Surgical Cost Awareness Stayed Poor Across Seven Departments
Cost literacy in surgery remains far below the standard many training programs hope to achieve. Across seven surgical departments at Naval Medical Center San Diego, interns, residents, and attending physicians consistently misjudged the price of routine disposables and specialty-specific consumables, and experience did not rescue performance. The findings point to a persistent gap in surgical cost awareness inside a training environment where systems-based practice is supposed to be part of everyday education.
The study surveyed clinicians between 2022 and 2023 and captured 123 respondents who contributed 2,460 individual cost estimates. Overall response rate reached 57%, giving the sample enough breadth to reflect multiple levels of training and several operative subspecialties. Accuracy was defined stringently: an estimate counted as correct only if it fell within 50% of the actual price. By that standard, overall accuracy reached 22.9%, while the median error was 156.4%, with an interquartile range of 53.9% to 891.7%.
Those numbers are not a minor bookkeeping issue.
Experience Did Not Translate Into Better Estimates
One of the most striking features of the survey is the flat relationship between seniority and performance. Age, sex, position, and length of experience were not associated with better accuracy. Interns did not outperform more advanced residents in any meaningful way, and attending physicians did not show a measurable advantage over trainees on the cost items tested. In a setting where repeated exposure to the operating room might be expected to sharpen intuition about supplies and resource use, the data showed no such drift toward greater precision.
That pattern matters because cost awareness is often assumed to accumulate informally, through repetition and apprenticeship. Here, repeated exposure to instruments, drapes, suture material, and other consumables did not appear to generate reliable price knowledge. In practical terms, clinicians can become adept at choosing the right device while remaining disconnected from its financial footprint. The operating room may be one of the most resource-intensive clinical environments in medicine, yet the people making real-time decisions about what gets opened and used often have only a vague sense of what those choices cost.
Self-assessment did not offer much reassurance either. Most respondents rated their own cost knowledge as low, but interest in further education was high. That combination creates a narrow opening for curriculum design: the problem is recognizable to the workforce, and the appetite for instruction appears to be present rather than forced from outside.
Orthopedic Surgery Showed Lower Accuracy Than General Surgery
Across specialties, the clearest difference emerged in orthopedics. Orthopedic surgery respondents were less accurate than the reference group of general surgery respondents, with an odds ratio of 0.59, 95% CI 0.4 to 0.86, and P = .0067. The study did not identify similar differences by age, sex, or experience length, which makes the specialty effect stand out more sharply.
Several plausible explanations fit the clinical workflow. Orthopedic practice often relies on procedure-specific implants, sets, and higher-cost disposable equipment, so the price structure may be less transparent than in general surgery. In many specialties, high-cost items are bundled into standardized supply chains, leaving clinicians insulated from the actual transaction price. When the line between a necessary implant and a consumed disposable becomes operationally routine, price visibility can fade even as device complexity rises.
Why Cost Literacy Belongs in Surgical Training
Poor cost estimation is not just an administrative flaw. In surgery, choices about consumables and procedural supplies affect institutional spending, patient access, and stewardship of finite resources. A clinician who cannot approximate the cost of a common item may still deliver excellent technical care, but that gap can weaken systems-based practice and reduce the ability to participate in value-conscious decision-making. Training programs increasingly ask physicians to balance quality, safety, and efficiency; those goals become harder to reach when even basic item prices are opaque.
The data also speak to the structure of medical education. If cost awareness does not improve with time in practice, then passive exposure is not enough. Informal learning appears insufficient to move estimates toward reality. Formal instruction, repeated reinforcement, and specialty-specific examples may be needed if programs want cost literacy to become part of everyday surgical judgment rather than a peripheral administrative skill.
A survey like this does not prove that cost education will immediately change operating room behavior, but it does identify a deficit that is large, measurable, and widespread. The median estimate error of 156.4% suggests that many clinicians are not merely off by a little; they are often far outside an acceptable range. In a field where margins are scrutinized and resource use is increasingly visible, that level of inaccuracy leaves a lot of room for improvement.
Single-Center Strengths and Limits of Generalization
The study’s broad specialty representation is a clear strength. Seven surgical departments were included, allowing the investigators to compare cost awareness across a more diverse sample than a single-department survey could provide. The project was also reviewed as exempt by the institutional review board under NMCSD.2021.0028, and it used a multivariable logistic regression approach to look for predictors of accuracy alongside nonparametric testing against known costs.
Even so, the setting places real limits on extrapolation. The work was performed at a single military training hospital, and the authors explicitly note that the single-payer structure may restrict generalizability to civilian healthcare systems. Response bias is another built-in concern, since clinicians who chose to participate may differ from those who did not. Those constraints do not erase the findings; they simply define the boundary of where the results can be applied with confidence.
What remains most actionable is the signal that surgical cost awareness is low across the board and does not improve automatically with seniority. Educational interventions aimed at cost literacy now have a clear target: not just trainees, but staff physicians as well, and not just one specialty, but multiple surgical disciplines operating under the same institutional roof.