Operant Conditioning and the Practice of Defensive Medicine

Abstract

n the United States, the enormous burden of health care expenditure on the national budget and the role of physiI cians in controlling these costs are under scrutiny. The Centers for Medicare and Medicaid Services estimates that national health care expenditure in 2014 accounted for 17.5% of the gross domestic product in the United States, reaching almost $3 trillion; although all aspects of medicine saw cost increases, the growth rate increase in expenditure on physician and clinical services nearly doubled. This situation dominates every budgetary discussion at federal, state, and local municipality levels. Cost reductions are a priority, as is a careful analysis of physician practices and resource utilization. Most, but not all, practicing physicians mature through a process of residency training and board certification. In the United States, national boards, such as the American Board of Neurological Surgery, assiduously ensure a high level and uniformity of physician competency. Certification is an arduous process, and it requires demonstration of knowledge, competency, and careful judgment; it provides a measure of physician excellence. However, the American Board of Neurological Surgery and other similar bodies have little control over the utilization of resources by physicians once they enter practice.