Monday, May 10, 2010

Conflicting Studies Address Cost Awareness As Part Of Physician Training

A recent study by the Accreditation Council for Graduate Medical Education concluded that most physicians are no longer being trained just to prescribe the best course of treatment medically. They are now taught to also consider the financial implications. This is a radical change from the past.

This sudden and dramatic shift has occurred since 2007 when physicians were first asked to incorporate considerations of cost awareness and risk-benefit analysis in caring for patients. Two other studies give conflicting data on how widely this new concept has been adopted as part of medical school curriculum. One study says 60% of the schools teach this while another says only 41% do.

Some schools like Mount Sinai School of Medicine take this very seriously by having students volunteer at a student run free clinic for the uninsured. These students must collaborate with social workers to assist patients in paying for medicines. They also are exposed to the cost of drugs and commonly ordered tests. This in my opinion is an important addition to medical curriculum.

Other research suggests that Electronic Medical Records have helped expose physicians to the cost of drugs and tests that they were not exposed to before. This has resulted in a slight but perceptible change in their ordering habits. Even this slight change has resulted in an annual savings of $1.7 million in laboratory charges at Brigham and Women's Hospital.

But one last study highlights an area where there is still need for change; the practice of defensive medicine. A national survey of over 1,400 physicians found that 83% of those between the ages of 25 and 34 said that they were taught to practice defensive medicine. They were taught to protect their livelihood as well as save lives. The US is the only major country where physicians are personally financially liable for their mistakes. Also, medical liability claims make up 10% of all tort cases. Until these facts change, teaching in medical schools on this issue will remain the same, as well they should.

So we are making inroads in teaching our new physicians to practice cost effective medicine. If we could achieve some meaningful tort reform, we could go even further in this direction.

More on this later.

Mark Brodeur

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