Physicians are evenly divided on the importance of considering societal cost and resource allocation while providing individual patient care, per data published in AJOB Empirical Bioethics.
The Choosing Wisely campaign, led by the American Board of Internal Medicine, seeks to reduce the overuse of medical resources. Along with similar initiatives, Choosing Wisely represents the increasing emphasis on physicians as “stewards” of social resources and medical care.
To investigate physician perceptions of their social responsibilities, researchers abstracted survey response data from the AMA Physician Masterfile. The survey, administered in 2010, assessed physician agreement with statements related to care cost. Respondent religious affiliation and care specialty were also captured, including amount of time spent caring for patients with advanced illness or providing palliative care.
The overall survey response rate was 62% (n=1156). Nearly half of respondents (47%) agreed that physicians “should not consider the societal cost of medical care when caring for individual patients,” while 69% agreed that “physicians should refuse requests…for costly interventions that have little chance of [benefit].”
Per logistic estimation models, physicians with experience providing end-of-life care were more likely to support refusing costly interventions with little expected benefit (adjusted odds ratio [aOR], 1.6; 95% CI, 1.2-2.2). Physicians who reported caring for a high number of patients (≥50) in the intensive care unit in the prior year were also more likely to refuse costly interventions (aOR, 1.6; 95% CI, 1.0-2.6) compared with physicians who cared for fewer patients (<8). Among respondents who supported the survey statement on avoiding costly interventions, around half also agreed that societal costs should be taken into consideration while providing care. Those who identified as Roman Catholic (aOR, 3.2; 95% CI, 1.5-6.9), evangelical Protestant (aOR, 2.8; 95% CI, 1.7-7.2), or nonevangelical Protestant (aOR, 2.3; 95% CI, 1.1-5.2) were more likely to disagree with the societal cost statement compared with physicians who identified with no religion.
As a nationwide study, these data provide substantial insight into physicians’ self-perceived role in allocating medical resources and safeguarding healthcare budgets. Specifically, most practitioners agree that costly interventions with little expected benefit should be avoided, although the debate on physician obligation to societal costs remains more contentious. Further research is necessary to examine the nuances behind these responses and inform initiatives to reduce the societal burden of medical care costs.
Stavig AR, Tak HJ, Yoon JD, Curlin FA. Taking societal cost into clinical consideration: U.S. physicians’ views [published online August 30, 2018]. AJOB Empirical Bioethics. doi: 10.1080/23294515.2018.1498408