This Month's News
Teaching tomorrow's doctors to be good stewards of health care resources
Physicians have a key leadership role to play in helping contain the increasing cost of health care in the United States. A recent survey of more than 2,500 physicians published in JAMA found that 85 percent of respondents agreed that "trying to contain costs is the responsibility of every physician."
At the same time, physicians place higher priority on their responsibility to individual patients regardless of cost concerns. In addition, one in four physicians surveyed reported being unaware of the costs of the tests/treatments they recommend.
These findings highlight the need for changes in medical education to ensure that medical students and resident/fellow physicians are made aware of the cost consequences of their clinical decisions.
One of the study's co-authors, Matthew K. Wynia, MD, discussed the importance of the survey vis-à-vis medical education. Dr. Wynia is director of physician and patient engagement for improving health outcomes at the AMA.
Q: What role should medical school and residency programs play in ensuring that today's trainees learn about stewardship?
A: Medical schools are playing a role by incorporating discussion of the social roles of the medical profession into their ethics and professionalism curriculae. Understanding how to teach and monitor professionalism, including the nuances of physician responsibilities to both individual patients and their communities, has been an important focus for several years, and is reflected in the program requirements of the Accreditation Council for Graduate Medical Education.
Q: What are the gaps in medical education related to health care cost, and how can we address these?
A: We have been less focused on teaching students (and physicians) what things cost, which is relevant information even if it shouldn't be the single determining factor in decision making. Many of the physicians in our survey said they know the costs of what they order, but a fair number did not—and prior research suggests that some of those who think they know what things cost actually don't.
Teaching about costs is tricky, however, since prices aren't fixed in stone—they often change over time and can depend on a large number of factors. I don't think medical school ought to turn into an Econ 400 seminar, but we do need to figure out how to teach students some of these general issues, and, given today's technology, there really ought to be easy ways to determine what something will cost, both for the patient and in total.
Q: Does what many trainees learn in academic medical centers (AMCs) reflect the real world (and fiscally responsible) practice of medicine?
Whether AMCs and the practice patterns we tend to model in AMCs are reflective of the "real world" is an interesting question, but it doesn't have a simple answer. More important, it might not be the best way to think about this issue—we should be asking whether what students are learning will help them be better practitioners. The "real world" is always changing. The differences between the "real world" and AMCs can reflect better or worse practices in both places, and ideally I'd like to teach students less about how to adopt current real (and often imperfect) practice patterns and more about our aims and hopes for a system that supports excellent practice, and how they can help us move toward that future.
The next meeting of the AMA Section on Medical Schools, set for Nov. 1 in Philadelphia, will include presentations on teaching physicians-in-training about stewardship. Also, check out a 2012 report by the AMA Council on Ethical and Judicial Affairs, Physician Stewardship of Health Care Resources, that outlines guidance for physicians on this topic.
In addition, a new Web-based video series seeks to help educate physicians on reducing wasteful practices. The Teaching Value Project, funded by the American Board of Internal Medicine Foundation, is an initiative of the nonprofit organization Costs of Care that brings together a multidisciplinary group of medical educators and health economists to teach care providers how to "deflate" medical bills.
Finally, the Alliance for Academic Internal Medicine and American College of Physicians have developed "a high value, cost-conscious care curriculum to help train internal medicine residents about how to avoid overuse and misuse of tests and treatments that do not improve outcomes and may cause harm."