Changing times bring cost awareness to medical curriculum

In the age of transparency and data-hungry healthcare consumers assuming more out-of-pocket costs, physicians are no longer being asked to just prescribe the best course of treatment medically, but to also consider the financial implications.

Thus, in a relatively sudden and polar shift from traditional thinking, residency programs in the United States have been required since 2007 to teach doctors to "incorporate considerations of cost awareness and risk-benefit analysis" in caring for patients, according to the Accreditation Council for Graduate Medical Education. But despite the push to make up for lost time, only about 60 percent of 102 American and Canadian medical schools include material on healthcare costs, according to a recent survey from the American Association of Medical Colleges, while a smaller study puts the number at just 41 percent, reports the New York Times.

"Medical schools have done a really terrible job over the years in educating students about the system that they're going to encounter," said Dr. Michael Whitcomb, former senior vice president for medical education at the AAMC and former editor of the journal Academic Medicine.

But some organizations have shown notable efforts. At the Mount Sinai School of Medicine in New York City, for example, students come to appreciate the impact of medical costs on patients by volunteering at the East Harlem Health Outreach Program, a student-run free clinic. As part of caring for their uninsured neighbors, these medical students collaborate with social workers to assist patients in paying for medicine and share responsibility for stocking the hospital pharmacy with cost-effective drugs. At Harvard Medical School, an elective class features a "Price Is Right"-style session in which students guess the costs of commonly ordered tests.

In addition, some research suggests that EMRs displaying the charges for ordered tests may decrease costs without compromising care, reports Kaiser Health News. Even though study results have varied, a pair of large randomized trials using the technology at Brigham and Women's Hospital in Boston revealed that even a seemingly small change in doctors' test-ordering behavior translated into a $1.7 million annual saving in hospital charges for laboratory tests, said the study's senior author, Dr. David W. Bates, the hospital's chief of general medicine. Doctors "really liked seeing the cost information, so we've continued to display it" on hospital computers, he said.

To learn more:
- read this New York Times/Kaiser Health Network piece
- check out this Kaiser Health Network article

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