PhotoMany of us trust that our doctor has our best interests in mind when advising treatments, but are they leaving certain options off the table?

A national survey has found that more than half of U.S. physicians withhold medical interventions from patients due to cost implications – even if the intervention would have benefitted the patient. This included practices like prescribing certain types of medication, ordering certain tests or scans, or repeating a lab test.

Researchers at the Mayo Clinic found that this “rationing behavior” is particularly prevalent among physicians with a solo practice – perhaps because they may not be equipped with the necessary resources to follow through with certain medical interventions.

“Solo practitioners have fewer resources to deal with the paperwork and other barriers; it may be easier not to make the effort in the first place when they know that their efforts will likely be in vain or will not be compensated,” said study leader Robert Sheeler.

Rationing treatments

The study sheds some light on the difficulties faced by doctors who have to be careful about how they manage and utilize resources. The initial survey was sent out to doctors in 2012; it asked them to self-rate their own rationing behavior and to clarify which factors contribute to that behavior.

When the results came back, the researchers found that 53.1% of all respondents said they engaged in some sort of rationing behavior in the previous six months. Out of all the rationed interventions, magnetic resonance imaging scans (MRIs) were rationed the most often, with 48.3% of doctors admitting to doing so.

Additionally, the researchers found that coming from a certain background or having a certain political stance affected physician behavior. Doctors who were described as more “liberal” were less likely to ration treatments. Surgical and procedural specialists were also less likely to ration treatments when compared to primary care physicians.

Understanding rationing behaviors

Sheeler and his colleagues believe that rationing treatments in solo practices can be explained by what he calls “rationing by proxy,” wherein doctors act as representatives for insurance companies.

“Physicians become rationing agents of insurance companies because of the paperwork burden and excessive hoops of prior authorizations or excessive out-of-pocket costs that are set up by payers and pharmacy benefit managers,” he says.

Further, he says that understanding why doctors choose to ration treatments is an important first step towards addressing the topic as a whole.

The full study has been published in the Journal of General Internal Medicine

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