Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Abstract

BACKGROUND:Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. OBJECTIVE: We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in costconscious care impacted responses. DESIGN: Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently rolemodel cost-conscious care from residency program, resident, and program director characteristics. PARTICIPANTS: Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. MAIN MEASURES: The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. KEY RESULTS: Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently rolemodeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in costconscious care did not have a significant impact on survey responses (odds ratio [OR] were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in costconscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

Trends in Prolonged Hospitalizations in the United States from 2001 to 2012: A Longitudinal Cohort Study

“…The demographic shifts to teaching hospitals may reflect a changing role for academic medical centers nationally, with an increased consolidation of complex and costly patients in academic hospitals. 17 This new role for academic medical centers may affect the educational opportunities for residents and medical students, as the educational value of caring for patients with prolonged stays differs from multiple patients with shorter stays, even as these long-stay patients may offer opportunities for new educational foci, such as value-based care and rehabilitation potential.…”

Time for System Redesign

“…9,10 Both studies validate that attendings are important role models, yet only about half model cost-conscious care. Moreover, this role-modeling does not appear to be changed by the presence of a curriculum focused on high-value, costconscious care.…”

Incorporating High Value Care into Undergraduate Medical Education

“…In a study compiled by the Association of Program Directors for Internal Medicine, only 15% of directors reported their programs offer formal curriculum in "cost-conscious care," while 48% of programs believed their faculty model cost-conscious care. [13] Considering the data, we find GME training insufficient to produce future physicians who practice HVC. If we allow future physicians to be trained to mimic all the habits of current faculty, we are unlikely to curb the high cost of healthcare attributed to unnecessary testing.…”