Survey: Most U.S. internal medicine residents lack knowledge about how to find treatment costs

High Value Care training is needed part of internal medicine residency

Philadelphia, June 24, 2015 -- Only about one in four internal medicine residents agreed with the statements "I know where to find estimated costs of tests and treatments" and with "I share estimated costs of tests and treatments with patients," according to survey results and an analysis published in Academic Medicine.

"The results of the survey show that it is important for faculty to discuss High Value Care concepts during patient care to help residents increase value for patients," said co-author Dr. Cynthia Smith, a Senior Physician Educator at the American College of Physicians (ACP). "The habits that residents learn during training have been shown to stay with them throughout their professional careers."

The authors conducted a cross-sectional survey of over 18,000 U.S. internal medicine residents who took the Internal Medicine In-Training Examination (IM-ITE) in October 2012. ACP and the Alliance for Academic Internal Medicine (AAIM) designed the survey to determine U.S. internal medicine residents' knowledge of, attitudes toward, and self-reported practice of High Value Care (HVC), or care that balances the benefits, harms, and costs of tests and treatments. The IM-ITE is a multiple-choice exam offered annually across the U.S. to help residents assess their knowledge in preparation for taking the specialty certification exam.

Other notable results of the survey included:

  • 88.2% agreed that they "incorporate patients' values and concerns into clinical decisions."
  • Discussions about balancing the benefits, harms, and costs of treatments with faculty during patient care at least a few times a week were reported by 40.1% and were associated with all self-reported HVC practices.
  • The training hospital's care intensity was inversely associated with self-reported incorporation of costs and patient values into clinical decisions but not with other self-reported behaviors.
  • 45.7% agreed that they "incorporate the cost of tests and treatments into clinical decisions."
  • Over two-thirds reported adequate knowledge of the benefits and harms of tests and treatments, offering patients alternatives, considering patients' values and concerns, and avoiding unnecessary care.
  • 58.7% agreed with "I reduce health care waste within my hospital and/or clinic."
  • Most respondents agreed that overuse was driven by defensive medicine (84.6%), followed by diagnostic uncertainty (60.9%), patient demands (54.8%), and concerns about inadequate patient follow-up (47.1%).

The authors note a number of limitations to their findings, including the cross-sectional survey study design and residents' self-reported knowledge and practice of HVC may not accurately reflect their actual practice.

ACP has an HVC initiative, which includes a curriculum for residents co-developed with the AAIM, designed to help doctors and patients understand the benefits, harms, and costs of tests and treatment options for common clinical issues so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.