Complaints about the cost of healthcare are common throughout the country, with patients often saying they have no idea how much a certain service may cost until it’s too late. But what about the individuals actually ordering the services? Do they know the costs? According to a study published in the Journal of the American College of Radiology, postgraduate physician trainees have “limited awareness” of the costs of common imaging examinations.

In January 2016, researchers surveyed more than 350 trainees about the Medicare national average total allowable fees for five diagnostic imaging examinations: two-view chest radiograph, contrast-enhanced CT abdomen and pelvis, unenhanced MRI lumbar spine, complete abdominal ultrasound and unenhanced CT brain. All respondents came from the same large academic medical center.

Overall, the trainees did not do well. Just 5.7 percent of all responses were correct (with “correct” being defined as any answer within ±25 percent of published amounts). More than 76 percent of all respondents provided an incorrect answer for all five examinations. Just one trainee provided more than two correct responses.

“Our survey demonstrates a striking knowledge gap with regard to common imaging costs, with 94.3 percent of all trainee estimates falling outside of the correct range,” wrote lead author Arvind Vijayasarathi, MD, MPH, MBA, department of radiology and imaging sciences at the Emory University School of Medicine in Atlanta, Georgia, and colleagues.

Looking deeper into the data, 87 percent of all survey responses were incorrect overestimates, while more than 7 percent of the responses were incorrect underestimates. In addition, there was “no significant difference in cost knowledge scores” between trainees who participated in a medical school radiology elective and trainees who did not.

One key detail about this study was that the trainees came from a variety of specialties. Vijayasarathi et al. explained that studies had been performed in the past focusing on radiology trainees’ understanding of imaging costs—and, for the record, they also did poorly—but this survey was taking a broader look at recent graduates.  

“Although the lack of awareness among radiology trainees regarding the costs associated with their own specialty is concerning, it may be less relevant than the results of our analysis, because radiologists rarely order diagnostic imaging examinations and, as such, may exert less control over diagnostic imaging spending than physicians from other specialties,” the authors wrote. “To our knowledge, no larger-scale study has specifically assessed the imaging cost awareness of physician trainees across all specialties and years of postgraduate training.”

So what can be done? The authors noted that the most obvious answer is to improve what students learn while still in medical school. Teach them more about costs of imaging, radiation dose and patient safety considerations, Vijayasarathi and colleagues said, and you would produce graduates better prepared to order imaging.

“Theoretically, trainees across a variety of fields could gain these requisite skills over time via focused teaching, interactions with radiologists, and self-study,” the authors wrote. “However, the opportunity for physicians of all specialties to develop a strong educational foundation in pertinent radiology-related areas begins during medical school.”