Choosing Wisely Reached Only a Quarter of Physicians in Health Affairs Survey Update

Up to 30 percent of US care may be waste, according to the Institute of Medicine. Five years after the ABIM Foundation launched Choosing Wisely with Consumer Reports to push back on unnecessary tests, treatments, and procedures, a new Health Affairs look suggests the campaign was useful to physicians who knew about it — but it still had limited reach.

That is the main takeaway from one of two Health Affairs articles released at the campaign’s five-year mark and slated for the journal’s November issue. The physician survey analysis looked at telephone surveys administered by ABIM in 2014 and 2017 and found that awareness of Choosing Wisely rose just 4 percentage points, from 21 percent to 25 percent.

For clinicians, the finding lands in a familiar place. Cutting low-value care is often framed as a cost issue, and it is that. It is also a workflow issue. Every unnecessary test can mean another result to track, another patient message to answer, another follow-up conversation about an incidental finding that never needed to enter the chart in the first place.

What the Health Affairs analysis found

The campaign itself began in 2012, when the American Board of Internal Medicine Foundation partnered with Consumer Reports to raise awareness among physicians and patients about avoiding unnecessary services. Health Affairs marked the initiative’s five-year point with two articles on what had and had not been accomplished.

The physician-focused study evaluated ABIM telephone surveys from 2014 and 2017 to assess physicians’ attitudes toward and awareness of low-value care. The topline number was modest: awareness of the Choosing Wisely campaign increased from 21 percent to 25 percent.

That means three things, and the source is careful on all of them.

• Awareness did increase.
• The increase was small.
• Physicians who were aware of the campaign found its materials helpful.

The source summary does not provide more detail than that on exactly which materials physicians found useful, how usefulness was measured, or whether awareness differed by specialty or practice setting. It also does not give the survey sample size in the summary provided.

Worth knowing. The source describes this as a gain in awareness, not evidence that the campaign broadly changed physician behavior across practice.

Health Affairs also frames the campaign against a large backdrop: the Institute of Medicine’s estimate that as much as 30 percent of US care is waste. That figure helps explain why even a modest change in awareness matters. Choosing Wisely was built around a straightforward idea — that some commonly ordered tests, treatments, and procedures offer little value and should be questioned before they become routine.

How this lands in practice

If you are in clinic or on service, the practical appeal of reducing low-value care is obvious. Fewer unnecessary orders can mean fewer downstream tasks. Less inbox noise. Fewer calls about borderline or incidental results. Less time spent explaining why a test that was ordered reflexively did not help the patient in front of you.

That does not mean this Health Affairs analysis proved gains in physician wellness or efficiency. It did not, at least from the details available here. The editorial lesson is narrower and still useful: when physicians knew about Choosing Wisely, they found the materials valuable. The harder part was getting the campaign in front of more of them.

That gap matters because low-value care is not just a utilization problem on paper. It shows up in ordinary workdays. An avoidable imaging study can create a chain of follow-up work that stretches across radiology review, portal messages, repeat visits, and referrals. An unnecessary treatment can generate monitoring and documentation burdens of its own. For many doctors, that is where overuse stops being an abstract policy concern and starts feeling like friction.

There is also a patient-facing side. Choosing Wisely was founded with Consumer Reports, a signal that the campaign aimed not only to influence physicians but also to support conversations with patients. In practice, materials that help explain why a service is unnecessary can make those discussions easier, especially when patients equate “more” with “better.” The source does not say how often that happened. It does suggest physicians saw some value in having those tools available.

The asterisks

The limits here are important.

The source summary gives only a snapshot of the survey findings. It tells us awareness changed from 21 percent to 25 percent and that physicians who knew the campaign found the materials helpful. It does not report:

• how many physicians were surveyed,
• whether awareness varied by specialty, age, or region,
• whether reported attitudes translated into changes in ordering,
• or whether patient outcomes or spending changed.

So this is best read as an update on visibility, not a final verdict on effectiveness.

It is also a reminder that national campaigns can be well known in policy circles and still not penetrate everyday practice as much as advocates assume. A modest awareness gain over several years suggests dissemination remained a challenge.

What to watch next

Health Affairs released two articles tied to Choosing Wisely’s five-year mark, with both also appearing in the journal’s November issue. For physicians, the next useful question is not simply whether awareness ticks up again. It is whether broader recognition of low-value care efforts translates into less unnecessary testing and treatment in ways that are visible in clinic.

For now, this update offers a restrained message. Choosing Wisely appears to have been useful to the physicians who knew it. By 2017, that was still only one quarter of respondents.