Do trainees or attendings know the cost of care? A multidisciplinary analysis

Purpose The rising cost of healthcare has become a prominent topic in healthcare systems and medical education, with the ACGME specifically requiring residents to demonstrate competency in cost-efficient care and that faculty must demonstrate a commitment to cost-effective care. We hypothesize that physicians – both faculty and trainees – have limited knowledge of the cost of care they are providing. Methods Following informed consent, a survey was administered to faculty and trainees in the Departments of Surgery (GS), Obstetrics and Gynecology (OB), and Urology (URO) at a single academic center. Participants estimated the cost of three laboratory studies, two imaging studies, and two specialty-specific procedures. These estimates were compared against 2025 Medicare payment rates for all operations and Fair Health Consumer cost estimates for all inpatient laboratory and imaging tests. Results 117 participants completed the survey, with the majority being trainees (63.2%). Participants overestimated costs on average, with normalized mean absolute percentage error (MAPE) ranging from 92.7% to 254.8%. No difference in MAPE was seen between faculty and trainees when estimating cost of procedures (184.8% vs. 265.3%, p = 0.267). Similar proportions of participants overestimated laboratory and imaging studies regardless of trainee level or specialty. However, significant differences were seen in both rates of overestimation and MAPE of procedures when stratified by specialty, with OB participants demonstrating lowest accuracy and highest rate of overestimation, followed by GS and URO. Conclusion Physicians across all training levels are expected to help reduce hospital system costs; however, they lack understanding of the cost of care they are directing. Our findings highlight a knowledge gap in both our trainees and their supervising faculty, identifying the opportunity for department-specific education on cost of care at academic centers.