People want the best care when they head to the doctor’s office, but they also don’t want to go bankrupt. As the brokers of medical tests, physicians are critical to keeping costs low, so it is surprising that up to 85 percent of new MDs are not learning about cost-conscious care.

That’s according to a recent survey of American internal medicine residency programs conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania and the Mayo Clinic.

Given many primary physicians complete internal medicine residencies, the trend has substantial implications toward the future of reducing costs for unnecessary care.

Nearly $750 billion is spent annually on wasted care — or treatments that could be avoided without affecting quality of care. This accounts for one out of three dollars dished out for medicine.

Meanwhile, studies have found that merely teaching veteran doctors about the prices of their medical procedures can substantially curb wasted care.

“Teaching new physicians to practice high-value, cost-conscious care has been recognized as a national priority," said first author Dr. Mitesh Patel, a physician at Philadelphia VA Medical Center and scholar at Perelman.

Of the 370 directors of internal medicine programs surveyed, only 15 percent in the U.S. and abroad said their schools taught cost-conscious care. Over half — 52 percent — cited that their faculty did not consistently role model cost saving practices. Two out of three directors said their residents did not have access to information of the costs of tests and procedure that they ordered.

West Coast schools were twice as likely to have formal curricula of cost-saving relative to the South and Midwest, and six times as likely compared to the Northeast.

But some positives did surface.

“There is hope in that about 50 percent of programs stated they were working on it,” Patel said. Plus, Medicare committed $3.5 billion in 2010 to funding cost-conscious classes in residency programs.

"There's a lot of work ahead as we look for ways not only to expand adoption of these curricula, but also to find ways to better standardize teaching and assessments methods that can be better implemented during residency training," said Patel. "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."

 

Source: Patel MS, Reed DA, Loertscher L, McDonald FS, Arora VM. Teaching Residents to Provide Cost-Conscious Care: A National Survey of Residency Program Directors. JAMA Internal Medicine. 2013.