Value-Based Cancer Care: What are the opportunities to improve training for future Radiation Oncologists on the Quality/Cost Equation?

Abstract

Purpose A cancer diagnosis can lead to lasting financial problems for many Americans. The American Medical Association has called for a greater focus on value and affordability education to increase awareness of burdens on both patients and the healthcare system. This study evaluated how future physicians were educated on cost and value-based principles during their undergraduate medical education. Radiation Oncologists were the focus given their oncology specific residency. Methods 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 (2016-2012) 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. Results Of 279 contacted, 67 (24.0% response rate) completed the survey. Participants graduated in 2016 (25.4%), 2017 (6.0%), 2018 (25.4%), 2019 (17.9%), 2020 (14.9%), and 2021 (10.4%); they trained in the Northeast (34.3%), South (26.9%), Midwest (29.9%), and West (9.0%). Less than half had a lecture on value (49.3%, n=33) or costs (32.8%, n=22). Only 19.4% (n=13) had an entire class on value. About half had heard value mentioned "occasionally" (55.2%, n=37) during their time on the wards and less than a third (28.4%, n=19) heard about it "frequently". Similarly, half had heard about costs "occasionally" (52.2%, n=35) and less than a quarter (17.9%, n=12) had heard it mentioned "frequently". Less than half had a lecture on health insurance (46.3%, n=31); about a third had heard it mentioned "occasionally" (38.8%, n=26) on the wards while less than a tenth (7.5%, n=5) had hear it mentioned "frequently". A third had NO education on improving affordability for patients (34.8%, n=23) although about a half had been taught to discuss the $4 list and/or pill splitting (47.0%, n=31). Less than a tenth (9.0%, n=6) had a "good idea" of the charged/billed prices and even less (6.0%, n=4) knew the out-of-pocket costs for standard tests, procedures, and medications. Most (89.6%, n=60) felt their education about value, affordability, and cost was marginal or insufficient. Discussion Most recent graduates entering radiation oncology have not received adequate education on cost, affordability, and value. This education gap leads to the vast majority stating ignorance to the cost burdens on patients. Given rising healthcare costs, systemic reform of medical education will be required to educate the next generation of oncologists on the importance of value-based cancer care. A cancer diagnosis can lead to lasting financial problems for many Americans. The American Medical Association has called for a greater focus on value and affordability education to increase awareness of burdens on both patients and the healthcare system. This study evaluated how future physicians were educated on cost and value-based principles during their undergraduate medical education. Radiation Oncologists were the focus given their oncology specific residency. 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 (2016-2012) 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. Of 279 contacted, 67 (24.0% response rate) completed the survey. Participants graduated in 2016 (25.4%), 2017 (6.0%), 2018 (25.4%), 2019 (17.9%), 2020 (14.9%), and 2021 (10.4%); they trained in the Northeast (34.3%), South (26.9%), Midwest (29.9%), and West (9.0%). Less than half had a lecture on value (49.3%, n=33) or costs (32.8%, n=22). Only 19.4% (n=13) had an entire class on value. About half had heard value mentioned "occasionally" (55.2%, n=37) during their time on the wards and less than a third (28.4%, n=19) heard about it "frequently". Similarly, half had heard about costs "occasionally" (52.2%, n=35) and less than a quarter (17.9%, n=12) had heard it mentioned "frequently". Less than half had a lecture on health insurance (46.3%, n=31); about a third had heard it mentioned "occasionally" (38.8%, n=26) on the wards while less than a tenth (7.5%, n=5) had hear it mentioned "frequently". A third had NO education on improving affordability for patients (34.8%, n=23) although about a half had been taught to discuss the $4 list and/or pill splitting (47.0%, n=31). Less than a tenth (9.0%, n=6) had a "good idea" of the charged/billed prices and even less (6.0%, n=4) knew the out-of-pocket costs for standard tests, procedures, and medications. Most (89.6%, n=60) felt their education about value, affordability, and cost was marginal or insufficient. Most recent graduates entering radiation oncology have not received adequate education on cost, affordability, and value. This education gap leads to the vast majority stating ignorance to the cost burdens on patients. Given rising healthcare costs, systemic reform of medical education will be required to educate the next generation of oncologists on the importance of value-based cancer care.