Choosing Wisely Helped the Doctors Who Knew It — but Awareness Barely Budged at 5 Years

Up to 30% of US care may be waste, according to the Institute of Medicine. Five years into Choosing Wisely, the campaign aimed at that problem had reached only a quarter of physicians surveyed.

That is the sharpest takeaway from two articles released by Health Affairs at the campaign’s five-year mark. The campaign, launched in 2012 by the American Board of Internal Medicine Foundation with Consumer Reports, set out to make physicians and patients think twice before ordering or agreeing to unnecessary tests, treatments, and procedures.

For working clinicians, the news is mixed. The campaign appears to have been valuable among physicians who knew about it. Yet awareness itself moved only modestly from 2014 to 2017, which gets at the harder part of reducing low-value care: getting the message into everyday practice, not just into policy circles and conference slides.

What the reports actually found

The physician-awareness piece looked at telephone surveys conducted by ABIM in 2014 and again in 2017. The question was straightforward: had Choosing Wisely changed physicians’ awareness of low-value care and their views about it?

The answer, at least on reach, was limited. The share of physicians aware of the Choosing Wisely campaign rose by 4 percentage points, from 21% to 25%.

That is movement, but not much for a national effort backed by major physician organizations and a consumer-facing partner in Consumer Reports. At the same time, the materials were reported as helpful by physicians who were familiar with them. The source summary does not provide the full breakdown of which materials clinicians used most or how that usefulness was measured, so the cleanest conclusion is the narrow one: among physicians who knew the campaign, it had value.

The broader context matters here. Choosing Wisely was built around a simple proposition that most doctors recognize from a busy clinic day or a weekend call shift: a test can be technically available, socially expected, and still not help the patient in front of you. The campaign tried to turn that daily tension into specific conversations between physicians and patients about when not to order, image, prescribe, or proceed.

The Health Affairs package also examined what the campaign had and had not accomplished overall by year five. Based on the source material provided, the central themes were these:

• physician awareness increased only modestly
• clinicians who knew the campaign found it useful
• the effort’s real-world effect on unnecessary care remained an open question

Worth knowing. The campaign was founded in 2012 by the ABIM Foundation in partnership with Consumer Reports, explicitly targeting both physician and patient decision-making.

That dual audience was always part of the strategy. Low-value care is not only a physician behavior problem. It is also a communication problem, a culture problem, and often a time problem. Saying no to an unnecessary test can take longer than ordering it.

How this lands in practice

For physicians, the findings are less about any single recommendation than about implementation. A campaign can produce lists, talking points, and patient handouts. If only a minority of doctors know the campaign exists, its ceiling is obvious.

Still, the reported usefulness among physicians who were aware of Choosing Wisely should not be dismissed. In practice, that likely means the campaign gave clinicians language or backing for conversations they were already trying to have: why an imaging study is unlikely to change management, why an antibiotic is not indicated, why more care is not always better care.

That is where these efforts tend to succeed or fail — not at the level of slogans, but in the exam room and at order entry. A physician with a familiar framework can sometimes de-escalate care more confidently, especially when a patient arrives expecting a test or procedure. The source material does not quantify changes in ordering behavior here, so it would be too much to say the campaign measurably reduced low-value care in routine practice based on this summary alone. What it does support is a narrower, practical point: awareness was limited, but those reached by the campaign saw some use in it.

For health systems and medical groups, there is another implication. Education by itself may not travel far enough. If the goal is to reduce unnecessary care, awareness campaigns likely need help from the surrounding practice environment — workflow, feedback, and local norms. That is common sense to most clinicians, even if these reports, as summarized here, do not test those solutions directly.

The asterisks

The biggest limitation is also the most obvious one: the source summary gives only a partial view of the two Health Affairs articles. We know the physician survey was administered by telephone in 2014 and 2017 through ABIM. We know awareness rose from 21% to 25%. We know physicians who knew the campaign found the materials helpful. Beyond that, the summary is truncated.

So there are important questions this account cannot answer. It does not state how many physicians were surveyed. It does not detail specialty breakdowns, response rates, or whether awareness differed by practice setting. It also does not provide direct measures of reduced testing, treatment, or procedure use from the physician survey itself.

There is also the usual caution with self-reported attitudes. A physician can endorse the idea of avoiding low-value care and still practice in a setting that nudges toward more testing. That gap between belief and behavior is where many quality campaigns run into trouble.

What to watch next

The five-year mark reads less like a victory lap than a progress report. Choosing Wisely clearly established a recognizable framework for discussing unnecessary care. What these Health Affairs reports suggest is that the framework had not spread especially far by 2017.

The next question is the one physicians care about most: whether broader awareness can translate into less low-value care at the bedside, in the clinic, and in the order set. By the campaign’s own logic, that means keeping both audiences in view. Doctors need practical support for saying no when no is the right answer. Patients need a credible explanation for why not doing something can be the better care plan.

Five years in, Choosing Wisely seemed to help where it had a foothold. The harder work was getting that foothold in more of American medicine.