Groups aim to teach resident physicians to weigh costs in care

Free curriculum from physician organizations educates these doctors on how to slow rising health care costs by considering the economics of treatment decisions.

By Carolyne Krupa — Posted Aug. 1, 2012

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With health care expenditures projected to reach nearly 20% of the nation’s gross domestic product by 2020, more physicians need to learn to weigh the costs and benefits of care to patients, say officials with the American College of Physicians and the Alliance for Academic Internal Medicine.

The two organizations have teamed up to offer a free curriculum designed to educate internal medicine residents about how to avoid contributing to rising health care costs with unnecessary care.

“Physicians receive little specific training about identifying and eliminating wasteful diagnostic and treatment options,” said Cynthia D. Smith, MD, the ACP’s senior medical associate for content development. “Residency training is an excellent time to introduce the concept of high-value, cost-conscious care, because the habits that residents learn during training have been shown to stay with them throughout their professional careers.”

The lessons are intended to give residents an understanding that more is not always better, said Cheryl O’Malley, MD, program director in the Dept. of Internal Medicine at Banner Good Samaritan Medical Center in Phoenix.

“The downstream costs of unnecessary testing can come in the form of the patient’s inconvenience, immediate risk of the test, long-term risks and the risk of misdiagnosis,” she said.

The curriculum, announced July 10 in the Annals of Internal Medicine, is available online (link).

It consists of 10, one-hour interactive sessions in which residents and faculty address real patient cases. The groups discuss the cases and analyze the potential pros and cons of different approaches, including the costs and use of evidence-based care, said the Annals article (link).

In the last module, residents are asked to undertake a quality improvement project at their institution.

The curriculum was developed by a 22-member committee of ACP and AAIM members and staff, as well as residents and residency program leaders. Leaders at 12 internal medicine residency programs represented on the committee have agreed to incorporate the modules into their training, Dr. Smith said.

“Eventually, we would like to see this content disseminated to all graduate medical education training programs and even to medical schools,” she said.

The lessons are designed to be flexible and can be adapted to other types of programs, said Dr. O’Malley, who represented the AAIM as a committee member.

“The cases are common in primary care, and the core content could be applied in various specialties with relatively minor modifications,” she said.

In the first week since its release, the web page had more than 1,300 views, and the curriculum was downloaded by 352 individuals.

Medical students and residents traditionally aren’t taught about the costs of care, such as the price of false positive test results, the dangers to patients of radiation exposure from too many x-rays or the inability of some patients to afford costly medications, Dr. Smith said. In fact, it was almost a faux pas to talk about limited resources or the economics of care, she said.

“This is really a paradigm shift in medical education,” Dr. Smith said. “Doctors can’t continue to put their head in the sand and say, ‘This is something I don’t know about.’ ”

The committee plans to continue to revise the curriculum as members get feedback. An updated version will be released in September.

“We’re really still working on it,” Dr. Smith said. “We don’t see this as a finished product.”

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