Is an annual physical always beneficial?

Although many doctors still recommend people get an annual checkup, growing research suggests that these visits have not had a significant impact on patients' long-term health.

According to a review published in JAMA, annual checkups were associated with better diagnosing and treatment of chronic diseases, but they were not linked to lower overall mortality rates or cardiovascular improvements.

Standard annual physicals have also not been effective in reducing the increase in chronic diseases, such as obesity and Type 2 diabetes, in recent years. Currently, CDC data shows that 42% of American adults are obese and 10% have Type 2 diabetes.

"There are parts of what we do in a yearly exam that are valuable," said Yul Ejnes, a primary care doctor who is on the board of the American Board of Internal Medicine. "It's just that the delivery method that's been used for decades may not be as effective as we think it is."

A shortage of primary care doctors in the United States may also be making it more difficult for patients to get annual exams. According to the Association of American Medical Colleges, there may be as many as 48,000 fewer primary care physicians practicing in the United States by 2034.

Katherine Morgan, a 30-year-old bookstore owner in Portland, Oregon, said she called several primary care clinics in December hoping for an appointment, but the earliest one she could get was in March. In January, she decided to visit a local urgent care clinic instead, where she was diagnosed with Type 2 diabetes.

"This shouldn't be as frustrating as it is, just try to get an appointment within the same year," Morgan said.

How some providers are redesigning their annual checkups

Rather than moving away from annual checkups completely, many providers are changing what they focus on during these appointments. Traditionally, an annual checkup focuses on physical assessments, including a patient's height, weight, and blood pressure. Providers will also listen to a patient's lungs and heart, check their reflexes, and conduct blood tests.

Now, some providers are choosing to focus more on patients' behavioral habits, such as exercise, sleep, and diet. For example, in 2020, One Medical redesigned its annual checkup to emphasize patients' personal health goals and lifestyle counseling rather than physical assessments.

According to Hemalee Patel, who heads One Medical's team focused on chronic disease management, paring down the physical exam has given the company's providers more time to talk with patients about behavioral changes or mental health.

"I could take a slew of vital signs and check reflexes and listen to your heart and you could leave that exam without any of the questions that you're hoping to get answered," Patel said.

Other organizations are also utilizing technology and pre-visit screenings to help providers take a different approach to preventive care.

For example, BellSant, a health technology company, has developed an app that allows patients to fill out health assessments and get blood tests. Doctors then use this information, along with data from patients' wearable devices, to determine which patients have urgent health needs and should be prioritized. For some patients, virtual care may be enough to take care of their needs.

"For an asymptomatic patient, it's not that they're never going to see a physician in person, they just might not be prioritized," said Lisa Lehmann, an associate professor of medicine at Harvard Medical School who sits on BellSant's advisory board of health experts. "When they do see a physician in person, that person is going to be armed with a lot more information about the patient."

However, even with some providers making these changes, many still support traditional annual exams. "[A] consistent, by-the-book physical exam with every patient allows [providers] to catch issues they might not otherwise, establishes a health baseline and reduces the chance of error," Janin writes.

According to Eve Glazier, a general internist and president of the multispecialty provider group UCLA Health Faculty Practice Group, a thorough physical examination can also help put patients at ease.

Mirza Rahman, a physician and president of the American College of Preventive Medicine, also noted that annual checkups become more beneficial as patients get older and are more likely to develop chronic conditions and take several different medications. (Janin, Wall Street Journal, 2/19)

Advanced practice providers (APPs) are on track to outnumber physicians in primary care across the United States. Discover three distinct strategies for deploying APPs to increase access to primary care in rural markets, improve chronic disease management, and test the viability of new business ideas.