Switching costs in medical education

Dear Editor: Medical education is associated with significant costs [1]. Those who are responsible for the delivery of medical education must continually make decisions that have financial consequences [2]. Sometimes decisions are to invest in a new product or service, sometimes to disinvest. Sometimes decisions involve the educator realising that they should switch from one provider of medical education to another, or from one product to another. Consciously or unconsciously these decisions are inevitably made on value-educators want to maximise the outcomes from medical education or to minimise costs [3,4]. But decisions to change inevitably involve cost in themselves-these are called switching costs (or sometimes switching barriers). Switching costs are not unique to medical education-they occur in all walks of life [5]. If switching costs are too high, they can cancel out any savings made as a result of going with a lower cost purchase. There are various types of switching costs-understanding the types and understanding methods of preventing or overcoming switching costs will enable medical educators to make better purchasing decisions. Switching costs come in a variety of forms. They include costs related to exit, search, learning, equipment , and installation. Some authorities would include non-financial costs in switching costs. These might include the psychological worry of changing from a tried and trusted provider to a new one. However for the purpose of this article, switching costs mean financial costs only. This is not to dismiss non-financial costs but rather to define terms at the start. Let's take the various types of financial switching costs one by one. Exit costs are the costs of giving up an existing product or service. They might include breach of contract payments. For example a medical educator may wish to change from one online learning provider to another. However the educator may have agreed terms and conditions with the existing provider that last for three years and may have to pay a penalty to exit the contract early. The way to prevent having to pay exit fees is simply to read the fine print in contracts in the first place and establish early potential break points in the contract. If exit fees are in place however and the provider insists that they are paid then the medical educator has no legal recourse but to pay. However some providers may wish to remain on good terms with purchasers and so may be willing to …