35% of orthopedic imaging costs stem from defensive medicine

Nearly 20% of imaging tests ordered by Pennsylvania orthopedic surgeons were for defensive purposes, according to a new study examining testing decisions of 72 surgeons.

The study, presented Feb. 16 at an American Academy of Orthopaedic Surgeons conference, found that defensive testing accounted for 35% of all imaging costs for surveyed surgeons. The most common defensive test ordered was an MRI, a more costly test that contributed to higher imaging expenses, the study said.

In the survey, members of the Pennsylvania Orthopaedic Society were asked to record a series of imaging decisions and note whether tests were for clinical care or defensive reasons. Test decisions were recorded for 2,068 patients.

The many lawsuits that hinge on claims that doctors should have ordered more diagnostic testing are probably the driving force behind the defensive tests, said John Flynn, MD, associate chief of orthopedic surgery at Children’s Hospital of Philadelphia. The hospital’s researchers conducted the study between 2009 and 2010.

Research showed veteran surgeons, more often than new physicians, requested the defensive tests.

“I thought that young doctors would come out of medical school immediately after training [and being] less confident … order more defensive tests,” Dr. Flynn said. “In fact, the opposite was true. We found that, in Pennsylvania at least, a surgeon’s defensive nature gets worse over time.”

The findings are similar to previous research. A study in the June 1, 2005, issue ofThe Journal of the American Medical Association showed that 93% of 824 Pennsylvania physicians practiced defensive medicine (

Additional research is needed on a variety of specialties to measure the total health care resources being lost to defensive medicine, Dr. Flynn said.


Josh Sandberg

Josh Sandberg is the President of Ortho Spine Partners and Partner for The De Angelis Group. He also serves as Co-Founder and Editor of OrthoSpineNews.

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