Executive physicals: what you are paying for, and what is missing

What the 2019 study found

Researchers looked at the executive physical packages offered by hospitals on U.S. News and World Report's best hospitals list and compared their contents with recommendations from the U.S. Preventive Services Task Force (USPSTF). The research letter was published in JAMA in September 2019.

Packages typically cost between about $1,700 and $10,000. Many included services that the USPSTF does not recommend for people at low risk, such as a resting or exercise ECG, and none included low-dose CT screening for lung cancer, which is recommended for eligible adults.

This does not mean the physicians running those programs are doing anything wrong. Packages are designed to feel comprehensive. But more tests are not automatically better care, and some can lead you down a path of follow-up procedures you did not need.

Why a low-value test can still cost you

The USPSTF recommends against screening with resting or exercise ECG in adults at low cardiovascular risk who have no symptoms. Its reasoning is that the potential harms are equal to or greater than the benefits. A borderline result can lead to more testing, anxiety and sometimes invasive procedures, with little chance of preventing a heart attack.

Even if your employer pays, your time, your stress and the risk of downstream procedures are real. The goal is to get the right tests for your risk, not the most tests.

What an executive physical does well

• A thorough, unhurried physical exam, which an online service cannot provide
• Imaging and procedures when they are indicated, such as a coronary calcium score or colonoscopy
• Coordination of several specialists in one day, saving you weeks of scheduling
• Skin checks, hearing and vision testing, and other hands-on assessments
• A relationship with a physician who knows your history

What one day a year cannot do

Most of the risk factors that matter in midlife, including blood pressure, weight, blood sugar, cholesterol, sleep and alcohol intake, move gradually and respond to treatment over weeks to months. A single annual snapshot cannot tell you whether a change you made is working.

Borderline results are often met with 'let's recheck next year.' That may be reasonable sometimes, but often a number can be acted on and retested in three months. Executive physicals also tend to focus on screening rather than ongoing management of issues like perimenopause, low testosterone or weight.

Questions to ask before you book

• Which tests are included, and which are based on my personal risk rather than a fixed package?
• Is lung cancer screening offered if I meet the criteria (ages 50 to 80, 20 pack-year history, currently smoking or quit within 15 years)?
• Will you measure apoB and lipoprotein(a), not just a standard cholesterol panel?
• Do you screen for sleep apnea?
• Who follows up with me on abnormal results, and how quickly?
• Will my results be shared with my own primary care doctor?

Getting more from the day itself

A little preparation makes an executive physical more useful. Bring a list of current medicines and supplements, any symptoms you have been putting off, and family history details such as early heart disease, cancers and the age at which relatives were diagnosed. If you track blood pressure, sleep or heart rate at home, bring a summary rather than raw data.

Afterward, ask for copies of all results, including the actual values rather than just 'normal.' Those numbers become your baseline. Without them, it is hard for any clinician, including your own primary care doctor, to see whether you are trending in the right direction next year.

Using both

For many busy people, a sensible approach is to use an executive physical or primary care visit for the exam, imaging and age-appropriate cancer screening, and an ongoing service for the measurement and treatment in between.

HealifyMD fits that second role. A licensed clinician can order lab work, review it with you online, treat what is appropriate, such as weight, menopause symptoms or confirmed low testosterone, and set a date to remeasure. We do not perform exams or imaging and we will tell you when you need them.