Growing concern about rising costs and potential harms of medical care has stimulated interest in assessing physicians’ ability to minimize the provision of unnecessary care. Conclusions: Regardless of overall medical knowledge, internists trained at programs in hospital referral regions with lower-intensity medical practice are more likely to recognize when conservative management is appropriate. These internists remain capable of choosing an aggressive approach when indicated.

Brenda E. Sirovich, MD, MS; Rebecca S. Lipner, PhD; Mary Johnston, MS; Eric S. Holmboe,MD