Why Not Educate Med Students About The Cost Of Care?

Dr. Neel Shah, an advocate for more transparency, value and rationality in the medical system, makes a persuasive case here that medical students are in dire need of instruction on how to think about the cost of medical care.

Dr. Neel Shah

Dr. Neel Shah

Writing for the blog “Wing of Zock” (if you’re not a doctor and don’t get the reference, click here) Shah points out that these days, physicians are compelled to consider costs through a variety of incentives, “top-down from policymakers who want more accountability in how we are using resources; bottom-up from patients who want more transparency in how we are spending their money.”

But, writes Shah, a chief resident in obstetrics and gynecology at Massachusetts General Hospital and Brigham & Women’s Hospital and the founder and executive director of the nonprofit Costs of Care, incentives are not enough. “We also need to give physicians the skills, training, and support they need to consider costs responsibly.” He continues:

Most physicians learn very little about health care costs during their training; in many cases, they are specifically taught not to consider costs while caring for patients. The traditional concern is that thinking about costs automatically means sacrificing the ingrained physician ethos to do everything possible for our patients. At the same time, many existing teaching methods may exacerbate the problem by embedding a “hidden curriculum,” leading to costlier diagnostic workups and rewards overutilization.

On the wards, our educational conferences focus on rare cases and our teaching emphasizes exhaustive differentials. We chastise sins of omission frequently and those of commission rarely. In the pre-clinical years, most schools don’t provide in-depth instruction in health economics, payment systems, or cost effectiveness.

What is the path forward? How can we teach cost-conscious care in a way that is both ethically coherent and sufficiently pragmatic? Clearly, there is a critical role for medical education to drive the adoption of high-value care…

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  • ThirdWayForward

    Excellent article.

    This is a no-brainer in terms of medical policy and medical education.

    We face a tragedy-of-the-commons situation where we cannot even see the eroding state of the commons (as seen in advancing copays and premiums) because of the fragmented and opaque character of our health system.
    Because we patients see only a fraction of the full costs of medical goods and services we consume, sometimes we don’t use them as wisely as we should, and the result is that everyone pays.

    We need price transparency at all levels of our medical system. Everyone at every level should have an idea of what things cost. If we all simply could see these costs, plenty of patients would forego or postpone expensive treatment options with little or no expected benefit.

    Second, there should be (small) incentives for patients to save money by postponing or foregoing more expensive treatments. For example, copays at less expensive community hospitals could be half those of more expensive hospitals — plenty of people would choose the cheaper option, but those who really cared about the difference could still get the care they want.

    Third, patients should always be given an option to see a mid-level practitioner (nurse-practitioner or physician assistant) before seeing a doctor. Most routine diagnoses and procedures can be carried out by these mid-levels (and those harder cases that cannot are automatically referred upwards to a doctor).

    Fourth, both doctors and patients need to be able to see the relative prices of branded and generic meds when they are being prescribed. There needs to be a conversation about the cost of the meds and their sustainability in terms of price.
    All of us need to be able to find the price of a med on-line, immediately, and to locate the copay involved.

  • Reaesonable?

    Doctors should be educated on the economics of price.
    Cost for routine procedures should go down over time.
    However this not the case in our health care system.
    Doctors enter the field with an understanding of price stability.
    Our current health care system is severely distorting economic signals.
    That is very dangerous for young doctors.