Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care

Andrea N.Leep Hunderfund, Liselotte N. Dyrbye, Stephanie R. Starr, Jay Mandrekar, James M. Naessens, 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, Darcy A. Reed

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care. Method Students at 10 U.S. medical schools were surveyed in 2015. Thirty-five items assessed attitudes toward, perceived barriers to and consequences of, and observed physician role-modeling behaviors related to cost-conscious care (using scales for cost-conscious and potentially wasteful behaviors; Cronbach alphas of 0.82 and 0.81, respectively). Regional health care intensity was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data: ratio of physician visits per decedent compared with the U.S. average, ratio of specialty to primary care physician visits per decedent, and hospital care intensity index. Results Of 5,992 students invited, 3,395 (57%) responded. Ninety percent (2,640/2,932) agreed physicians have a responsibility to contain costs. However, 48% (1,1416/2,960) thought ordering a test is easier than explaining why it is unnecessary, and 58% (1,685/2,928) agreed ordering fewer tests will increase the risk of malpractice litigation. In adjusted linear regression analyses, students in higher-health-care-intensity regions reported observing significantly fewer cost-conscious role-modeling behaviors: For each one-unit increase in the three health care intensity measures, scores on the 21-point cost-conscious role-modeling scale decreased by 4.4 (SE 0.7), 3.2 (0.6), and 3.9 (0.6) points, respectively (all P <.001). Conclusions Medical students endorse barriers to cost-conscious care and encounter conflicting role-modeling behaviors, which are related to regional health care intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address health care costs.

Original languageEnglish (US)
Pages (from-to)694-702
Number of pages9
JournalAcademic Medicine
Volume92
Issue number5
DOIs
StatePublished - May 1 2017

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Medical Students
medical student
health care
Delivery of Health Care
Costs and Cost Analysis
costs
physician
experience
Physician's Role
Students
Physicians
Atlases
Malpractice
Primary Care Physicians
Jurisprudence
student
Medical Schools
Health Care Costs
Linear Models
chronic illness

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

Hunderfund, A. N. L., Dyrbye, L. N., Starr, S. R., Mandrekar, J., Naessens, J. M., Tilburt, J. C., ... Reed, D. A. (2017). Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care. Academic Medicine, 92(5), 694-702. https://doi.org/10.1097/ACM.0000000000001223

Role Modeling and Regional Health Care Intensity : U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care. / Hunderfund, Andrea N.Leep; Dyrbye, Liselotte N.; Starr, Stephanie R.; Mandrekar, Jay; Naessens, James M.; Tilburt, Jon C.; George, Paul; Baxley, Elizabeth G.; Gonzalo, Jed D.; Moriates, Christopher; Goold, Susan D.; Carney, Patricia A.; Miller, Bonnie M.; Grethlein, Sara J.; Fancher, Tonya L; Reed, Darcy A.

In: Academic Medicine, Vol. 92, No. 5, 01.05.2017, p. 694-702.

Research output: Contribution to journalArticle

Hunderfund, ANL, Dyrbye, LN, Starr, SR, Mandrekar, J, Naessens, JM, Tilburt, JC, George, P, Baxley, EG, Gonzalo, JD, Moriates, C, Goold, SD, Carney, PA, Miller, BM, Grethlein, SJ, Fancher, TL & Reed, DA 2017, 'Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care', Academic Medicine, vol. 92, no. 5, pp. 694-702. https://doi.org/10.1097/ACM.0000000000001223
Hunderfund, Andrea N.Leep ; Dyrbye, Liselotte N. ; Starr, Stephanie R. ; Mandrekar, Jay ; Naessens, James M. ; Tilburt, Jon C. ; George, Paul ; Baxley, Elizabeth G. ; Gonzalo, Jed D. ; Moriates, Christopher ; Goold, Susan D. ; Carney, Patricia A. ; Miller, Bonnie M. ; Grethlein, Sara J. ; Fancher, Tonya L ; Reed, Darcy A. / Role Modeling and Regional Health Care Intensity : U.S. Medical Student Attitudes Toward and Experiences with Cost-Conscious Care. In: Academic Medicine. 2017 ; Vol. 92, No. 5. pp. 694-702.
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abstract = "Purpose To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care. Method Students at 10 U.S. medical schools were surveyed in 2015. Thirty-five items assessed attitudes toward, perceived barriers to and consequences of, and observed physician role-modeling behaviors related to cost-conscious care (using scales for cost-conscious and potentially wasteful behaviors; Cronbach alphas of 0.82 and 0.81, respectively). Regional health care intensity was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data: ratio of physician visits per decedent compared with the U.S. average, ratio of specialty to primary care physician visits per decedent, and hospital care intensity index. Results Of 5,992 students invited, 3,395 (57{\%}) responded. Ninety percent (2,640/2,932) agreed physicians have a responsibility to contain costs. However, 48{\%} (1,1416/2,960) thought ordering a test is easier than explaining why it is unnecessary, and 58{\%} (1,685/2,928) agreed ordering fewer tests will increase the risk of malpractice litigation. In adjusted linear regression analyses, students in higher-health-care-intensity regions reported observing significantly fewer cost-conscious role-modeling behaviors: For each one-unit increase in the three health care intensity measures, scores on the 21-point cost-conscious role-modeling scale decreased by 4.4 (SE 0.7), 3.2 (0.6), and 3.9 (0.6) points, respectively (all P <.001). Conclusions Medical students endorse barriers to cost-conscious care and encounter conflicting role-modeling behaviors, which are related to regional health care intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address health care costs.",
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AU - Starr, Stephanie R.

AU - Mandrekar, Jay

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AU - Tilburt, Jon C.

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N2 - Purpose To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care. Method Students at 10 U.S. medical schools were surveyed in 2015. Thirty-five items assessed attitudes toward, perceived barriers to and consequences of, and observed physician role-modeling behaviors related to cost-conscious care (using scales for cost-conscious and potentially wasteful behaviors; Cronbach alphas of 0.82 and 0.81, respectively). Regional health care intensity was measured using Dartmouth Atlas End-of-Life Chronic Illness Care data: ratio of physician visits per decedent compared with the U.S. average, ratio of specialty to primary care physician visits per decedent, and hospital care intensity index. Results Of 5,992 students invited, 3,395 (57%) responded. Ninety percent (2,640/2,932) agreed physicians have a responsibility to contain costs. However, 48% (1,1416/2,960) thought ordering a test is easier than explaining why it is unnecessary, and 58% (1,685/2,928) agreed ordering fewer tests will increase the risk of malpractice litigation. In adjusted linear regression analyses, students in higher-health-care-intensity regions reported observing significantly fewer cost-conscious role-modeling behaviors: For each one-unit increase in the three health care intensity measures, scores on the 21-point cost-conscious role-modeling scale decreased by 4.4 (SE 0.7), 3.2 (0.6), and 3.9 (0.6) points, respectively (all P <.001). Conclusions Medical students endorse barriers to cost-conscious care and encounter conflicting role-modeling behaviors, which are related to regional health care intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address health care costs.

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