title: Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?
abstract: BACKGROUND
  Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied.
  
  
  METHODS
  A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training.
  
  
  RESULTS
  The survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training.
  
  
  CONCLUSIONS
  This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.
authors.affiliation: University of California, San Diego, Department of Emergency Medicine and Department of Anesthesiology, Division of Critical Care, San Diego, California.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Tainter
authors.affiliation: The University of Oklahoma, Tulsa, Department of Emergency Medicine, Tulsa, Oklahoma.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Gentges
authors.affiliation: Weill Cornell College of Medicine in Qatar and Hamad Medical Corporation, Department of Emergency Medicine, Doha, Qatar.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
authors.affiliation: The University of Oklahoma, Tulsa, Department of Emergency Medicine, Tulsa, Oklahoma.
authors.forename: Boyd D
authors.initials: BD
authors.lastname: Burns
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum / Q000592:standards*; D003955:Diagnostic Tests, Routine / Q000191:economics*; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010865:Pilot Projects; D011795:Surveys and Questionnaires