US Physicians Self-Report Rationing Behavior

Results of a national survey of US physicians conducted to evaluate self-reported rationing behavior showed that more than half of respondents said they participated in behavior consistent with rationing.

Of 2541 physicians who responded to the survey, 1348 (53.1%) reported behavior consistent with rationing. Prescription drugs and use of magnetic resonance imaging (MRI) were reported as the most frequently rationed clinical services (48.3% and 44.5%, respectively). Other reported clinical services rationed included referral for surgery (20.2%), hospital admission (18.8%), and referral to an intensive care unit (10.9%). 

The researchers found that most physicians reported rationing less than monthly; however, one-third reported rationing prescription drugs at least and one-fourth reported rationing MRIs monthly. Among respondents who reported daily rationing, prescription drugs were the most likely to be rationed (13.5%).  

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The survey also found that physicians in specific subgroups were less likely to self-report rationing behavior. Compared to primary care physicians, rationing behavior was less likely to be reported by surgical (adjusted odds ratio [OR], 0.8 [95% CI, 0.9-0.9]) or procedural (adjusted OR, 0.5 [95% CI, 0.4-0.6]) specialists. Physcians in medical school settings were also less likely to report rationing behavior compared with those working in small or solo practices (adjusted OR, 0.4 [95% CI, 0.2-0.7]), as were those who identified themselves as very or somewhat liberal compared to those who identified as very or somewhat conservative (adjusted OR, 0.7 [95% CI, 0.6-0.9]).

The majority of respondents were male (69.9%) and white (77.6%), and 32.6% worked in the south, 23.4% in the Midwest, 21.6 in the East, and 22.4% in the West. Most physicians worked in a Group or HMO practice setting (64.5%), followed by small or solo practice  (19.1%), government (13.2%), medical school (2.3%), or other (0.9%).

“This study... goes beyond physician-reported attitudes, to physician self-reported behavior that rationing does occur,” the researchers wrote. “Future research... can explore why differences exist in rationing behavior among US physicians and the impact this has on the practice of medicine and resource use.

“US physicians should be able to safely and openly discuss the ethics of rationing,” they concluded.—Mary Beth Nierengarten