Preventive MedicineWellness

EXECUTIVE PHYSICALS: Are they worth the money?

Most large medical centers like the Mayo, Ochsner, and Cleveland Clinics and medical school hospitals like Massachusetts General at Harvard and Stanford University Medical Center offer “Executive Physicals.” These are the comprehensive, 1-2 day extensive evaluations used by corporate leaders and financially-affluent people to assess their health status. The exams are very involved and depending on what testing is done, can cost as much as $10,000.

Most such exams include screenings for breast and cervical (women) cancer, colon cancer, and prostate cancer (men). Extensive blood testing, vision, and hearing screenings, and tests of cardiovascular disease (EKG, stress testing, carotid and abdominal ultrasounds, chest x-ray, and coronary calcium scores) are done commonly. Some include bone density testing and pulmonary (lung) function tests, and depending on how much the individual wants to spend, these “physicals” may include even a total body CT scan. No investigative stone is unturned.

Of course these “physicals” are totally voluntary and are rarely covered by health insurance. The cost is borne by the individual (or his employer) who is seeking peace of mind in knowing he has done everything he can to assure his health is good and that nothing worrisome is going undetected. In some cases, businesses offer these exams as a perk to high level personnel as part of their compensation. Most willingly take advantage of the offer and are evaluated every 1-2 years.

When I was in practice, I did what I called “complete physicals”(CPE’s) on 2-4 patients every day. My CPE’s were nowhere near as comprehensive as large health care organizations provide, but I had a large number of folks who annually followed this practice. I think the popularity of CPE’s has declined, however, because of the unreimbursed expense of the tests and the persistent admonition that they are a waste of time (and money).

The United States Preventative Services Task Force (USPSTF) is an independent agency which grades the pertinence and value of 102 categories of medical tests and screening procedures. Annually, it publishes recommendations about these categories as guidelines for physicians and consumers. It is a very influential organization. It’s positions on many topics are controversial at the very least and at worst, misleading. Most of their recommendations are based on cost-effectiveness; is XYZ test worth its cost and is there scientific evidence to justify widespread use in screening individuals?

The USPSTF hasn’t specifically come out against executive physicals, but many of the exam components have been rated “D” (recommend against) or “I” (insufficient evidence to recommend) by the agency. In other words, they find evidence lacking to prove that many of the components of such exams are cost effective and save lives. In fact, the two most commonly included services, hearing exam and EKG, were graded “I” by the USPSTF—there was no evidence of value to recommend them. Some tests, like PAP testing and CT screening for lung cancer, were graded “A” (recommended). Overall, though, the USPSTP finds executive physicals hard to support and promote.

A recent “Letter to the Editor” in JAMA by physicians from Memorial Sloan Kettering Cancer Center argued against executive physicals and suggested they promoted “excessive, low-value care.” These “highly ranked academic medical centers are influential and respected…and inclusion of services in executive physicals…may be interpreted as endorsement of their importance…they help academic medical centers generate income and extend influence..”

How dare these institutions make a profit! How dare they recommend tests that the USPSTF doesn’t recommend! How dare they tell people, especially those with the means, they shouldn’t spend money on an executive physical! If a company wants its executives to be in tip-top health, so be it. Let them pay for it. Sure, this is giving execs a privilege that hourly workers don’t receive, but since life isn’t fair or equal, if someone gets peace of mind from a physical and can afford it, I say they should have that opportunity. The USPSTF can recommend against them all they want, but for those who gain reassurance, executive physicals are worth the money. If you like filet mignon more than hamburger, and you can afford it, there’s nothing saying you can’t have it.

The real concern is whether or not executive physicals save or lengthen lives. That debate has gone on for decades, and both sides have strong advocates. I have always been in favor of preventive physicals even though I know they aren’t perfect. But getting people in to the doctor, for whatever reason, talking with them, examining them, and doing a few tests has to be worth something.

Reference: Korenstein D, Mamoor M, Bach PB. Preventive Services Offered in Executive Physicals at Top-Ranked Hospitals JAMA 2019 Sep 17;322(11):1101-1102.

Related Articles

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Back to top button