Training Physicians To Provide High-Value Cost-Conscious Health Care

Lorette A. Stammen, MD Department of Educational Development and Research Faculty of Health, Medicine, and Life Sciences Maastricht University, Maastricht The Netherlands

Dr. Stammen Interview with:
Lorette A. Stammen, MD
Department of Educational Development and Research
Faculty of Health, Medicine, and Life Sciences
Maastricht University, Maastricht
The Netherlands

Medical Research: What is the background for this study? What are the main findings?
Dr. Stammen: Research indicated that we can improve the quality of care and reduce the health care costs by eliminating health care waste. Health care waste are health care services that are not beneficial to patients. There are many ways to reduce health care waste, like through insurance and government policies modification,  but we were especially interested in how the medical expertise of physicians could improve high-value, cost-conscious care. We conducted a systematic review with the aim of understanding how training programs cause learning among physicians, residents and medical students. We analyzed 79 articles using realist review method and found three important factors that facilitate the learning of physicians (in training).

  • First, educational programs should focus on knowledge transmission. Knowledge that is essential entails knowledge regarding prices and general health economics, scientific evidence, and patient preferences.
  • Besides knowledge, the second factor of training for high-value, cost-conscious care is reflective practice. Reflective practice for example using feedback and asking reflective questions, by peers, colleagues and supervisors to reflect on decisions made in daily practice.
  • The third element of training programs should address an supportive environment in which physicians, residents and medical students learn. A supportive environment is important to cultivate the importance of high-value, cost-conscious care on multiple levels in the health care system. Since physicians are a part of a health care team their training programs should incorporate the training of health care professionals.
  • Furthermore, it is important that role models demonstrate high-value cost-conscious care.

Medical Research: What should clinicians and patients take away from your report?

Dr. Stammen: It is important that physicians are aware of the fact that some health care services, such as diagnostic procedures or therapeutic services, do not add value. A critical attitude towards daily decisions in health care is important for eliminating health care waste. Discussing the relevance of care provided by professionals is an important aspect and physicians can fulfill an important role in the training of residents and students as a role model of high-value, cost-conscious care. The future of health care entails innovation, medical and technical, and more resources will become available for physicians and patients. Considerate use of these services is an important feature of the current and future physician.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Although measuring the value of care is extremely complex, it is important that outcome measures do no only focus on health care costs. Focussing solely on volume or costs to evaluate high-value, cost-conscious care might promotes the incorrect assumption that cheaper is better, Future researchers should be considerate of which outcome measures to use in evaluating high-value, cost-conscious care.


Stammen LA, Stalmeijer RE, Paternotte E, et al. Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review. JAMA. 2015;314(22):2384-2400. doi:10.1001/jama.2015.16353.






Last Updated on December 16, 2015 by Marie Benz MD FAAD