One in three physicians unlikely to get routine medical care

November 26, 2000

Doctor, heal thyself? That seems the motto among a group of physicians surveyed by Johns Hopkins researchers: More than a third said they were unlikely to see a doctor on a regular basis.

Of 915 physicians queried by the Hopkins team, 312 (34 percent) said they had no regular source of care. Internists, surgeons and pathologists were significantly less likely to have a regular health provider than pediatricians or psychiatrists, the survey found. And those that reported no regular source of care were less likely to get flu shots or recommended breast, colon and prostate cancer screenings over the next six years.

Results of the study, published in the Nov. 27 issue of the Archives of Internal Medicine, also reported that those less likely to get regular medical attention reject care because they think it's unnecessary. They either believe they can take care of themselves or that their health is a matter of luck or chance.

"The interventions that physicians didn't take advantage of - mainly screening for colon cancer - also are practiced less among the general population," says Michael J. Klag, M.D., M.P.H., interim chairman for the Department of Medicine at Hopkins and director of the study. "Still, because physicians' health beliefs and practices influence how they treat patients, we would like to see all health providers take advantage of these potentially life-saving medical tests."

The doctors surveyed were less likely to have a regular care provider than those in the general population, where about 15 percent don't have a regular source of care. But overall, physicians' use of preventive health measures was much higher than that of the general population, "so on average, physicians do practice what they preach," Klag says.

The research team, led by Cary P. Gross, M.D., drew their survey subjects from the Johns Hopkins Precursors Study, a long-term investigation of 1,337 medical students, mostly male, enrolled at Hopkins between 1948 and 1964 who are surveyed every year about health behaviors and disease occurrence. The average age of the respondents was 61; 8 percent were women. Researchers looked at whether the physicians used a regular health provider in 1991, and compared that to whether they underwent various cancer screenings or got flu shots in 1997.

Those who had no regular source of care included the 252 (28 percent) who had no medical care at all, and the 60 (7 percent) who treated themselves. Approximately 43 percent had an independent physician as their main source of care, while 18 percent saw a colleague in their own medical practice. Not having a regular doctor was unrelated to age or gender but did vary widely by specialty, ranging from 21 percent among psychiatrists to 46 percent among pathologists. Internists were most likely to report self-treatment.

Nearly three-quarters (73 percent) of the entire survey population had colon cancer screening, 71 percent of the women a mammogram, 76 percent a PSA test and 74 percent a flu shot. Among those who didn't have a regular doctor in 1991, only 55 percent underwent a colon cancer screening, 44 percent had mammograms, 62 percent had a PSA test, and 59 percent had a flu shot.

Researchers also asked the survey group whether they believed their health was controlled by chance, by their own means or by others. Among those who strongly felt health was up to chance, nearly 43 percent had no regular care provider. About 40 percent of those who felt internal means could control their health lacked a health provider and only 21 percent of those who felt others have control over their health lacked a health provider. Senior author Daniel E. Ford, M.D., M.P.H., indicated that such health beliefs likely affect most people's decision to seek preventive medical care.

A history of cancer in one or both parents did not influence the physicians' choice to have a regular health provider.

Klag cautions that these data are limited to graduates of The Johns Hopkins University School of Medicine and may not apply to other doctors or the general population.
The study was supported by the National Institutes of Health and the Robert Wood Johnson Clinical Scholars Program. Other authors were Lucy A. Mead, Sc.M.; and Ford of Hopkins; and Gross of Yale University School of Medicine, New Haven, Conn. Gross was a Robert Wood Johnson Clinical Scholar at Hopkins when the study was conducted.

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