Choosing Wisely at 5 Years: Physician Awareness Moved Modestly, Health Affairs Reports

Up to 30 percent of US care may be waste, by the Institute of Medicine’s estimate. Five years after the launch of Choosing Wisely, a new Health Affairs package asks a blunt question: did the campaign change much where it counts?

The answer, at least on physician awareness, is: not much. In a Web First release tied to its November issue, Health Affairs highlighted two articles examining what the ABIM Foundation’s Choosing Wisely campaign has and has not accomplished since its 2012 launch with Consumer Reports. One study looked at ABIM-administered telephone surveys of physicians in 2014 and 2017 and found that awareness of the campaign rose only modestly, from 21 percent to 25 percent.

That number matters because Choosing Wisely has become one of the better-known national efforts aimed at low-value care: unnecessary tests, treatments, and procedures that clinicians confront every day. For physicians who already knew about the campaign, the materials appeared to have value. The problem, according to the summary, is reach.

What Health Affairs actually found

The campaign began in 2012, when the ABIM Foundation partnered with Consumer Reports to raise awareness among physicians and patients about avoiding unnecessary care. At the five-year mark, Health Affairs released two articles assessing progress.

The first study, as described in the summary, evaluated ABIM telephone surveys of physicians conducted in 2014 and again in 2017. The aim was to examine physicians’ attitudes toward, and awareness of, low-value care. The top-line finding was modest: the share of physicians who were aware of the Choosing Wisely campaign increased by 4 percentage points, from 21 percent to 25 percent.

The summary also says respondents found the campaign materials helpful, though the text provided here does not include further detail on how that helpfulness was measured or which materials physicians were asked about.

That leaves a split-screen picture. The campaign appears to have offered practical value to clinicians who knew about it. Yet overall awareness remained limited and changed only slightly over the period examined.

Worth knowing. The physician survey data highlighted by Health Affairs came from 2014 and 2017 telephone surveys administered by ABIM.

The source notes that two articles were released, both slated for the November issue of Health Affairs. The summary supplied here, though, provides specifics only for the physician survey analysis. It does not include design details, sample size, specialty breakdown, or direct measures of whether use of low-value services actually fell.

How this lands in practice

For a working physician, the practical lesson is less about a single campaign and more about the stubbornness of low-value care. Awareness campaigns can help, especially when they give clinicians language to explain why a test is unnecessary or why a treatment is unlikely to help. Anyone who has had the Tuesday-morning conversation about an imaging study a patient expects, or a screening test ordered out of habit, already knows the terrain.

Choosing Wisely was built for those moments. The idea was straightforward: give physicians and patients a credible framework for saying no to care that adds little or no value. According to the Health Affairs summary, physicians who knew the campaign found those materials useful. That is not trivial. In practice, a concise specialty-backed rationale can be exactly what helps a clinician push back on reflexive ordering or reassure a worried patient.

Still, usefulness among the already aware is not the same thing as broad uptake. If only a quarter of surveyed physicians recognized the campaign by 2017, the initiative had not yet broken through at the level many reformers probably hoped for. For clinicians and health system leaders, that suggests the harder work is not just publishing lists of low-value services. It is getting those recommendations into workflow, conversations, and local culture.

The asterisks

This summary leaves several important questions unanswered.

First, it does not provide the underlying sample size for the physician surveys or say which physicians were surveyed. That makes it hard to judge generalizability across specialties, practice settings, or regions.

Second, the source gives an awareness measure, not a direct patient-care outcome. Awareness is useful, but it is an intermediate step. The summary does not say whether clinicians who knew about Choosing Wisely actually reduced use of low-value tests, treatments, or procedures, or whether any change translated into lower spending or better patient experience.

Third, the details on “helpful” campaign materials are thin in the excerpt provided. We are not told which materials were most useful, whether they changed ordering behavior, or how physicians weighed them against other pressures, including patient expectations and defensive practice habits.

And while Health Affairs says it released two articles at the five-year mark, the material here does not fully describe the second study’s findings. So the picture is informative, but incomplete.

What to watch next

The near-term next step is the November issue of Health Affairs, where both five-year Choosing Wisely articles were set to appear. For readers following value-based care, the central question is not whether physicians like the concept. It is whether campaigns like this can move from awareness to behavior change, and from behavior change to less waste in ordinary practice.

That remains the live issue. The Institute of Medicine’s estimate — up to 30 percent of care as waste — gives the campaign its urgency. The Health Affairs snapshot suggests Choosing Wisely had some traction among physicians who encountered it, but limited spread by 2017. In other words, the message may work. Getting it heard is the harder part.