There are six things that young doctors need to learn during their training period as interns and residents, starting with basics like acquiring “medical knowledge” and honing their “patient care” skills. The Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties make sure that doctors-in-training master these general competencies before they complete their residency training.
One more item should be added to this list, according to Dr. Steven E. Weinberger, chief executive of the American College of Physicians: how to provide high-quality medical care without breaking the bank.
It’s certainly no secret that medical costs are rising out of control. In fact, the medical system already wastes as much as $700 billion a year on unnecessary tests, hospital visits that could have been prevented and other needless spending, according to the Institute of Medicine. That amounts to 30 cents of every healthcare dollar.
In an essay published in Tuesday’s edition of Annals of Internal Medicine, Weinberger writes that the problem is the No. 1 issue in medicine but that medical trainees have pretty much no idea how much it costs to do the tests they order or fill the prescriptions they write. Indeed, interns and residents are more likely to get in trouble for ordering too few tests rather than too many:
“In the typical training environment, residents are encouraged to do thorough diagnostic work-ups, and criticism from faculty is more often related to failure to order a test than to overuse of testing,” he writes. “The question posed on teaching rounds is typically, ‘Why didn’t you order test X?’ rather than, ‘Why did you order test X, and what are you going to do with the information?’”
Residency is the ideal time to influence young doctors and instill in them the importance of keeping costs in mind to put scarce resources to the best use, Weinberger writes. Once they finish residency, their habits are already in place and they’re much less likely to be influenced by role models.
Unfortunately, past efforts to teach residents to be cost-conscious haven’t worked very well. In one residency program at a “major academic medical center,” weekly lectures and regular audits were not enough to reduce the cost of care ordered by residents, he notes.
But that doesn’t mean it’s time to give up. “New methods must be tried,” he writes:
“Now that cost control in health care has reached a crisis level, it is essential that we … change the culture of the training environment with regard to health care costs. Residents … must be thoughtful in ordering diagnostic tests, avoiding the overuse and misuse of imaging studies and laboratory tests that have become rampant in health care. They must avoid duplication of studies and must be conscious of opportunities to prevent avoidable hospitalizations or readmissions. In short, they must become part of the solution to control health care costs.”