Cost-Conscious Care Training: A Missing Ingredient in Many Residency Programs
Given near-universal concern over rising health care costs, are new physicians being taught to keep costs in check?
Not enough of them, according to a research letter published in JAMA Internal Medicine in December. Lead author Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, and his research team analyzed survey responses from nearly 300 U.S. internal medicine residency programs. They found that fewer than 15 percent have curricula designed to teach residents to be more cost-conscious.
“Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians,” Patel and his team wrote. Among 295 programs that responded to a questionnaire on cost-conscious care in a 2012 survey from the Association of Program Directors in Internal Medicine, 14.9 percent indicated that they had a formal curriculum in cost-conscious care; another 49.8 percent responded that they did not, but were working on it.
Among all programs surveyed, nearly 85 percent agreed that graduate medical education has a responsibility to help contain rising health care costs. But only 57.5 percent indicated that the majority of their faculty were consistent role models for cost-conscious care, and only 33.2 percent indicated that residents had access to information on the costs of the tests and procedures they order.
The research team noted that several models for training residents in high-value, cost-conscious care have been proposed. If graduate medical education “is going to play a significant role in curtailing the rising cost of health care,” the researchers wrote, “it must leverage such models to develop more robust teaching and assessment methods and provide faculty development.”
Read the research letter in JAMA Internal Medicine.
Read coverage of the research in FierceHealthcare.
Read a post Patel wrote for the RWJF Human Capital Blog on using a “VALUE framework” in medical education.