Patients of physicians who score higher on ABIM quarterly assessments less likely to get low-value tests and treatments

Findings point to importance of physician knowledge and judgment in reducing wasteful care and spending

Philadelphia, July 13, 2026 - Patients whose physicians scored higher in the first year of the American Board of Internal Medicine's (ABIM) Internal Medicine Longitudinal Knowledge Assessment (LKA^®) were significantly less likely to receive low-value healthcare services, which cumulatively cost the U.S. healthcare system an estimated $100 billion each year. The authors say the findings, published today in JAMA Internal Medicine, highlight an association between greater physician knowledge and lower use of tests and interventions that provide little to no benefit to patients.

Key findings revealed:

• Patients cared for by physicians in the top LKA performance quartile compared to the bottom quartile were nearly 8% less likely to receive any of 25 primary care low-value services (28.6% compared to 31% of their patients).
• Significant reductions in patients receiving unnecessary diagnostic/preventive testing (a 16% lower likelihood, with 8.7% of those cared for by the highest-scoring physicians receiving those services compared to 10.4% of patients who saw the lowest-scoring doctors), cancer screening (11% lower likelihood; 12.3% compared to 13.8% of patients) and imaging (4% lower likelihood; 13.2% compared to 13.8% of patients) services.

The findings were drawn from data on nearly 900,000 Medicare beneficiaries cared for by 7,089 outpatient general internists who first enrolled in the Internal Medicine LKA in 2022 or 2023. Results suggest that if all general internists utilized low-value services at the rate observed among the top-scoring LKA participants, 80,000 fewer Medicare fee-for-service beneficiaries would receive any of these services each year. The differences observed were driven largely by triiodothyronine (T3) testing among patients with hypothyroidism and prostate-specific antigen (PSA) screening for men 75 years of age and older-two of the costliest low-value tests in the U.S., both of which rarely lead to actionable findings. PSA testing for older patients, in particular, often leads to a cascade of additional testing that can be both costly and invasive.

"These findings suggest an important question for further study: If those who scored lower in the first year increase their knowledge, and therefore their score, over time, will they then order fewer low-value services?" said lead author Jonathan L. Vandergrift, MS, a Senior Health Services Researcher at ABIM. "We hope to learn more about whether the healthcare system may cut unnecessary costs through education and assessments that steer clinicians toward higher-value care that provides the most benefit to patients."

In the future, the authors hope to examine the degree to which LKA participation over the full five-year cycle might result in further reductions in the use of low-value care and the cost savings associated with those practice changes.

The study found use of these services was common across all physician knowledge levels, with approximately 30% of patients receiving at least one type of low-value modality no matter how their doctor scored on their LKA, including among physicians with the highest scores in their first year. The study assessed use of 25 different services considered to be low-value care, which also include vitamin D testing without a specific reason, carotid artery disease screening for patients without symptoms, homocysteine testing in cardiovascular disease and head imaging for uncomplicated headache.

More than 92,000 physicians currently participate in the LKA, an assessment pathway launched in 2022 that is available to most ABIM-certified physicians along with the option to take a one-day, proctored exam in a testing center. Physicians who choose the LKA receive 30 questions every quarter in five-year cycles along with explanations and journal citations after each question. At the end of the cycle, they receive a final pass-or-fail result for the LKA.

The findings add a new dimension to prior research showing that patients whose physicians demonstrate more medical knowledge and judgment through continuing certification have a better prognosis on a host of outcomes, including multiple studies that demonstrated lower readmission rates and lower risk of death.

"This is an extremely rigorous analysis of the association between physicians' clinical knowledge and judgment as measured by a standardized exam, and an outcome that is important to both patients and healthcare systems," said senior author Bradley Gray, Ph.D., ABIM's Principal Health Services Researcher. "Though health systems, policymakers, insurers and individual physicians all play a role in trimming costs of care, we are encouraged to see that physician expertise may be a powerful lever in helping reduce the use of unnecessary and often costly tests and treatments."

Additional study authors include Bruce E. Landon, MD, MBA, MSc, a Professor of Healthcare Policy at Harvard Medical School and Professor of Medicine at the Beth Israel Deaconess Medical Center, and Weifeng Weng, Ph.D., Director of Research and Data Intelligence at ABIM.

Editor's note: Dr. Landon has received consulting fees from ABIM for research assistance.

Photo Caption: Use of imaging studies for uncomplicated headaches are among the 25 types of low-value care examined in the new study published in JAMA Internal Medicine.

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About the American Board of Internal Medicine

Since its founding in 1936, certification by the American Board of Internal Medicine (ABIM) has stood for the highest standard in internal medicine and its 20 subspecialties. Nearly 300,000 physicians are certified by ABIM, representing more than a quarter of all doctors in the United States. Patients whose doctors demonstrate more medical knowledge and judgment through ABIM certification and Maintenance of Certification have better prognoses on a host of outcomes. Visit the ABIM Blog to learn more and follow ABIM on LinkedIn and Instagram. ABIM is a Member Board of the American Board of Medical Specialties.

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