title: Self-Reported Rationing Behavior Among US Physicians: A National Survey.
abstract: Rationing is a controversial topic among US physicians. Understanding their attitudes and behaviors around rationing may be essential to a more open and sensible professional discourse on this important but controversial topic.
  
  
  
  To describe rationing behavior and associated factors among US physicians.
  
  
  
  Survey mailed to US physicians in 2012 to evaluate self-reported rationing behavior and variables related to this behavior.
  
  
  
  US physicians across a full spectrum of practice settings.
  
  
  
  A total of 2541 respondents, representing 65.6 % of the original mailing list of 3872 US addresses.
  
  
  
  The study was a cross-sectional analysis of physician attitudes and self-reported behaviors, with neutral language representations of the behaviors as well as an embedded experiment to test the influence of the word "ration" on perceived responsibility.
  
  
  
  Overall percentage of respondents reporting rationing behavior in various contexts and assessment of attitudes toward rationing.
  
  
  
  In total, 1348 respondents (53.1 %) reported having personally refrained within the past 6 months from using specific clinical services that would have provided the best patient care, because of health system cost. Prescription drugs (n = 1073 [48.3 %]) and magnetic resonance imaging (n = 922 [44.5 %]) were most frequently rationed. Surgical and procedural specialists were less likely to report rationing behavior (adjusted odds ratio [OR] [95 % CI], 0.8 [0.9-0.9] and 0.5 [0.4-0.6], respectively) compared to primary care. Compared with small or solo practices, those in medical school settings reported less rationing (adjusted OR [95 % CI], 0.4 [0.2-0.7]). Physicians who self-identified as very or somewhat liberal were significantly less likely to report rationing (adjusted OR [95 % CI], 0.7 [0.6-0.9]) than those self-reporting being very or somewhat conservative. A more positive opinion about rationing tended to align with greater odds of rationing.
  
  
  
  More than one-half of respondents engaged in behavior consistent with rationing. Practicing physicians in specific subgroups were more likely to report rationing behavior.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA. sheeler.robert@mayo.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sheeler
authors.affiliation: University of Iowa, Iowa, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Mundell
authors.affiliation: Institute for Ethics, History, and Humanities, University of Geneva, Geneva, Switzerland.
authors.forename: Samia A
authors.initials: SA
authors.lastname: Hurst
authors.affiliation: Division of General Internal Medicine, Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
authors.forename: Susan Dorr
authors.initials: SD
authors.lastname: Goold
authors.affiliation: Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.|Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Bjorg
authors.initials: B
authors.lastname: Thorsteinsdottir
authors.affiliation: Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.|Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.affiliation: Department of Bioethics, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000191:economics / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: cost; physician attitudes; physician behavior; rationing