We all know that Americans spend too much money on healthcare – more than twice as much per patient as people in other industrialized countries, on average – but we don’t necessarily know who to blame. A study published in Tuesday’s edition of Archives of Internal Medicine offers up a surprising culprit: primary care doctors who admit that they give their patients too much care.
That’s right – 42% of the docs in a nationwide survey said the patients in their own practices “were receiving too much medical care” and 28% said they personally were ordering more tests and making more referrals to specialists than they would “ideally like to be.”
Why do they do it? Three reasons:
1. 76% of doctors in the survey said fear of malpractice lawsuits prompted them to practice more aggressive medicine;
2. 52% blamed it on the use of clinical performance measures that are used to judge whether doctors are doing their jobs correctly; and
3. 40% said they didn’t get to spend enough time with their patients to figure out what is really wrong with them, so they ordered tests and consultations to provide some of the answers.
Defensive medicine was clearly a problem. In the survey, 83% said they felt that “they could easily be sued for failing to order a test that was indicated,” but on the flip side only 21% worried that a patient might file a lawsuit against a doctor who ordered a test that wasn’t medically necessary.
Making money was another factor. Only 3% of the 627 internists and family practice doctors who participated in the survey acknowledged that they sometimes ordered extra tests to boost their own bottom line, but 39% said they thought that other primary care physicians ordered tests in part to boost their own revenue.
If they were suspicious of their colleagues, they held even lower opinions about subspecialists – 62% said these doctors (think cardiologists, oncologists, etc.) “would cut back on testing in the absence of a financial incentive,” according to the study.
Overall, 61% of the primary care doctors judged subspecialists to be providing too much care. In addition, 47% felt that nurse practitioners and physician assistants – thought to be lower-cost substitutes for doctors – were practicing too aggressively.
“Many primary care physicians believe there is substantial unnecessary care that could be reduced, particularly by increasing time with patients, reforming the malpractice system, and reducing financial incentives to do more,” wrote the authors from the Veterans Administration Outcomes Group in White River Junction, Vt., and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
That’s easier said than done, of course. Changing the medical malpractice system would be no small task. There’s also the matter of changing the way doctors are reimbursed so that they can get paid for talking and thinking as well as for doing.
On the plus side, it should be possible to spend less on medical bills while actually improving the quality of medical care.