About 18% of the US gross domestic product is consumed by health care—more than that of any other industrialized country—and that number is expected to increase to 20% by 2020. Physicians are principal gatekeepers who decide when, how, and what health care services are delivered, with some estimates that at least 60% of health care costs are determined or influenced by physicians. Despite the enormous resources at stake, physicians receive little education in how to manage and steward finite resources, making formal education of physicians in “program integrity” an essential component of medical professionalism.

Shantanu Agrawal, MD Julie Taitsman, MD Christine Cassel, MD