A patient called my office last month asking if she could “just get her labs done” without coming in. She wasn’t being difficult. She’d had the same panel run every year for a decade, felt fine, and didn’t see why a 15-minute conversation needed to precede a blood draw. Another patient, a few weeks later, arrived for his physical with a list of eleven things he wanted addressed: three medication refills, a knee that had been bothering him since spring, and a question about whether he should see a cardiologist, all stacked into a 20-minute slot because that’s when his “annual” landed on the calendar.
Both patients were telling me the same thing, in opposite ways: The annual physical, as most of us practice it, isn’t matching what people actually want or need from their doctor.
The problem with the “all-in-one” visit
The annual physical is a nearly century-old construct. Its earliest form emerged in the early 1900s from military and industrial entry exams, and was promoted largely by the life insurance industry, which saw regular examinations as a way to prevent morbidity before it became a financial liability. Morbidity, however, looked very different at the time, with infectious diseases like influenza, tuberculosis, and pneumonia leading the way. The American Medical Association (AMA) formally endorsed the practice in 1922. By the 1980s, though, that endorsement had been walked back considerably. The focus shifted from a single annual visit to periodic, risk-based screening, most of which was never meant to happen annually at all.
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That’s a meaningful shift, but it undersells the deeper issue: Research has repeatedly failed to show that the annual visit, on its own, improves outcomes. Reviews of large studies have found no measurable difference in mortality or illness between patients who get annual physicals and those who don’t, and some components, like lab and screening tests ordered on healthy, asymptomatic patients, produce enough false positives to cause real harm. The visit was never actually shown to do what we’ve long assumed it does.
What’s stuck around since then has as much to do with how visits get scheduled and reimbursed as it does with what’s clinically useful. Today, the annual physical is where screenings, paperwork, medication refills, and (increasingly) whatever else has been quietly piling up all get crammed into one appointment. That’s not a clinical decision. It’s a scheduling one, made because insurance and practice economics reward bundling more than they reward flexibility.
Unfortunately, the result shortchanges everyone in the room. Patients leave with follow-up questions unanswered because there wasn’t enough time to address them. Physicians leave having triaged rather than treated. Neither of those outcomes is what either person walked in hoping for.
What the annual visit could actually become
I’m not arguing the annual visit was accomplishing its original goal and just needs better logistics. It wasn’t, and the evidence backs that up. The honest question isn’t how we restore the annual physical: It’s what better use that protected time could serve instead.
Medicare already offers a partial answer. Beyond the one-time “Welcome to Medicare” physical, every year after that covers an Annual Wellness Visit, and notably, it doesn’t include a physical exam at all. It’s built around a different set of priorities: functional status, mood, cognitive screening, medication review, coordination across specialists, and a conversation about what the patient actually wants from their remaining years of health. It treats “wellness” as something broader than what shows up on a lab panel or screening test. That’s closer to what I think this time could be for: not a revival of the traditional exam, but a genuinely different kind of visit, built around a patient’s priorities instead of a checklist.
The patient-centricity gap
Here’s what strikes me most: Almost every other service industry has moved toward self-serve, on-demand access. Patients show us this preference constantly: through “Dr. Google,” retail clinics, and the growing comfort people have managing parts of their own care through an app or website. Yet, for a lot of meaningful preventive care, the front door is still the same: Book the annual physical, even for things your primary care physician doesn’t personally perform.
That’s a mismatch worth naming. The opportunity isn’t to eliminate the visit; it’s to decouple access to preventive care from a single once-a-year appointment. Even at its best, with technology signaling that a patient is “due” for their annual, the approach is hugely reactive. A screening that’s due shouldn’t need to wait for an annual slot to open up. A refill doesn’t need a full physical attached to it. When we free those tasks from the calendar constraint of “the annual,” patients get what they need faster, and what’s left on the calendar becomes time worth actually protecting.
What shouldn’t change
I want to be careful here, because this isn’t an argument for replacing the doctor-patient relationship with technology. The relationship-building function of the annual visit is not a nice-to-have. Rather, it’s where trust gets built, and trust is what makes everything else in primary care work. A screening result means little without a physician who knows the patient’s history and priorities well enough to interpret it in context.
The role I see for technology here is narrower and, I think, more honest: Give physicians back the time that administrative and transactional work currently consumes, so more of it can go toward the conversation that actually requires a physician in the room. Give the patient a more proactive, barrier-free way to address their preventive screening.
The question worth asking
My patient didn’t need to come in for her labs. She needed 15 protected minutes to talk about the year ahead. If we can separate those two things (routine preventive tasks handled continuously, and the annual visit reimagined as something closer to a Medicare Annual Wellness Visit), the checkup stops being a rushed, low-yield ritual and becomes something we’ve never actually had: a visit built around what a patient wants from their health, not around a checklist that was never shown to help.
That’s worth building toward. If all the periodic screenings and preventive gaps were already closed before a patient ever sat down with their doctor, what could we do with that time instead?
Acey Albert is an internal medicine and pediatric physician.
