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Disclosure: Nothing to report.Hospitalists' specialized focus on inpatient care services has been conjectured to offer increased efficiency and reduce costs of inpatient care. Hospitalists' estimates of the unadjusted patient-charges generated by commonly-used services were measured. Hospitalists' agreement with one another, and accuracy relative to the actual patient-charges were both low. Hospitalists' awareness of inpatient charges appears subject to the same opacity of pricing known to limit patient knowledge, and at present hospitalists' cognizance of charges and costs is unlikely to facilitate decreased care expenditures. Hospitalists have been suggested to offer rational and efficient medical care through specialized knowledge about inpatient care services.1 The goal that hospitalists will use care resources more efficiently presumes hospitalists' accurate knowledge about charges and costs. Data regarding physicians' awareness of care charges and its impact upon care is limited. An international meta-analysis of clinicians' awareness of pharmaceutical prices demonstrated poor accuracy of physicians' estimates of charges, but effects of increasing their knowledge remained unexamined.2 Continuous exposure to education and alerts about charges have been demonstrated to diminish physicians' unnecessary use of specific laboratory assays in a single teaching hospital, in a pediatric emergency department, and an outpatient primary care system; test use declined when physicians were alerted to test charges at the point-of-care without negative impact upon clinical outcomes; when the notices ceased, utilization climbed back towards baseline levels. Specific to inpatient care, a single-center study evaluated the impact of price-alerts upon laboratory and imaging use, but showed no effects. 3-6Applicability of these existing data for contemporary hospitalists are limited, and most data were collected before hospitalists developed as an organized focus of practice. A review of existing literature revealed no published data demonstrating hospitalists' higher expert awareness of charges generated by inpatient care. Published comparisons of the care expense generated by hospitalists' care versus that of general internists or academic teams have shown minimal and inconsistent effects. [7][8][9] Those data showing reduced costs from hospitalists were associated with small length-ofstay reductions, rather than more expert resource utilization. 7 We measured the accuracy and precision of hospitalist's estimates of charges associated with services commonly used in inpatient care. SettingTwo community-based private, academic-affiliated hospitals operated by a not-for-profit health system in Washington State, comprising together 895 inpatient beds. The questionnaire instrument was approved by the governing Institutional Review Board (IRB). MethodsA list of ''true'' charges for 14 services, procedures, tests, and physician charges commonly ordered by adult medicine hospitalists was acquired directly from the responsible departm...

The ACGME's six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.