Medical subspecialty training and interest in cost containment education

To investigate academic physicians' interest in learning methods to reduce health care costs, we asked the faculty and housestaff of a university-based department of internal medicine to rate their interest in 30 potential topics for medical grand rounds, a traditional forum for continuing medical education. The 30 topics were equally divided among clinical, research and cost-containment categories. The 29 housestaff and the 41 subspecialty faculty members clearly favored clinical and research topics over cost-containment topics (p less than 0.001). On the other hand, the nine general internists considered the cost-containment topics as attractive as the clinical and research topics and ranked them higher than did both the subspecialists (p less than 0.001) and the house-staff (p less than 0.05). Efforts to alter costs in academic medical centers may be hampered by the relative disinterest in cost-containment education among house officers and subspecialists, who are responsible for most of the health care delivery in this setting.