title: The role of training environment care intensity in US physician cost consciousness.
abstract: OBJECTIVE
  To examine a potential relationship between training environment and physician views about cost consciousness.
  
  
  METHODS
  This was a cross-sectional study of US physicians who responded to the Physicians, Health Care Costs, and Society survey conducted between May 30, 2012, and September 30, 2012, for whom information was available about the care intensity environment of their residency training hospital. The exposure of interest was a measure of the health care utilization environment during residency from the Dartmouth Atlas of Health Care Hospital Care Intensity (HCI) index of primary training hospitals. The main outcome measure was agreement with an 11-point cost-consciousness scale. The generalized estimating equations method was used to measure the association between exposure and outcome.
  
  
  RESULTS
  Of the 2556 physicians who responded to the survey, 2424 had a valid HCI index (95%), representing 649 residency programs. The mean ± SD cost-consciousness score among physicians trained at hospitals in the lowest quartile of care intensity (31.8±5.0) was higher than that for physicians trained at hospitals in the top quartile of care intensity (30.7±5.1; P<.001). Adjusting for other physician and practice characteristics, a population of physicians trained in hospitals with a 1.0-point higher HCI index would score approximately 0.83 points lower on the cost-consciousness scale (beta coefficient = -0.83; 95% CI, -1.60 to -0.05; P=.04).
  
  
  CONCLUSIONS
  The intensity of the health care utilization environment during training may play a role in shaping physician cost consciousness later in their careers.
authors: Division of General Internal Medicine, University of Pennsylvania, Philadelphia. Electronic address: ryskina@mail.med.upenn.edu.
authors: Kira L
authors: KL
authors: Ryskina
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Biostatistics and Epidemiology, and Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia.
authors: Scott D
authors: SD
authors: Halpern
authors: School of Arts and Sciences, University of Pennsylvania, Philadelphia.
authors: Nancy S
authors: NS
authors: Minyanou
authors: Department of General Internal Medicine, University of Michigan, Ann Arbor.
authors: Susan D
authors: SD
authors: Goold
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Jon C
authors: JC
authors: Tilburt
mesh_terms: D001291:Attitude of Health Personnel; D003363:Cost Control; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload
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