Annual Physical Exam: Unneeded Expense?

Sept. 24, 2007 -- An annual physical exam is a tradition for many U.S. adults, but it is not always necessary, according to a new study.

"I'm not advocating we should get rid of these visits," says researcher Ateev Mehrotra, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine and a policy analyst at RAND Corp.

Rather, the preventive services and tests ordered at these exams that are actually necessary often can be received -- and often already are -- at other visits and times, says Mehrotra. The study is published in the Sept. 24 issue of the Archives of Internal Medicine.

Using two national surveys, Mehrotra and his colleagues analyzed 8,413 doctor visits for preventive health exams (annual physicals) and preventive gynecological exams -- which women schedule to get Pap tests and pelvic exams. The doctor visits too place from Jan. 1, 2002, to Dec. 31, 2004.

Among the findings:

• About 44.4 million adults, or nearly 21% of the population, get a preventive physical exam annually.
• About 19.4 million women, or about 18% of adult women, get a preventive gynecological exam annually.?
• Together, these account for 8% of all doctors' office visits. If every U.S. adult got an annual physical, the U.S. health care system would need to provide up to 145 million additional visits annually, the researchers estimate.
• Most preventive care, about 80%, was received outside the preventive exams, when the patient saw the doctor for other reasons.
• The cost of providing both types of routine exams was about $7.8 billion -- almost the amount spent for breast cancer care in the U.S. in 2004.
• More than a third of the annual physicals in the study included testing such as complete blood cell counts or urinalysis, which Mehrotra says are not proven to improve patient outcomes when performed routinely and so may be unneeded.? Complete blood cell counts and urinalysis cost about $192 million a year in the study.
• The annual physicals and preventive gynecological exams, however, were the most common avenue for getting certain crucial tests such as mammograms and Pap tests.
• The number of adults getting the annual physicals varied by region, reflecting differing beliefs and practices. "Those in the Northeast have a 60% increased chance of getting a physical compared to those on the West Coast," Mehrotra tells WebMD.

(Do you get an annual physical? Why or why not? Talk with others on WebMD's Health Café message board.)

Annual Physical Exams: The Ongoing Debate

The discussion about whether an adult needs an annual physical has been ongoing for nearly a century, Mehrotra tells WebMD. Currently, no major North American health-related organizations recommend the routine annual exams, he says.

Still, many patients as well as many doctors believe the annual visits are a medical necessity. "The vast majority of people think they are being good patients if they go in to see their doctor every year," says Mehrotra. "Most doctors actually believe the same thing."

Yet, the value of the exams has not been established in studies, he says.

"We need to figure it out," Mehrotra says. "Do people need to come in for a special visit? Can't we do a lot of these services at other times, without the need for a visit?"

The new study, he says, suggests that crucial preventive services can easily be received during other visits, and often are.