By Marty Muntz, MD, FACP
I am not an economist.
This is how I start my high-value care session during the internal medicine clerkship orientation day at MCW, and it is absolutely true. It doesn’t take an economist, though, to realize that healthcare is too expensive. Healthcare spending as a percentage of GDP has increased from around 7% in 1970 to almost 18% in 2010. An estimated 30% of the $2.8 trillion spent healthcare is wasteful. And we can blame whomever we want. Trial lawyers? Insurance companies? Pharmaceutical sales? Even patients? Certainly there is more than enough responsibility to go around – but as physicians, we are not innocent. And we would be foolish to expect others to fix this mess for us.
And while I hope our current physician workforce is ready to change, we were trained differently. I remember double- and triple-checking my patient list before morning report to make sure I had been complete when ordering tests for my broad differentials. The good residents investigated multiple zebras in addition to the clear most likely diagnosis, and we wanted to look good in front of our peers and esteemed faculty. I don’t remember discussions on cost or value.
And while some would scoff at the contribution of primary care specialties to this issue compared to specialties like cardiology, radiology, emergency medicine, and surgeons who are more likely to order high-cost tests and treatments, it is clear that the sheer numbers of patient visits in primary care clinics and admissions to the general medicine or pediatric wards generate essentially limitless opportunities to practice high-value, cost-conscious care. In fact, the cost savings of applying “Top 5” lists for healthcare cost stewardship across the primary care specialty organizations alone would approach $7 billion annually.
Though I’m not an economist, I am a teacher. I am fortunate to have the opportunity to work alongside and impact the skills and attitudes of the next generation of physicians. These are amazing people – smart, enthusiastic, and dedicated to their patients…and yet, they are often relegated to shadowing roles during medical school – or assigned tasks that we would never ask physicians to complete. Why? Innovations aimed at aimed at physicians in practice and residency programs have been published showing decreases in spending and resource utilization, but none that have put our highly capable students in the “agents of change” role during the time when they are first developing their patient care skills and professional identities.
So we figured “why not us”? And while we are proud of our results showing immediate decreases in resource utilization and increases in high-value care teaching and discussions among faculty, residents, and students, we are even more hopeful that this leads to significant changes in practice as these bright young future doctors enter the workforce and start teaching our future students. And that leaders might consider medical students as team members who can play a meaningful role solving a problem facing the healthcare team. They are absolutely up to the challenge.
By Marty Muntz, MD, FACP is an Associate Professor of Medicine and the Internal Medicine Clerkship Director at the Medical College of Wisconsin in Milwaukee. His team was also selected as one of the winners of the 2nd Annual Teaching Value and Choosing Wisely Challenge. You can reach him at: @mmteacherdoc and @MedicalCollege