Choosing Wisely Got National Attention. Physician Awareness Barely Moved.

Up to 30% of US care may be waste, by the Institute of Medicine’s estimate. Five years into one of medicine’s best-known efforts to trim that excess, physician awareness of the campaign itself appears to have budged only slightly.

That is the main message from a pair of Health Affairs articles released at the Choosing Wisely campaign’s five-year mark. The campaign, launched in 2012 by the American Board of Internal Medicine Foundation with Consumer Reports, set out to push physicians and patients away from unnecessary tests, treatments, and procedures. For working clinicians, the news is less about the idea — which is familiar — than about uptake: in telephone surveys conducted by ABIM in 2014 and 2017, the share of physicians who said they were aware of Choosing Wisely increased from 21% to 25%.

The finding matters because Choosing Wisely has been one of the most visible national efforts aimed at low-value care. If awareness remained limited even after years of professional society lists, patient-facing materials, and broad media attention, that says something uncomfortable about how hard it is to move stewardship campaigns from conference slides and journal pages into the exam room.

What Health Affairs reported

Health Affairs said it is publishing two articles on what the campaign did and did not accomplish over its first five years, with both also slated for the journal’s November issue. The source material highlights one of those studies, which examined physicians’ attitudes toward and awareness of low-value care using telephone surveys administered by ABIM in 2014 and 2017.

The top-line result was modest. Physician awareness of Choosing Wisely rose by 4 percentage points over that span, from 21% to 25%.

The source also says respondents found the campaign materials valuable if they knew about them. That is an important distinction. The problem described here was not that clinicians who encountered the campaign rejected it outright. The bigger issue was reach.

What the source does not provide are the finer details physicians usually want to see before leaning too hard on a policy finding: survey size, specialty breakdown, response rate, or whether awareness differed by practice setting. It also does not spell out the second article’s results, beyond saying Health Affairs is releasing two pieces on what has and has not been accomplished.

Worth knowing. The campaign was founded in 2012 by the ABIM Foundation in partnership with Consumer Reports.

That origin story matters a bit. Choosing Wisely was built not just as a physician professionalism project, but as a joint physician-patient communication effort. The premise was straightforward: if doctors and patients had clearer conversations about interventions unlikely to help, some low-value care could be avoided.

How this lands in practice

Most physicians do not need a campaign to recognize the broad problem. Unnecessary imaging, repeat testing, and low-yield interventions are a routine source of friction in clinic and on the wards. The harder part is saying no in real time, with a patient in front of you, limited minutes, and the usual mix of anxiety, habit, defensive practice, and fragmented prior care.

That is why the Health Affairs snapshot feels familiar. High-profile campaigns can shape the professional conversation without fully reaching the bedside. A doctor may agree with the principles of avoiding low-value care and still never have engaged directly with Choosing Wisely materials, or may know the name without changing ordering habits.

For clinicians, the practical takeaway is narrow but useful: don’t assume the campaign’s visibility in policy circles translates to broad frontline penetration. If your group has leaned on Choosing Wisely recommendations for local education, decision support, or patient discussion, that may still be worthwhile. The source suggests physicians who knew about the materials considered them helpful.

At the same time, the numbers argue against mistaking awareness for saturation. A campaign can be famous in academic medicine and still have shallow uptake across day-to-day practice.

The asterisks here

This report leaves several unanswered questions.

First, awareness is not the same as behavior change. The source gives a measure of whether physicians knew about Choosing Wisely, not whether they ordered fewer low-value tests or procedures because of it.

Second, the increase was modest, and the source does not offer subgroup data. That means readers cannot tell from this summary whether awareness improved more in some specialties than others, or whether certain practice environments were more receptive.

Third, the source is thin on methods. Telephone surveys can be useful, but without details on sampling and response, it is hard to judge how broadly these results should be generalized.

And there is another limitation baked into the framing. Choosing Wisely was designed to raise awareness and support conversations. It was not, by itself, a payment policy, utilization management tool, or ordering-system intervention. If the goal is meaningful reduction in waste, awareness campaigns may be necessary without being sufficient.

What to watch next

The immediate next step is publication of both articles in Health Affairs’ November issue. Those full reports should give readers a better sense of what the campaign changed, where it fell short, and whether any effects extended beyond name recognition.

For now, the five-year check-in offers a blunt reality test. The campaign helped define the language of low-value care in American medicine. Yet by 2017, only a quarter of surveyed physicians were aware of it by name.

That gap — between national visibility and frontline awareness — may be the most useful finding here. It suggests that if the profession wants less waste, slogans and lists are only the start.