18
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      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

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references34

          • Record: found
          • Abstract: found
          • Article: not found

          Generational changes and their impact in the classroom: teaching Generation Me.

          Many faculty members believe that students today differ from those in the past. This paper reviews the empirical evidence for generational changes among students and makes recommendations for classroom teaching based on these changes. Generational changes are rooted in shifts in culture and should be viewed as reflections of changes in society. This paper reviews findings from a number of studies, most of which rely on over-time meta-analyses of students' (primarily undergraduates') responses to psychological questionnaires measuring IQ, personality traits, attitudes, reading preferences and expectations. Others are time-lag studies of nationally representative samples of high school students. Today's students (Generation Me) score higher on assertiveness, self-liking, narcissistic traits, high expectations, and some measures of stress, anxiety and poor mental health, and lower on self-reliance. Most of these changes are linear; thus the year in which someone was born is more relevant than a broad generational label. Moreover, these findings represent average changes and exceptions certainly occur. These characteristics suggest that Generation Me would benefit from a more structured but also more interactive learning experience, and that the overconfidence of this group may need to be tempered. Faculty and staff should give very specific instructions and frequent feedback, and should explain the relevance of the material. Rules should be strictly followed to prevent entitled students from unfairly working the system. Generation Me students have high IQs, but little desire to read long texts. Instruction may need to be delivered in shorter segments and perhaps incorporate more material delivered in media such as videos and an interactive format. Given their heightened desire for leisure, today's students may grow into professionals who demand lighter work schedules, thereby creating conflict within the profession.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Setting a research agenda for medical overuse

            Although overuse in medicine is gaining increased attention, many questions remain unanswered. Dan Morgan and colleagues propose an agenda for coordinated research to improve our understanding of the problem
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review.

              Increasing health care expenditures are taxing the sustainability of the health care system. Physicians should be prepared to deliver high-value, cost-conscious care.
                Bookmark

                Author and article information

                Contributors
                leep.andrea@mayo.edu
                dyrbye.liselotte@mayo.edu
                starr.stephanie@mayo.edu
                mandrekar.jay@mayo.edu
                tilburt.jon@mayo.edu
                paul_george@brown.edu
                baxleye@ecu.edu
                jgonzalo@hmc.psu.edu
                cmoriates@austin.utexas.edu
                sgoold@med.umich.edu
                carneyp@ohsu.edu
                bonnie.m.miller@vanderbilt.edu
                sjgrethl@iu.edu
                tlfancher@ucdavis.edu
                matthew.wynia@ucdenver.edu
                reed.darcy@mayo.edu
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                22 November 2018
                22 November 2018
                2018
                : 18
                : 275
                Affiliations
                [1 ]ISNI 0000 0004 0459 167X, GRID grid.66875.3a, Neurology, Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [2 ]Medical education and medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
                [3 ]ISNI 0000 0004 0459 167X, GRID grid.66875.3a, Science of Health Care Delivery Education, Mayo Clinic School of Medicine, Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [4 ]ISNI 0000 0004 0459 167X, GRID grid.66875.3a, Biostatistics and Neurology, Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [5 ]ISNI 0000 0004 0459 167X, GRID grid.66875.3a, Biomedical ethics, Mayo Clinic, ; 200 First Street SW, Rochester, MN 55905 USA
                [6 ]ISNI 0000 0004 1936 9094, GRID grid.40263.33, Family medicine and medical science, Warren Alpert Medical School, Brown University, ; 222 Richmond Street, Providence, RI 02903 USA
                [7 ]ISNI 0000 0001 2191 0423, GRID grid.255364.3, Family medicine, Brody School of Medicine, East Carolina University, ; 600 Moye Blvd, Greenville, NC 27834 USA
                [8 ]ISNI 0000 0001 2097 4281, GRID grid.29857.31, Medicine and public health sciences and associate dean for health systems education, Pennsylvania State University College of Medicine, ; 500 University Drive, Hershey, PA 17033 USA
                [9 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Division of Hospital Medicine, and director, Caring Wisely Program, , University of California San Francisco, ; San Francisco, California, USA
                [10 ]ISNI 0000 0004 1936 9924, GRID grid.89336.37, Dell Medical School at the University of Texas at Austin, ; 1501 Red River Road, Health Learning Building, Austin, TX 78701 USA
                [11 ]ISNI 0000000086837370, GRID grid.214458.e, Internal medicine and health management, Center for Bioethics and Social Sciences in Medicine, University of Michigan, ; 500 South State Street, Ann Arbor, MI 48109 USA
                [12 ]ISNI 0000 0000 9758 5690, GRID grid.5288.7, Family medicine and of public health and preventative medicine, Oregon Health & Science University, ; 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA
                [13 ]ISNI 0000 0001 2264 7217, GRID grid.152326.1, Medical education and administration, professor of clinical surgery, associate vice chancellor for health affairs, and senior associate dean for health sciences education, Vanderbilt University, ; 2201 West End Ave, Nashville, TN 37235 USA
                [14 ]ISNI 0000 0001 2287 3919, GRID grid.257413.6, Clinical medicine, Department of Medicine, , Indiana University School of Medicine, ; 340 W 10th St 6200, Indianapolis, IN 46202 USA
                [15 ]ISNI 0000 0004 1936 9684, GRID grid.27860.3b, Division of General Medicine, , Medicine and associate dean for workforce innovation and community engagement, University of California Davis School of Medicine, ; 4610 X Street, Sacramento, CA 95817 USA
                [16 ]ISNI 0000000107903411, GRID grid.241116.1, Internal medicine, Center for Bioethics and Humanities at the University of Colorado Denver, ; 1250 14th Street, Denver, CO 80204 USA
                [17 ]ISNI 0000 0004 0459 167X, GRID grid.66875.3a, Medical education and medicine, Mayo Clinic School of Medicine, ; Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
                Author information
                http://orcid.org/0000-0002-7784-504X
                Article
                1388
                10.1186/s12909-018-1388-7
                6249745
                30466489
                308c829b-e2b0-4067-a31a-c7b4fe9871e0
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 February 2018
                : 14 November 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100001459, American Medical Association Foundation;
                Award ID: Accelerating Change in Medical Education
                Funded by: FundRef http://dx.doi.org/10.13039/100000102, Health Resources and Services Administration;
                Award ID: UH1HP29965
                Funded by: FundRef http://dx.doi.org/10.13039/100001146, Greenwall Foundation;
                Award ID: (Faculty Scholars Program)
                Funded by: Mayo Clinic Program in Professionalism and Ethics
                Award ID: Project award
                Funded by: Mayo Clinic Foundation
                Award ID: Early Career Development Award
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Education
                cost-conscious care,high value cost-conscious care,high value care,value-based health care,healthcare costs,health care costs,undergraduate medical education,national survey,cohort effect,generational differences

                Comments

                Comment on this article