The Price Is Right: Assessing Surgical Cost Awareness of Residents and Staff Across Surgical Specialties at a Single Training Hospital

Introduction Awareness of the cost of providing healthcare is increasingly emphasized within graduate medical education (GME). Although studies have evaluated cost awareness within single departments, few have assessed awareness across multiple specialties or training levels. We sought to determine whether surgical cost awareness varies by specialty or with career experience. Materials and Methods Between 2022 and 2023, seven surgical departments at Naval Medical Center San Diego were surveyed. Interns, residents, and staff physicians estimated costs of common and specialty-specific disposable or consumable surgical items. Respondents were surveyed on their self-perceived cost awareness and interest in cost literacy. Accuracy was scored based on error within 50% of actual cost. One-sample Wilcoxon signed rank tests were used to compare distributions of estimates against known true costs. Multivariable logistic regression was used to identify predictors of accuracy. This project was deemed exempt by the institutional review board (NMCSD.2021.0028). Results There were 123 respondents constituting 2,460 cost estimates (overall response rate 57%). Although most self-assessed cost knowledge was low, interest in additional education was high. Overall accuracy was 22.9%, with a median error of 156.4% (IQR 53.9-891.7%). Estimates were significantly different than true cost for all common items and many specialty-specific items. No differences in accuracy were found by age, sex, position, or experience length. Orthopedic surgery respondents were less accurate than reference general surgery respondents (OR 0.59, 95% CI 0.4-0.86, P = .0067). Conclusions Cost awareness among surgical staff and trainees was low and did not improve with experience. Broad representation of all surgical specialties is a particular strength of this study, while limitations include inherent response bias and a single-payer structure which may restrict generalizability to civilian healthcare settings. Formal educational interventions should be considered to improve cost literacy as a component of systems-based practice competencies.