Choosing Wisely / Good Stewardship

“Promoting Good Stewardship in Medicine” is a project of the 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 billion… More >>

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.”

  • Choosing Wisely Overview
  • Choosing Wisely Video Mini-Series
  • Principles Guiding Wise Choices:  The Responsibility of Physicians, Patients and the Health Care Community in Building a Sustainable System

Good Stewardship Related Articles in Journal and Medical Publications:

  • “Medical specialties to develop list of unnecessary procedures,”
    American Medical News, 1/9/2012
  • “Reducing Health Care Costs While Improving Care,”
    Health Affairs Blog, 11/9/2011
  • “Heeding advice on primary care ‘don’ts’ would save $6.7 billion annually,”
    American Medical News, 10/19/2011
  • “Unnecessary EKGs – The Heart of the Matter,”
    The Medical Professionalism Blog, 9/20/2011
  • “Tips for improving quality of primary care,”
    The Clinical Advisor, 7/15/2011
  • “How primary care physicians can improve health and lower costs,”, 6/2/2011
  • “US doctors identify top five activities that can be reduced,”
    British Medical Journal, 5/26/2011


Good Stewardship Related Media Coverage:

  • “Too many tests? Routine checks getting second look,”
    Associated Press, 1/23/2012
  • “Doctors estimate $6.8 billion in unnecessary medical tests,”
    Washington Post, 10/31/2011
  • “Awareness: Top 5 Don’ts for Doctors in Primary Care,”
    New York Times, 6/3/2011
  • “Advice from Doctors: Top 5 Ways to Lower Costs and Improve Care,”
    Time, 5/24/2011
  • “7 tests and treatments docs say you often don’t need,”
    Consumer Reports, 5/24/2011
  • “How to Improve Medical Care? Doctors’ Group Counts the Ways,”
    PBS News Hour, 5/23/2011
  • Overtreated:  Why Too Much Medicine is Making us Sicker and Poorer,
    by Shannon Brownlee
  • The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health
    and What You Can Do to Prevent It,
    by Rosemary Gibson


For more information about the project, contact NPA at