A majority of primary care providers report giving unnecessary referrals to specialists because their patient requested one, according to a study published in the American Journal of Managed Care.

 In addition, more than 38% of primary care providers also reported prescribing a brand-name drug over a generic drug due to patient requests, according to Sapna Kaul, PhD, MA, and colleagues.

It is estimated that 30% of healthcare costs in the United States are unnecessary, a number that must be reduced to keep the healthcare system sustainable. To determine how provider decisions affect these costs, the researchers sought to determine how providers responded to patient requests for unnecessary care.

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The study included data from a 2009 survey of 840 primary care providers in the United States: 274 family practice providers, 257 internal medicine providers, and 309 pediatric providers. The researchers investigated 2 types of unnecessary practices: unnecessarily referring patients to specialists and prescribing brand-name medication when generics were available.

When a patient requested it, 51.9% of providers said they made unnecessary specialty referrals, and 38.7% said they prescribed brand-name drugs. Compared with pediatric providers, both family and internal medicine providers were more likely to make unnecessary referrals and prescribe brand-name drugs. Providers were also more likely to engage in these behaviors if they interacted with drug/device representatives, had more years of clinical experience, saw fewer safety net patients, and were part of a 1- or 2-person practice.

The researchers believe that these percentages may be lower than the actual frequency due to social desirability bias.

“We recommend that efforts to reduce unnecessary practices generated in response to patient requests should include educating and training PCPs about the direct (cost-saving) and indirect (time-saving and minimizing physical/mental harm to patients) benefits that can result from avoidance of overuse/underuse of medical services,” the researchers said.


  1. Laul S, Kirchhoff AC, Morden NE, et al. Physician Response to Patient Request for Unnecessary Care. Am J Manag Care. 2015; 21(11):823-932.