Is your annual physical a waste of time?
A growing number of physicians say the value of a yearly physical depends in part on your age and health history, and that some young, healthy patients can afford to skip it. Some studies have suggested that the annual visits aren’t doing much to improve our long-term health, and a growing shortage of primary-care doctors can drag out appointment wait times.
Plenty of doctors still recommend an annual checkup, but more are changing what they do in that appointment, focusing on habits such as sleep, exercise and diet with less poking and prodding in a physical exam.
An increased focus on lifestyle reflects the recognition that standard once-a-year physicals haven’t managed to stop the rise in chronic diseases such as obesity and Type 2 diabetes, which now affect roughly 42% and 10% of American adults respectively, according to Centers for Disease Control and Prevention data.
“There are parts of what we do in a yearly exam that are valuable,” says Dr. Yul Ejnes, a primary-care doctor who sits on the board of the American Board of Internal Medicine. “It’s just that the delivery method that’s been used for decades may not be as effective as we think it is.”
Other than managing blood pressure, assessing body-mass index, and screening for cervical cancer in women, regular physical exams in asymptomatic patients haven’t been shown to improve health, says the latest recommendation from the Society of General Internal Medicine, a professional group.
A review in the medical journal JAMA found that overall, checkups weren’t linked to lower mortality rates or improvements in cardiovascular problems, although they were linked to better catching and treating of chronic disease.
Another analysis found that annual physical exams were associated with lower mortality risk among healthy adults compared with those who didn’t attend annual physicals.
If you’re at high risk of chronic disease, worried about your health or rarely see your doctor, you’re likely to benefit from annual checkups, according to the SGIM. Most doctors still recommend patients come in for a yearly visit—which often includes a thorough physical exam—especially as they move into midlife and beyond.
Doctors recommend that you follow guidelines for preventive screenings regardless of whether you get annual physical exams. Even young, healthy patients aren’t immune to health risks, such as rising rates of some cancers.
Rethinking the yearly visit
In 2022, roughly 78% of adults reported seeing the doctor in the past year for a wellness visit, according to the CDC, including 68% of adults under 45.
Traditionally, the annual physical involves a head-to-toe assessment that often includes listening to a patient’s lungs and heart; recording their weight, height and blood pressure; and checking reflexes and blood tests.
One Medical, a membership-based primary-care practice with offices around the country, redesigned its annual checkup in 2020 to emphasize patients’ personal health goals and lifestyle counseling rather than strictly a physical assessment. It starts with patients filling out a questionnaire in advance that covers topics such as sleep and exercise habits, alongside family history of illness.
Generally, that means patients can keep their clothes on during the “Live Well” visit, says Dr. Hemalee Patel, who heads a team focused on chronic-disease management at One Medical. The physical exam is pared down compared to a traditional checkup—Patel says she doesn’t always check reflexes or look in a patient’s ears, for example. That allows more time for talking through topics such as mental health and behavioral changes, she says.
“I could take a slew of vital signs and check reflexes and listen to your heart and you could leave that exam without any of the questions that you’re hoping to get answered,” she says.
Regardless of how young or healthy they are, patients are still recommended to come in annually, she says. Roughly a quarter of the company’s members came in for the annual visit in the past year.
Previsit screening
Other approaches lean on technology and previsit screening.
BellSant, a health technology company, is hoping to sell doctors on a new preventive care approach.
Rather than patients scheduling an annual physical, they would fill out health assessments on an app and get a blood test. Their doctors would use that information, plus data from users’ wearable devices, to give priority to patients with more urgent health needs.
For some patients, virtual care might suffice, says Dr. Lisa Lehmann, a physician on BellSant’s advisory board of about 20 health experts.
“For an asymptomatic patient, it’s not that they’re never going to see a physician in person, they just might not be prioritized,” says Lehmann, who is also an associate professor of medicine at Harvard Medical School. “When they do see a physician in person, that person is going to be armed with a lot more information about the patient.”
Supporters of the traditional approach say conducting a consistent, by-the-book physical exam with every patient allows them to catch issues they might not otherwise, establishes a health baseline and reduces the chance of error. A thorough examination also helps put many patients at ease, says Dr. Eve M. Glazier, a general internist and president of the multispecialty provider group UCLA Health Faculty Practice Group.
The traditional annual physical becomes more useful as patients age and are more likely to develop chronic conditions and take multiple medications, says Dr. Mirza Rahman, physician and president of the American College of Preventive Medicine.
Not enough doctors
Spending less time on physicals for young, healthy people could ease a strain on primary-care doctors, some say. The Association of American Medical Colleges estimates there will be as many as 48,000 too few primary-care physicians practicing in the U.S. by 2034.
In some ways, patients are already reinventing the annual physical themselves. More are visiting retail clinics and urgent-care centers that rely more heavily on nurse practitioners and physician assistants to provide primary care.
Katherine Morgan, a 30-year-old bookstore owner in Portland, Ore., says she called several primary-care clinics in early December before she finally found one with an opening in March. In January, she decided to visit a local urgent care, which ultimately diagnosed her with Type 2 diabetes.
“This shouldn’t be as frustrating as it is, just try to get an appointment within the same year,” says Morgan.