Attaining Financial Fluency among Physicians: Start with the Students.

One in three chronically ill patients is unable to afford medications, food, or both. Too often, physicians do not discuss costs of care, risking decreased patient adherence. Physicians may be uncomfortable talking about prices and costs with patients because they receive little training in how to do so. The authors argue that one way of teaching provid- ers financial fluency—defined here as physician knowledge of and comfort with discussing economic barriers to care—is to provide that training early in their careers. The concept of anchoring bias supports this argument, as it suggests that humans often rely heavily on the first piece of information obtained. An ideal training setting is the student- run community clinic, where volunteer physicians see low- income, uninsured patients, and medical students coordinate care. This early exposure trains students to expect, rather than fear, a discus- sion about the cost of care. These experiences should be expanded and formally evaluated.