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Annual Physical Exam: Unneeded Expense?

New Research Adds to Debate About the Value of a Yearly Physical

By Kathleen Doheny
WebMD Health News

Reviewed By Louise Chang, MD

Sept. 24, 2007 -- An annual physical exam is a tradition for many U.S. adults, but it is not always necessary, according to a new study.

"I'm not advocating we should get rid of these visits," says researcher Ateev Mehrotra, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine and a policy analyst at RAND Corp.

Rather, the preventive services and tests ordered at these exams that are actually necessary often can be received -- and often already are -- at other visits and times, says Mehrotra. The study is published in the Sept. 24 issue of the Archives of Internal Medicine.

Using two national surveys, Mehrotra and his colleagues analyzed 8,413 doctor visits for preventive health exams (annual physicals) and preventive gynecological exams -- which women schedule to get Pap tests and pelvic exams. The doctor visits too place from Jan. 1, 2002, to Dec. 31, 2004.

Among the findings:

  • About 44.4 million adults, or nearly 21% of the population, get a preventive physical exam annually.
  • About 19.4 million women, or about 18% of adult women, get a preventive gynecological exam annually.
  • Together, these account for 8% of all doctors' office visits. If every U.S. adult got an annual physical, the U.S. health care system would need to provide up to 145 million additional visits annually, the researchers estimate.
  • Most preventive care, about 80%, was received outside the preventive exams, when the patient saw the doctor for other reasons.
  • The cost of providing both types of routine exams was about $7.8 billion -- almost the amount spent for breast cancer care in the U.S. in 2004.
  • More than a third of the annual physicals in the study included testing such as complete blood cell counts or urinalysis, which Mehrotra says are not proven to improve patient outcomes when performed routinely and so may be unneeded. Complete blood cell counts and urinalysis cost about $192 million a year in the study.
  • The annual physicals and preventive gynecological exams, however, were the most common avenue for getting certain crucial tests such as mammograms and Pap tests.
  • The number of adults getting the annual physicals varied by region, reflecting differing beliefs and practices. "Those in the Northeast have a 60% increased chance of getting a physical compared to those on the West Coast," Mehrotra tells WebMD.

Annual Physical Exams: The Ongoing Debate

The discussion about whether an adult needs an annual physical has been ongoing for nearly a century, Mehrotra tells WebMD. Currently, no major North American health-related organizations recommend the routine annual exams, he says.

Still, many patients as well as many doctors believe the annual visits are a medical necessity. "The vast majority of people think they are being good patients if they go in to see their doctor every year," says Mehrotra. "Most doctors actually believe the same thing."

Yet, the value of the exams has not been established in studies, he says.

"We need to figure it out," Mehrotra says. "Do people need to come in for a special visit? Can't we do a lot of these services at other times, without the need for a [special] visit?"

The new study, he says, suggests that crucial preventive services can easily be received during other visits, and often are.

Second Opinion

The study provides some valuable information, says Douglas K. Owens, MD, senior investigator, VA Palo Alto Healthcare System and professor of medicine at Stanford University. "The researchers are saying these [annual physicals] are common, often provide preventive services, but that many preventive services are provided at other visits."

"It is important to understand what these exams accomplish," he says, "and that there are other ways to accomplish the same thing that might be more efficient and cost-effective."

Owens chairs a subcommittee of the American College of Physicians that develops guidelines about treatment and care but says he is giving his opinion, not that of the college. The ACP has no official guideline about the annual physical, he says.

Some advocates of the annual physicals see the yearly exam, Owens points out, as a good way to build the patient-doctor relationship. Yet that relationship can be worked on, others say, in any doctor office visit, not just the traditional annual physical visit.

Take-Home Points on Annual Physicals

What's the message for patients? "The important thing for consumers is, there are preventive services important to get," Owens says. "If they are getting them as part of their routine care, that is great. If not, a periodic health exam may be a good avenue to get them."

"Have a conversation [with your doctor]," Mehrotra suggests. "If your doctor tells you [that] you don't need to come in for an annual physical or don't need some of these tests, he's not [just] trying to save money. Patients should realize there is a lot of controversy about the value of physicals and they should have a conversation with their doctor about it."

Patients should also realize, he says, that the preventive services they absolutely need can be received outside the traditional annual physical exam.

SOURCES: Ateev Mehrotra, MD, MPH, assistant professor of medicine, division of general internal medicine, University of Pittsburgh School of Medicine; policy analyst, RAND Corp. Douglas K. Owens, MD, senior investigator, Center for Healthcare Evaluation, VA Palo Alto Healthcare System; professor of medicine, Stanford University. Mehrotra, A. Archives of Internal Medicine, Sept. 24, 2007; vol 167: pp 1876-1883.

© 2007 WebMD Inc. All rights reserved.





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