Choosing Wisely Reached Only 25% of Physicians in ABIM Surveys at 5 Years

Five years after Choosing Wisely launched to curb unnecessary care, physician awareness in ABIM telephone surveys had moved only modestly: from 21% in 2014 to 25% in 2017.

That is the clearest signal from a new Health Affairs Web First release marking the campaign's five-year point. The campaign, founded in 2012 by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, was built around a simple goal: get physicians and patients to think twice about tests, treatments, and procedures that add little value. For practices trying to cut low-value care, the finding matters because a campaign can't change behavior very far beyond the clinicians who know it exists.

The backdrop is familiar to any practicing doctor. The Institute of Medicine has estimated that up to 30 percent of care in the United States is waste. Choosing Wisely entered that space with a professional-society-driven message about avoiding overuse. What Health Affairs is now highlighting is a mixed early report card: physicians who knew about the campaign found its materials valuable, yet overall awareness remained fairly flat.

What the Health Affairs release actually found

Health Affairs said it is publishing two articles on what Choosing Wisely has and has not accomplished at the campaign's five-year mark, with both studies also appearing in the journal's November issue.

One of those studies evaluated ABIM-administered telephone surveys of physicians conducted in 2014 and 2017. The aim was to examine physicians' attitudes toward and awareness of low-value care. In those surveys, awareness of Choosing Wisely rose by 4 percentage points, from 21 percent to 25 percent.

That is movement, but not much reach for a national campaign that had been running for five years by the time of the later survey. The release also says respondents found the campaign materials valuable. The source material does not provide more detail on how that value was measured, which specialties were surveyed, or whether awareness differed by practice setting.

Still, the basic split is hard to miss:

• awareness increased only modestly
• physicians familiar with the campaign viewed the materials as useful
• Health Affairs framed the overall record as including both accomplishments and limits

Worth knowing. The source describes awareness and attitudes from physician telephone surveys; it does not report patient outcomes, utilization changes, or savings figures.

That distinction matters. A rise in awareness is not the same thing as a reduction in unnecessary imaging, screening, prescribing, or procedures. And a favorable response among those already aware of the campaign does not tell us how much it changed care at the bedside.

How this lands in practice

For a working physician, this is less about brand recognition than about implementation. Choosing Wisely has always depended on clinicians carrying the message into everyday conversations: why a test isn't needed, why a treatment is unlikely to help, why watchful waiting may be better than doing something simply because it is available.

The Health Affairs release suggests the campaign may work best as a tool for clinicians who already know it. If that's true, the practical problem is reach. A resource can be well regarded by the quarter of physicians who recognize it and still fail to shape the wider culture of overuse.

In clinic, that means the burden remains local. Practices that want to reduce low-value care may need to do more than point to a national campaign. They may need their own workflows, scripts for patient discussions, and reinforcement inside the practice, because passive awareness alone appears to have gone only so far.

It also speaks to a common frustration around overuse efforts. Most physicians don't need to be persuaded that waste exists. The harder part is changing behavior in real time, in the exam room or hospital bed, when uncertainty, patient expectations, and habit all push toward doing more.

The asterisks here

The source material is thin, and the limits are important.

Health Affairs' summary gives only a top-line look at one study. It does not include the survey sample size, response rate, physician mix, or exact wording of the awareness questions. It also does not spell out what "valuable" meant to respondents, or whether awareness translated into measurable changes in ordering patterns.

There is also no detail here on the second article beyond Health Affairs' broad statement that it addresses what the campaign has and has not accomplished. So while the release offers a useful snapshot, it is not enough to draw firm conclusions about the campaign's effect on utilization or spending.

And because the data came from telephone surveys, they reflect self-reported awareness and attitudes rather than direct observation of care delivery.

What to watch next

The immediate next step is the full November issue of Health Affairs, where both Choosing Wisely studies were slated to appear. That is where readers will need to look for the methods, subgroup detail, and any stronger conclusions about what changed beyond awareness.

For now, the five-year message is fairly restrained. Choosing Wisely appears to have had value for physicians who knew about it. Its broader penetration, at least by these ABIM surveys, remained limited.

For anyone leading utilization review, quality improvement, or practice change, that's probably the most useful takeaway: the idea may be sound, but diffusion is its own problem.