Docs need training in cost awareness

Cost-consciousness training for residents will make doctors aware of the costs of the care they recommend.

PHILADELPIA – Healthcare costs are in a constant state of expansion yet physicians do not understand how much the care they recommend costs and they are not getting the training they should have so that they will understand those costs and what they can do to responsibly contain them, said Steve Weinberger, MD, executive vice president and CEO of the American College of Physicians, in an opinion piece published in September in the ACP’s Annals of Internal Medicine.

In his opinion piece, “Providing High-Value, Cost-Conscious Care: A Critical Seventh Competency for Physicians,” Weinberger argues that a new, seventh general competency for physicians emphasizing the importance of cost-consciousness and stewardship of resources should be created by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS).

“Physicians often develop their ‘habits’ of how they practice during their residency (or subspecialty fellowship) training. If we are going to have a long-term impact on healthcare costs, we need to incorporate cost consciousness, with reduction of overuse and misuse of care, as a priority within the training environment,” said Weinberger.

“Teaching residents about the costs involved with certain treatments is an important element of their education,” said Sunny Yoder, director of healthcare affairs, Association of American Medical Colleges.

“While there are challenges that come along with implementing this kind of training, the work that has been done so far has shown that it is highly beneficial to resident physicians in bringing them closer to the costs of healthcare and helping them to make the best care decisions for their patients.”

But having the ACGME elevate cost-consciousness training to a new competency level isn’t necessarily what needs to be done, said ACGME CEO Thomas Nasca, MD.

“The ACGME agrees that residents must demonstrate the ability to provide excellent clinical care in a cost efficient fashion,” said Nasca. “The Six Domains of Clinical Competency is a conceptual organizational framework for the key elements of competency of the physician. It is not a hierarchical organizational framework of what is important in medicine. The essential element of teaching and learning cost efficiency lies not in the ACGME calling it a ‘separate core clinical competency,’ but rather in its modeling by faculty in daily practice in teaching hospitals across the country.”

Raising cost consciousness to a new competency level signals to faculty a culture change in the training environment. “Changing the culture is not just a matter of providing educational resources for trainees – it also requires a broader change of practice from the faculty and other practicing clinicians within the training environment so that the trainees have appropriate best practice models that they can emulate,” said Weinberger.

Weinberger’s vision for a cost-consciousness training program includes a curriculum that educates residents about the costs of healthcare and covers the clinical situations where care is overused or misused; training application in a clinical setting; and some measurement to provide feedback to residents and allow for the development of a plan to improve performance.


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