Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training
Abstract Background The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12909-018-1388-7 |
| _version_ | 1823928128996638720 |
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| author | Andrea N. Leep Hunderfund Liselotte N. Dyrbye Stephanie R. Starr Jay Mandrekar Jon C. Tilburt Paul George Elizabeth G. Baxley Jed D. Gonzalo Christopher Moriates Susan D. Goold Patricia A. Carney Bonnie M. Miller Sara J. Grethlein Tonya L. Fancher Matthew K. Wynia Darcy A. Reed |
| author_facet | Andrea N. Leep Hunderfund Liselotte N. Dyrbye Stephanie R. Starr Jay Mandrekar Jon C. Tilburt Paul George Elizabeth G. Baxley Jed D. Gonzalo Christopher Moriates Susan D. Goold Patricia A. Carney Bonnie M. Miller Sara J. Grethlein Tonya L. Fancher Matthew K. Wynia Darcy A. Reed |
| author_sort | Andrea N. Leep Hunderfund |
| collection | DOAJ |
| description | Abstract Background The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes of physicians and medical students. Methods A paper survey was mailed in mid-2012 to 3897 practicing physicians randomly selected from the American Medical Association Masterfile. An electronic survey was sent in early 2015 to all 5,992 students at 10 U.S. medical schools. Survey items measured attitudes toward cost-conscious care and perceived responsibility for reducing healthcare costs. Physician responses were first compared across age groups (30–40 years, 41–50 years, 51–60 years, and > 60 years) and then compared to student responses using Chi square tests and logistic regression analyses (controlling for sex). Results A total of 2,556 physicians (65%) and 3395 students (57%) responded. Physician attitudes generally did not differ by age, but differed significantly from those of students. Specifically, students were more likely than physicians to agree that cost to society should be important in treatment decisions (p < 0.001) and that physicians should sometimes deny beneficial but costly services (p < 0.001). Students were less likely to agree that it is unfair to ask physicians to be cost-conscious while prioritizing patient welfare (p < 0.001). Compared to physicians, students assigned more responsibility for reducing healthcare costs to hospitals and health systems (p < 0.001) and less responsibility to lawyers (p < 0.001) and patients (p < 0.001). Nearly all significant differences persisted after controlling for sex and when only the youngest physicians were compared to students. Conclusions Physician attitudes toward cost-conscious care are similar across age groups. However, physician attitudes differ significantly from medical students, even among the youngest physicians most proximate to students in age. Medical student responses suggest they are more accepting of cost-conscious care than physicians and attribute more responsibility for reducing costs to organizations and systems rather than individuals. This may be due to the combined effects of generational differences, new medical school curricula, students’ relative inexperience providing cost-conscious care within complex healthcare systems, and the rapidly evolving U.S. healthcare system. |
| first_indexed | 2024-12-16T20:49:36Z |
| format | Article |
| id | doaj.art-2bbe7a2ca3784946b6b30bea9e19e044 |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-12-16T20:49:36Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-2bbe7a2ca3784946b6b30bea9e19e0442022-12-21T22:16:50ZengBMCBMC Medical Education1472-69202018-11-0118111110.1186/s12909-018-1388-7Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of trainingAndrea N. Leep Hunderfund0Liselotte N. Dyrbye1Stephanie R. Starr2Jay Mandrekar3Jon C. Tilburt4Paul George5Elizabeth G. Baxley6Jed D. Gonzalo7Christopher Moriates8Susan D. Goold9Patricia A. Carney10Bonnie M. Miller11Sara J. Grethlein12Tonya L. Fancher13Matthew K. Wynia14Darcy A. Reed15Neurology, Mayo ClinicMedical education and medicineScience of Health Care Delivery Education, Mayo Clinic School of Medicine, Mayo ClinicBiostatistics and Neurology, Mayo ClinicBiomedical ethics, Mayo ClinicFamily medicine and medical science, Warren Alpert Medical School, Brown UniversityFamily medicine, Brody School of Medicine, East Carolina UniversityMedicine and public health sciences and associate dean for health systems education, Pennsylvania State University College of MedicineDivision of Hospital Medicine, and director, Caring Wisely Program, University of California San FranciscoInternal medicine and health management, Center for Bioethics and Social Sciences in Medicine, University of MichiganFamily medicine and of public health and preventative medicine, Oregon Health & Science UniversityMedical education and administration, professor of clinical surgery, associate vice chancellor for health affairs, and senior associate dean for health sciences education, Vanderbilt UniversityClinical medicine, Department of Medicine, Indiana University School of MedicineDivision of General Medicine, Medicine and associate dean for workforce innovation and community engagement, University of California Davis School of MedicineInternal medicine, Center for Bioethics and Humanities at the University of Colorado DenverMedical education and medicine, Mayo Clinic School of MedicineAbstract Background The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes of physicians and medical students. Methods A paper survey was mailed in mid-2012 to 3897 practicing physicians randomly selected from the American Medical Association Masterfile. An electronic survey was sent in early 2015 to all 5,992 students at 10 U.S. medical schools. Survey items measured attitudes toward cost-conscious care and perceived responsibility for reducing healthcare costs. Physician responses were first compared across age groups (30–40 years, 41–50 years, 51–60 years, and > 60 years) and then compared to student responses using Chi square tests and logistic regression analyses (controlling for sex). Results A total of 2,556 physicians (65%) and 3395 students (57%) responded. Physician attitudes generally did not differ by age, but differed significantly from those of students. Specifically, students were more likely than physicians to agree that cost to society should be important in treatment decisions (p < 0.001) and that physicians should sometimes deny beneficial but costly services (p < 0.001). Students were less likely to agree that it is unfair to ask physicians to be cost-conscious while prioritizing patient welfare (p < 0.001). Compared to physicians, students assigned more responsibility for reducing healthcare costs to hospitals and health systems (p < 0.001) and less responsibility to lawyers (p < 0.001) and patients (p < 0.001). Nearly all significant differences persisted after controlling for sex and when only the youngest physicians were compared to students. Conclusions Physician attitudes toward cost-conscious care are similar across age groups. However, physician attitudes differ significantly from medical students, even among the youngest physicians most proximate to students in age. Medical student responses suggest they are more accepting of cost-conscious care than physicians and attribute more responsibility for reducing costs to organizations and systems rather than individuals. This may be due to the combined effects of generational differences, new medical school curricula, students’ relative inexperience providing cost-conscious care within complex healthcare systems, and the rapidly evolving U.S. healthcare system.http://link.springer.com/article/10.1186/s12909-018-1388-7Cost-conscious careHigh value cost-conscious careHigh value careValue-based health careHealthcare costsHealth care costs |
| spellingShingle | Andrea N. Leep Hunderfund Liselotte N. Dyrbye Stephanie R. Starr Jay Mandrekar Jon C. Tilburt Paul George Elizabeth G. Baxley Jed D. Gonzalo Christopher Moriates Susan D. Goold Patricia A. Carney Bonnie M. Miller Sara J. Grethlein Tonya L. Fancher Matthew K. Wynia Darcy A. Reed Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training BMC Medical Education Cost-conscious care High value cost-conscious care High value care Value-based health care Healthcare costs Health care costs |
| title | Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training |
| title_full | Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training |
| title_fullStr | Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training |
| title_full_unstemmed | Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training |
| title_short | Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training |
| title_sort | attitudes toward cost conscious care among u s physicians and medical students analysis of national cross sectional survey data by age and stage of training |
| topic | Cost-conscious care High value cost-conscious care High value care Value-based health care Healthcare costs Health care costs |
| url | http://link.springer.com/article/10.1186/s12909-018-1388-7 |
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