“Promoting Good Stewardship in Medicine” is a project of the npalliance.org inspired by the Physician Charter on Professionalism and funded in 2009 by the American Board of Internal Medicine Foundation to identify five steps primary care physicians could take in their daily practices to achieve the highest goals of doctors and patients alike: excellent care that we can afford together.

The NPA Good Stewardship Project, under the leadership of Clinical Practice Project Director Dr. Stephen R. Smith, engaged three working groups with five physicians in each specialty: Family Medicine, Internal Medicine and Pediatrics. The project working groups used comparative effectiveness studies to determine the following lists of “5 Things You Can Do in Your Practice” to provide excellent patient care while appropriately conserving health care resources in the fields of internal medicine, family medicine, and pediatrics:

May 2011, The Top 5 Lists in Primary Care: Meeting the Responsibility of Professionalism,” published in the Archives of Internal Medicine  (Arch Intern Med. 2011;171(15):1385-1390)

Describing the results of the NPA’s Promoting Good Stewardship in Clinical Practice project, inspired by the ABIM Foundation’s Physician Charter on Professionalism, this article explains how physician panels in the primary care specialties of family medicine, internal medicine, and pediatrics identified common clinical activities that could lead to higher quality care and better use of finite clinical resources.  More>>

September 2011, NPA Good Stewarship Project Awarded 2nd Grant
Call for Demonstration Projects
The American Board of Internal Medicine Foundation awarded a second grant to the NPA to carry on its Good Stewardship project.

The first phase of the project enabled the NPA to develop a “Top 5″ list of evidence-based, quality-improving, resource-sparing activities that could be incorporated into the routine practice of primary care providers in family medicine, internal medicine, and pediatrics.  The second phase of the project will provide proof of concept by actually implementing the “Top 5” recommendations in actual practice.  More>>

October 2011, “Top 5” Lists Top $5 Billion in Potential Savings published in online article in the Archives of Internal Medicine by Drs. Salomeh Keyhani, Minal S. Kale, Tara F. Bishop, and Alex D. Federman. (Arch Intern Med 2011;171:1856-1858.)

According to the authors adoption of the Top 5 Lists in Primary Care generated by the National Physicians Alliance Good Stewardship Project would generate an annual savings of $6.76 billionMore >>

November 2011, Demonstration Practices Selected for Good Stewardship Project
Three practices have been selected to serve as demonstration practices for the
Good Stewardship project of the NPA
.  The selected practices have committed
themselves to putting the “Top 5” lists in primary care into practice.

The selected practices are the Long Beach Family Medicine Residency Program, the Yale Primary Care Center, and the University of Washington Family Medicine Residency Program. The residents and faculty of each of the programs will participate in training sessions, followed by a 6-month period in which the “Top 5” recommendations in their respective specialties will be put into practice.  The training sessions will focus on a 5-step approach that physicians can follow when communicating with patients who may be resistant to following the plan of care recommended in the “Top 5” lists.   More>>



December 2011, NPA Good Stewardship Project Top 5 List Provide Successful Model for the ABIM Foundation’s Choosing Wisely CampaignTM –a campaign to identify overuse or misuse of tests or procedures.”

Good Stewardship Related Articles in Journal and Medical Publications:


Good Stewardship Related Media Coverage:


For more information about the project, contact NPA at npa@npalliance.org