Residency Programs Fail to Practice Cost-Conscious Care

The high cost of health care is a major issue in the United States—one that is falling on physicians to remedy with cost-conscious care. However, few residency programs are addressing costs of care, according to new research.

A study found that less than 15% of internal medicine residency programs have a formal curriculum addressing the cost of care. The lead author on the research, published in JAMA Internal Medicine, was Mitesh S. Patel, MD, MBA, a physician at the Philadelphia VA Medical Center and Robert Wood Johnson Clinical Scholar at the Perelman School of Medicine at the University of Pennsylvania.

“Teaching new physicians to practice high-value, cost-conscious care has been recognized as a national priority,” Patel said in a statement. “In this study, we evaluated whether formal curricula were in fact being adopted by internal medicine residency programs. While we found that this was not the case in the overwhelming majority of internal medicine residency programs, there is hope in that about 50 percent of programs stated they were working on it.”

According to the authors, health care costs account for nearly $3 trillion annually and 30% of that is actually care that could have been avoided without affecting quality. Residents might be the best targets for learning cost-conscious care.

“Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians,” Patel and colleagues wrote.

In a recent interview with WRVO, Patel said that greater transparency around costs of treatments could make a difference. This wouldn’t just benefit patients, but doctors too. Less than a third of physicians have access to information on costs in the clinical setting, according to Patel.

However, there is hope. Programs in the western US, those that were university-based and those with more residency positions were more likely to adopt a cost-conscious care curriculum.

While 85% of programs surveyed said the responsibility to curtail rising health care costs lies with graduate medical education, they don’t practice what they believe. Slightly less than half of programs said that the majority of faculty role model cost-conscious care and just a third said residents have access to the costs of the tests and procedures they order.

“Early adopters of cost-conscious care curricula should look for ways to further its efforts by studying its impact on physician training and patient care,” Patel said in a statement.