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Table 1 Attitudes of U.S. Practicing Physicians and Medical Students toward Cost-Conscious Care

From: Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training

Survey Itema Moderately or Strongly Agree, n (%)b
Practicing physicians (n = 2556) Medical students (n = 3395)
Age > 60 years (n = 411) Age 51–60 years (n = 962) Age 41–50 years (n = 833) Age 30–40 years (n = 350) p-value All yearse(n = 3395) p-value
Unadjustedc Adjusted for sexd Unadjustedc Adjusted for sexd
Doctors are too busy to worry about the costs of tests and procedures. 86/386 (22) 217/921 (24) 238/802 (30) 112/342 (33) < 0.001 < 0.001 995/2947 (34) < 0.001 < 0.001
Trying to contain costs is the responsibility of every physician. 334/383 (87) 800/919 (87) 659/798 (83) 286/342 (84) 0.03 0.06 2640/2932 (90) < 0.001 < 0.001
Physicians should take a more prominent role in limiting use of unnecessary tests. 344/381 (90) 825/922 (89) 695/797 (87) 298/342 (87) 0.26 0.30 2896/3003 (96) < 0.001 < 0.001
Cost to society should be important in physician decisions to use or not to use an intervention. 218/382 (57) 492/919 (54) 400/796 (50) 197/342 (58) 0.05 0.06 2062/2951 (70) < 0.001 < 0.001
Physicians should sometimes deny beneficial but costly services to certain patients because resources should go to other patients who need them more. 60/381 (16) 140/913 (15) 119/794 (15) 47/340 (14) 0.90 0.03 1024/2987 (34) < 0.001 < 0.001
It is unfair to ask physicians to be cost-conscious and still keep the welfare of their patients foremost in their minds. 147/383 (38) 359/919 (39) 359/794 (45) 158/343 (46) 0.01 0.02 887/2950 (30) < 0.001 < 0.001
Practicing cost-conscious care will undermine patients’ trust in physicians.f 101/389 (26) 255/913 (28) 246/780 (32) 102/327 (31) 0.15 0.01 482/2931 (16) < 0.001 < 0.001
Physicians should be aware of the costs of the tests or treatments they recommend. 297/384 (77) 719/921 (78) 608/798 (76) 239/434 (70) 0.02 0.003 2920/3000 (97) N/Ag N/Ag
Physicians should try not to think about the cost to the health care system when making treatment decisions. 156/386 (40) 359/920 (39) 354/800 (44) 143/343 (42) 0.17 0.27 652/2997 (22) N/Ag N/Ag
Physicians should be solely devoted to individual patients’ best interests, even if that is expensive. 299/383 (78) 708/918 (77) 623/797 (78) 272/340 (80) 0.75 0.78 2265/3005 (75) 0.17 0.05
The cost of a test or medication is only important if the patient has to pay for it out of pocket. 63/385 (16) 126/921 (14) 130/800 (16) 68/343 (20) 0.06 0.05 399/2951 (14) 0.009 0.002
  1. aSurvey items listed as they appeared in the medical student survey. Unless otherwise indicated, physicians (surveyed in mid-2012) and medical students (surveyed in early 2015) were asked to indicate their extent of agreement on a four-point Likert scale (1 = strongly disagree, 2 = moderately disagree, 3 = moderately agree, 4 = strongly agree). Data for medical students are previously published. [17]
  2. bPercentages not all based on a denominator of 350 (for physicians age 30–40 years), 833 (for physicians age 41–50 years), 962 (for physicians age 51–60 years), 411 (for physicians age > 60 years), or 3395 (for students) because of missing responses to some survey items
  3. cPearson Chi square test; p-values < 0.001 considered statistically significant
  4. dMultivariate logistic regression controlling for sex; p-values < 0.001 considered statistically significant
  5. eMost medical students were age 30 or younger (2657/2958, 90%)
  6. fPhysicians were asked to indicate their extent of agreement with this item by checking a box (checked = agree, unchecked = disagree) as part of a “check all that apply” question; the denominator for this item represents the number of respondents who checked any box associated with this question
  7. gFor these items, medical students were asked what physicians should do whereas physicians were asked what they actually do. Thus, although survey items measured similar constructs, direct statistical comparisons of student and physician responses were not performed