Value-Based Cancer Care: How are We Training Future Radiation Oncologists on the Quality/Cost Equation?

Abstract

<h3>Purpose/Objective(s)</h3> The cost of a cancer diagnosis has increasingly caused financially harm to many Americans. Calls have been made by the American Medical Association and others to educate physicians on value and affordability with the goal to improve patient care and contribute to systemic change. This study sought to evaluate how future physicians are educated on cost and value-based principles during their undergraduate medical education. As a terminal oncology residency, radiation oncologists were the focus. <h3>Materials/Methods</h3> An anonymous 18-question survey was developed by the study team to assess undergraduate medical education experiences on cost, quality, and value. A list of recently graduated (2016-2021) physicians was generated from residency applications; emails and Twitter handles were identified via publicly available data and contacted August 2021- February 2022 to complete the survey. <h3>Results</h3> Of 279 contacted, 62 (22.2% response rate) completed the survey. The graduation year breakdown was: 2016 (27.4%), 2017 (4.8%), 2018 (24.2%), 2019 (19.4%), 2020 (14.5%), and 2021 (9.7%). Respondents trained in the Northeast (32.3%), South (29.0%), Midwest (29.0%), and West (9.7%). Less than half had had a lecture on value in healthcare (46.8%, n=29) or costs (32.3%, n=20); only 16.1% (n=10) had a class on value, and for most of those (60%, n=6) it was elective. 98.4% (n=61) had previously met a patient unable to afford healthcare however only 9.7% (n=6) had a good idea of the charged/billed prices and even less (6.5%, n=4) had a good idea of the out-of-pocket costs for standard tests, procedures, and medications. Two-thirds (64.5%, n=40) indicated that the value or cost of a test, procedure, or medication was rarely or never discussed at the point of care. 48.4% (n=30) hadn't heard of the "Choosing Wisely" guidelines during medical school although 82.3% (n=51) were are least vaguely familiar with the concept of "financial toxicity". Most physicians (90.3%, n=56) felt their education about value, affordability, and cost was marginal or insufficient. The vast majority indicated they thought these topics are important for their patients (96.8%, n=60). <h3>Conclusion</h3> Most recent graduates training in radiation oncology have suboptimal education on cost, affordability, and value during medical school despite widespread interest. Few had had a class on these vital topics and most indicated that costs and value were rarely discussed when ordering tests or medications. These educational gaps likely contribute to their present vague understanding of either billed or out of pocket costs. Given rising health care costs, systemic reform of medical education will be required to educate the next generation of oncologists on the importance of value-based cancer care.