Choosing Wisely at 5 Years: Useful to Physicians Who Know It, Still Reaching Too Few

Up to 30% of care in the United States may be waste, by the Institute of Medicine’s estimate. Five years after Choosing Wisely launched to chip away at that problem, its biggest limitation looks less like resistance than reach.

That is the central message from a pair of articles released by Health Affairs at the campaign’s five-year mark. The Choosing Wisely campaign, founded in 2012 by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, set out to help physicians and patients avoid unnecessary tests, treatments, and procedures. Yet in telephone surveys of physicians administered by ABIM in 2014 and 2017, awareness of the campaign moved only modestly, from 21% to 25%.

For clinicians, the finding matters because it captures a familiar disconnect. Most physicians do not need to be convinced that low-value care is a problem. The harder task is getting a national campaign off policy slides and into the ordinary churn of clinic, the ED, the consult note, the awkward conversation when a patient expects a test that is unlikely to help.

What the Health Affairs pieces actually found

The new Health Affairs release centers on two articles examining what Choosing Wisely has, and has not, accomplished in its first five years. One study evaluated physician telephone surveys conducted by ABIM in 2014 and again in 2017, focusing on physicians’ attitudes toward and awareness of low-value care.

The topline number is the simplest one: physician awareness of the Choosing Wisely campaign increased by 4 percentage points over that period, from 21% to 25%.

That is movement, but not much. For a campaign launched by a major professional foundation and paired with a consumer-facing partner, the finding suggests that diffusion into frontline practice remained limited through year five.

At the same time, the Health Affairs summary says the campaign was valuable for physicians who knew about it. The source material does not provide more detailed survey results in the excerpt available here, so it is not possible to say from this summary exactly which materials physicians found most useful or how that usefulness was measured. What can be said is narrower and still important: among physicians who were aware of Choosing Wisely, the campaign appeared to have practical value.

That distinction matters. It means the story is not simply that the effort failed. It is that endorsement and usefulness did not translate into broad awareness.

Worth knowing. The awareness gain reported here was modest: 21% in 2014 vs 25% in 2017.

The larger backdrop is the scale of the problem the campaign was trying to address. The Institute of Medicine estimate cited in the Health Affairs summary puts waste at up to 30% of US care. Choosing Wisely entered that space in 2012 with a straightforward premise: identify tests, treatments, and procedures that are commonly used and often unnecessary, then make those conversations easier for clinicians and patients.

How this lands in practice

For a working physician, the practical takeaway is less about any single recommendation than about implementation. Choosing Wisely has always been a communication tool as much as a quality initiative. If the clinicians who know the campaign find it useful, that suggests the content can help with a recurring clinical problem: saying no, or not now, in a way that feels evidence-based rather than dismissive.

That could matter in primary care, hospital medicine, and specialty practice alike, especially when low-value care is driven by habit, defensive medicine, or patient expectation. The campaign’s premise is familiar to any attending who has tried to explain why more testing is not always better medicine.

Still, this Health Affairs snapshot argues that usefulness alone is not enough. A campaign cannot change practice patterns if most physicians are not aware of it. From a newsroom perspective, that may be the most telling finding in the package. The profession broadly supports reducing waste. Getting clinicians to see, remember, and use the specific tools is another job entirely.

The asterisks

The source material here is a summary of the Health Affairs release, not the full articles, so there are limits on how far the analysis can go.

We are told the physician data came from telephone surveys administered by ABIM in 2014 and 2017. The available summary does not include the survey sample size, the specialties surveyed, response rates, or the exact wording of the questions. It also does not detail the second Health Affairs article beyond noting that two studies were being released for the campaign’s five-year mark.

Those gaps matter. Awareness is not the same as behavior change, and endorsement is not the same as fewer low-value services delivered. The summary supports a careful conclusion about reach and perceived value, not a sweeping claim that the campaign did or did not reduce unnecessary care across the system.

What to watch next

The immediate next step, according to the source, was publication of both studies in the November issue of Health Affairs after their Web First release on October 24, 2017.

The broader question is the one Choosing Wisely has faced from the start: can a campaign built around professional guidance and patient education penetrate ordinary clinical workflow deeply enough to change care? Five years in, the answer appears mixed. The campaign had value for physicians who knew it. Too few did.