How faculty, students can improve care while saving money

Medical school faculty could do more to cultivate a new generation of physicians focused on containing health care costs, a new research report finds. It outlines the opportunities and obstacles on the road to greater cost consciousness.

Nine out of 10 students agree that physicians have a role in containing costs as well as limiting unnecessary tests and treatments for the sake of patients and society, according to a report in Academic Medicine. But it found that faculty and physicians must lead the way, modeling cost-conscious behavior and making clear it has a place in clinical practice.

“[Students] recognize that excess testing and unnecessary procedures threaten patient safety and that spending more money on health care does not necessarily lead to better health outcomes,” the report’s authors said.

The findings are based on a survey of 3,395 students at 10 medical schools, all of them members of the AMA Accelerating Change in Medical Education Consortium.

The authors outlined the severity of the cost-control challenge. Up to 30 percent of health care spending is wasted, largely because of unnecessary services, they said. Wasted care exposes patients to added risk, burdens them with more out-of-pocket costs and displaces the care they actually need. Medical education must enlist faculty and future physicians in the campaign to control costs, the authors found.

However, most students reported seeing role models that displayed “wasteful” behaviors, such as ordering numerous tests all at once rather than waiting for the results of initial tests or repeating tests rather than trying to get the results of recently performed tests.

Students who took the survey identified other barriers to cost consciousness:

• More than one-half of students thought ordering fewer tests would raise the risk of medical liability litigation.
• One-half of students said that ordering a test is easier than explaining to a patient why it is unnecessary.
• Only 11 percent of students said it is easy to determine how much tests and procedures cost.
• Many students said the organizational culture makes it hard to address the cost of care.

The authors suggested students training in institutions that provide few cost-conscious role models could be “imprinted” with a culture of higher spending. To prevent that they said educators must both teach and model cost consciousness. They called on medical schools to:

• Encourage faculty to understand that any action observed by learners is role modeling.
• Strategically expose students to physicians who are known to model high-value, cost-conscious care.
• Pursue cost savings in ways that are visible to students, praise them for proposing cost-effective plans of care and encourage them to include value in their case presentations.
• Encourage cost-conscious role modeling in high-spending environments.
• Introduce concepts of stewardship and systems thinking early, equip student with strategies to overcome barriers to cost-conscious care, and encourage discussion about whether the overall learning environment reinforces what is taught in the formal curricula.

The campaign for cost-conscious care could well pay off in the long run for patients, medical systems and society, the report’s authors concluded: “Efforts to enhance physician role modeling in undergraduate medical education may play an important role in preparing the next generation of physicians to address health care costs.”

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