American physicians showed mixed opinions on how to decrease the country’s soaring health care costs, but in general felt that they were not primarily responsible for the problem, study findings show.

“Our data suggest that physicians struggle with navigating the tensions between their responsibilities to address overall health care resource use and their primary obligation to do what is best for individual patients,” Jon C. Tilburt, MD, MPH, of the Mayo Clinic, in Rochester, Minn., and colleagues reported in the Journal of the American Medical Association.

The United States spends more than 2.5 trillion dollars on health care annually, and many expect that figure to continue to grow unless major policy reform is undertaken. To better understand the role doctors play as the country tries to cut some of these costs, Tilburt and colleagues conducted a cross-sectional study by mail in 2012 involving 3,897 U.S. physicians who were randomly selected from the American Medical Association Masterfile. At total of 2,556 physicians responded (65%). 

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The researchers used a literature review and focus groups to come up with questions about stakeholder responsibility, cost-containment strategies, and problems associated with more cost-conscious practices.

Only 36% of participating physicians felt that they had a “major responsibility” in reducing health care costs. Instead, they placed that burden on other parties, such as patients (52%), hospitals (56%), drug and device manufacturers (56%), insurance companies (59%), and lawyers (60%).

Doctors were more concerned about improving the quality of care for their patients, as 75% were “very enthusiastic” about promoting continuity of care. Other popular measures included rooting out fraud and abuse (70%) and promoting chronic disease care coordination (69%). Less than half (47%) expressed major enthusiasm for expanding access to free preventative care.

However, the dilemma created by wishing simultaneously to provide the best possible care and also reduce health care costs was reflected in the mixed responses to other questions. On one hand, 78% of the physicians agreed that they should be solely devoted to their individual patients’ best interests, regardless of price. Furthermore, 85% do not support denying beneficial, but costly services to certain patients so that the resources can be used elsewhere.

But 89% also said that doctors needed to better limit their use of unnecessary tests, and only 34% agreed that there was too much emphasis on the costs of tests and procedures, indicating that many physicians are adopting a more cost-conscious attitude.

A minority of physicians (7%) expressed support for eliminating fee-for-service payment models as an approach to reducing healthcare costs. 

Ezekiel J. Emanuel, MD, PhD, and Andrew Steinmetz, BA, both of the Department of Medical Ethics and Health Policy at the University of Pennsylvania wrote in an accompanying editorial that the study findings are congruent with doctor’s refusal to accept major responsibility for containing healthcare costs and called the results “discouraging.”

“Someone outside — either insurance companies, a government board, or some organization determining cost-effectiveness ratios — would bear the responsibility for bringing cost into the health care equation,” they wrote.

They noted that survey participants were not very willing to change their payment structure, which could have a greater impact on health care costs. Large majorities were not enthusiastic about eliminating fee-for-service payment models or allowing Medicare payment cuts to doctors (70%, 94%, respectively).

“Physician autonomy and leadership can only be affirmed if accompanied by acceptance of responsibility and accountability,” Emanuel and Steinmetz wrote. “Unless physicians want to be marginalized — unless they are willing to become just another deckhand — they must accept and affirm that they are responsible for controlling health care costs.”


  1. Tilburt JC et al. JAMA. 2013;310(4):380-388.
  2. Emanuel EJ, Steinmetz BA. JAMA. 2013;310(4):374-375.