Primary Care Physicians’ Views on the Health Care System

I’m constantly telling you what I think of the US health care system, so it only seems fair to talk about what other doctors think of it. There’s a new manuscript out in Archives of Internal Medicine that does just that. A number of researchers surveyed a nationally representative random sample of US primary care physicians (general internal medicine and family practice). They had a 70% response rate, which is really good for mail surveys of physicians, for a sample of 627 docs. They were mostly male (72%), had been practicing for a median of 24 years, and were fairly about evenly split between family medicine (54%) and internal medicine (43%).

The first set of questions dealt with perceptions of how aggressive care was in their estimation:

  • 42% thought their patients were receiving too much medical care, versus 6% who thought they were receiving too little care (52% thought that care was just right)
  • 28% said they were practicing more aggressively than they would like to be
  • 29% said that other primary care physicians were practicing too aggressively
  • 47% thought that mid-level providers, like nurse practitioners and physician assistants practice too aggressively
  • 61% thought that medical subspecialists practice too aggressively

Bottom line? They think too much care is being provided, but most of it is coming from mid-level providers or medical subspecialists. When asked why they might be practicing more agressively than they would like to, they gave three main reasons:

  • 76% said malpractice concerns
  • 52% said clinical performance measures
  • 40% said inadequate time with patients

I wish I could say that I agree with this. I really do. I mean, I trust that the results are accurate, but I don’t think that means we should act on them.

Why? Well, three-quarters of primary care physicians say that concerns about being sued make them practice more aggressively than they’d like. But research shows that physicians in low malpractice risk areas don’t practice much differently than docs in high malpractice risk areas. They also don’t practice much differently after tort reform passes. You’ve heard me talk about how Texas’ malpractice reform didn’t bring spending down much at all.

Half blame performance measures, which are intended to help them improve quality. I’m not surprised that lots don’t like them, though; physicians really don’t like being told what to do.

I sympathize with the last reason. Patient visits are short in the US. But I’m not sure that if they were longer, docs would order fewer tests.

Notice what’s not in the top reasons? Money. Could it be that doctors might practice more aggressively because when they do, they make more? Well, only 3% believed that financial considerations could influence their own practice. Most, however, thought that other physicians would be affected by such things.

One of my co-bloggers refers to this sort of thing as “magical thinking”. I call it delusional.

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