Physicians undergo less preventive testing than the public

A study out of Ontario, Canada, has found that physicians undergo less guideline-recommended preventive testing for conditions like hyperlipidemia and diabetes, yet they fare better than members of the public when it comes to long-term health outcomes.

The work, led by Dennis T. Ko, MD, MSc, of ICES (the Institute for Clinical Evaluative Sciences), compared cardiac risk factor burden, health services use and major CV event incidence between doctors and the general population in Ontario. The authors said people typically believe physicians take better care of themselves than the average person, but noted that in reality, “they often favor their professional obligations over their own health.”

The increasing burden of physician burnout, fatigue and stress is also a factor, they said—especially since burned-out physicians are more likely to deliver poor-quality care than those who are happy at work.

Ko et al. considered a primary outcome of major CV events, including CV death or hospitalization for MI, stroke, heart failure or coronary revascularization, over a period of eight years. Their study population comprised 17,071 physicians and 5,306,038 non-physicians, all of whom were around 53 years old at baseline.

Compared to non-physicians, the authors found that physicians in Ontario:

  • Had lower baseline rates of hypertension (16.9% vs. 29.6%)
  • Had lower baseline rates of diabetes (5.0% vs. 11.3%)
  • Smoked less (13.1% vs. 21.6%)
  • Had better cholesterol profiles (Total cholesterol greater than 240 mg/dL: 13.3% vs. 16.5%; LDL-cholesterol greater than 130 mg/dL: 33.2% vs. 36.8%)

Physicians underwent periodic health exams less often than their non-practicing counterparts (58.9% vs. 67.9%), as well as screenings for hyperlipidemia (76.3% vs. 83.3%) and diabetes (79.0% vs. 85.3%). Still, they recorded higher rates of cardiologist consultations (25.2% vs. 19.5%)—something the authors said might be due to the fact that many physicians have professional relationships with specialists that could allow them to bypass routine primary care.

“Physicians had fewer visits to family physicians and periodic health examinations, but were more likely than the general population to have consulted with specialists,” the authors wrote in JAMA Network Open, where they published their results Nov. 22. “This discrepancy could be associated with physicians engaging more in routine self-care and therefore not routinely seeing or consulting with a PCP as often as the general population. In addition, many physicians have encounters with specialists in their work environment that facilitate direct consultation.”

Ultimately, Ko and colleagues said the eight-year age- and sex-standardized outcome incidence was 4.4 major CV events per 1,000 person-years for physicians and 7.1 major CV events per 1,000 person-years for the general population. Physicians saw a 22% lower risk of experiencing the study’s primary outcome.

“A remarkable finding was that, even though we accounted for the difference in cardiovascular risk factors and health services practices, physicians had a substantially lower hazard of major cardiovascular events compared with non-physicians,” Ko and co-authors said. “Future studies are needed to understand the factors that explain these differences.”