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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