6% said they were receiving too little. The most important factors physicians identified as leading them to practice more aggressively were malpractice concerns (76%), clinical performance measures (52%), and inadequate time to spend with patients (40%). Physicians also believe that financial incentives encourage aggressive practice: 62% said diagnostic testing would be reduced if it did not generate revenue for medical subspecialists (39% for primary care physicians). Almost all physicians (95%) believe that physicians vary in what they would do for identical patients; 76% are interested in learning how aggressive or conservative their own practice style is compared with that of other physicians in their community.

Conclusions: Many US primary care physicians believe that their own patients are receiving too much medical care. Malpractice reform, realignment of financial incentives, and more time with patients could remove pressure on physicians to do more than they feel is needed. Physicians are interested in feedback on their practice style, suggesting they may be receptive to change.

Trial registration: clinicaltrials.gov Identifier: NCT00853918.

Figure

Primary care physicians’ opinions (n=627) on the style of medical care practiced in their communities. The most extreme responses (along a 5-point Likert scale) are shaded in white and black; gray shading represents the intermediate responses (eg, “too little” and “too much” for the first question). The neutral category (eg, “just about right”) is omitted from the Figure. Item nonresponse for the 5 questions, in order, was 1.3%, 2.6%, 5.6%, 2.6%, and 2.2%. *No physicians responded “much too little.” NPs indicates nurse practitioners; PAs, physician assistants.