How can doctors understand the business side of medicine?

What do you regret about your medical training or specialty selection?

Anything?

One thing I regret is not taking advantage of the Masters degree in Health Administration program at my medical school. At the time, I was focused solely on medicine and on being a doctor. I didn’t think the business side of medicine was all that important. In fact, I didn’t consider the business side of medicine at all.

I regret that.

In a recent Medscape discussion physicians of different specialties discussed individual and collective regrets.

More than a few doctors regretted their choice of specialty. Pathologists seemed very unhappy with their choice because of the job market and the future of healthcare. An ER doctor regretted not choosing a surgical career. Several General Practitioners regretted choosing Primary Care.

However, many doctors were more concerned with what they did or didn’t get during their training. Gastroenterologists and ophthalmologists cited the lack of training in the business side of medicine as a gap to be filled.

Research has found that fewer than half of graduating medical students in the U.S. receives adequate training to understand healthcare system strategic approach and the economics of practicing medicine.

In a recent article in the New England Journal of Medicine two University of Michigan physicians recommended that healthcare policy be added to Medical School Curriculum.

“’Medical student and resident education has to include instruction on how healthcare systems function — especially with the advent of complicated national healthcare reforms,’ University of Michigan physicians said.”

“Without education in health policy and the healthcare system, physicians are missing critical tools in their professional toolbox,” said co-author Matthew M. Davis, MD, associate professor at U-M in Pediatrics and Communicable Diseases, Internal Medicine and Public Policy.

The U-M Medical School has added an elective course in healthcare policy. Davis notes that it is enrolled to the maximum.

But is there time for this information to be integrated into medical school and post-graduate training, each already overflowing with information? How can this curriculum be integrated with clinical instruction and permeate educational training without jeopardizing other topics?

Three years after I graduated from medical school I went back to school and got a business degree. However, going back to school requires a huge investment of time and resources that many of us are already short on. Most of the skills needed to succeed in the corporate world are already inherent in a doctor or cultivated by the discipline, dedication, drive and desire it takes to become a doctor. The business degree alone isn’t going to put you on the fast track to success.

What is the best way for doctors to appreciate and understand the business side of medicine? It’s important for the success of a clinical doctor who needs to market and oversee a practice. It’s important as we move into the realm of changes due to health reform and doctors must take leadership roles and be able to effectively negotiate their future employment situations. It’s important for the success of a doctor who is working in the non-clinical world in the financial sector or in a marketing, sales or management role.

What do you think?

Michelle Mudge-Riley DO successfully made the transition from clinical practice to non-direct clinical work and now works for a brokerage firm in Richmond, Virginia as Director of Wellness and Health Promotion. This post originally appeared on Freelance MD.

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Comments

Anonymous
Strange I come across your article when studying “Theories of Management and Change” as an elective subject for the Master of Education course. My reading takes me to a chapter on “Using the medical model of diagnostics to understand change in an organisation” and the disadvantages of such an investigative approach to problem solving. Should doctors leave the managing to external contractors and focus on the skills of treatment and cure or should they get into the semantics and technical workings of Weber’s, Bourdieu’s, Lewin’s, Systems or contigency approaches to medical management? Quite a debatable point!
Lorraine
Anonymous
It’s not only physicians who need this education; nurses need it, too. We were living in Chicago and my husband remarked that with my GPA, I should get an MBA at Northwestern. “An MBA?” I scoffed. “I’m a nurse! What would I do with an MBA?” Because of my experiences with referrals, requests for second opinions and insurance in the outpatient setting, I understood a lot more than my counterparts who only worked inpatient nursing and just assumed everyone who walked through the door could afford what the hospital was doing for them.
http://twitter.com/DarrellWhite Darrell White
Well-written and well-thought out. A couple of quick thoughts…
There is precious little time in med school now for all of the added stuff poured into a med student’s education over the last few years. Imagine, in an era where medical knowledge doubles at about the rate that microprocessor speed doubles, there is LESS time to learn medicine since other priorities have been injected into the mix (learning empathy, learning cultural sensitivity). No value judgement here, just an accounting of the clock and the calendar. The risk of teaching it in school is that any ingrained viewpoint on the part of the professor or the department (single-payer bent, libertarian market-based bent) will be taint the class and the course material. Tough call.
Traditionally the injection of business into discussions among doctors was considered vulgar, demeaning, beneath the dignity of the profession. Of necessity this has changed, but much of that sense is still in evidence. Doctors often feel as though they need to shower after an insurance negotiation, to was their hands after meeting with the accountant. A business consultant comes into the office through the back door and skulks around silently lest the staff and (gasp!) patients realize that s/he is there. Doctors who openly practice business as well as medicine are vilified by colleagues and laypersons alike for the heinous crime of seeking to make a profit…any profit. The opposite is laughingly true as well: doctors practicing the most very basic of business principals are hailed as veritable geniuses, although what they do is done every day in thousands of Seven-Eleven’s across the country.
I’d like to see real business stuff become part of the residency system. Business is different in some ways for a radiologist and a pediatrician, and the coursework should reflect this.
Nice article. Made me think a bit. Thanks.
Courtney Ross
Great post!
I just graduated with a dual degree (MD/MHA) and would absolutely do it all over again and have tried convincing fellow medical students to do the same. The information from the MHA was valuable and invaluable all at once. In one of our final med school sessions, there were more than a handful of students who not only did not know the true distinction between Medicare and Medicaid but also did not understand how much these agencies will impact our practices. It was frightening. And this is just one example of the gap in knowledge that future physicians have. After that session, I was even more grateful for the extra year I took to get the additional degree. I don’t think there is enough space in the med school curriculum to give adequate exposure to the administrative side of medicine, but maybe during 4th year – when students have more flexibility? Maybe a 1 month required elective? I’ve given a lot of thought to this. And I would recommend making it optional, but I don’t believe most medical students would want to take the extra time for it if they didn’t have to – simply because they may not know how important it is … the “Oh, I’ll just learn it later” mentality. I get that. We’re ridiculously busy and have a lot on our plates. But I’ve heard on more than one occasion how physicians just don’t “get it” – the business side of medicine, that is. And I feel so fortunate to “get it”. Certainly experience is the best teacher, but I know that I have a fantastic foundation to build upon. So I agree wholeheartedly that we need to somehow figure out how to incorporate the administrative piece into the clinical.
http://twitter.com/BabyProFinder BabyProFinder
Very interesting post. I created a web-based directory that includes REs, Ob/Gyns, Peds, and FPs. I am wondering how physicians like to be approached about business solutions? What do you give your attention to most- mailers, email, reps stopping by your office? Do you even entertain a sales rep if they calling asking for 2 minutes of your time or do you let your office manager handle it? Any insight about best practices would be appreciated!
http://pulse.yahoo.com/_WALHKZALAGSRD2M3BAURIPSRLA Sasha
I practiced for years as an associate, per diem, taught part time, merged my practice with a group, and eventually realized that the business side of medicine permeates into all aspects of the private practice model. I went back to school to get an MBA, thinking I would go into healthcare consulting, offer insight and direction to other clinicians. In the end, I was offered a position as chief of ophthalmology for a large hospital. While I agree that knowledge of strategic healthcare delivery is vital, most people “don’t go there” until there is a need or you’ve had an interest in it all along. The easiest option for the time being is to have a means of doing such training, whether it be in school initially, post degree, as a continuing education program or as a part time executive training program. The magnet will pull those that have an interest.

http://pulse.yahoo.com/_LTLMLNGZLOUTJEJS32QYBHPXTQ DeshPremi
The Magnet will pull those that have an interest. Well it is all on interest and understanding how far one has to go combining skill

David Samuels
This is music to my ears. While I[m not a physician, I have taught physicians and various other clinicians in Chapman University’s MHA program about healthcare finance (and even basic accounting), managed care, and even just management analysis techniques. I’ve just completed my fifth book in managed care and finance (available 12/7/11 from CRC Press) and my entire second book was devoted to teaching the basics of healthcare finance to physiciansl, using diagnostic and therapeutic frameworks applied to :”the business side of medicine.” My new book is a complete guide to msnaged care — not just from physician’s perspective, but also to understand the business side of managed care from health plan, hospital, and even the PATIENT’S perspectives. Someone had to come clean that patient non-adherence to physician’s instructions costs everyone money, and physicians have been scapegoated too long, and the missing accountability in America is how to make members accountable for their lifestyles and health status.
Anonymous
If a master’s degree is required to understand the business side of medicine, are we patients going to hear about how much more time and money doctors put into their education?
With such specialized skills, wouldn’t it be better for doctors to practice medicine instead of spending time running a business?
Anonymous
Depending on what medicine stands for, for an individual medical student the answer to the question of how to manage the business of medicine and not how to care for a patient allows a departure from the ethical guidelines that govern his interaction with his patient. Allowance of this departure challenges the levels of compassion, competence and trust that the physician aught to have for his patient in order to care for the patient instead of managing their care.
http://www.cadencemed.com/blog Matt Langan
Obviously medical schools have to prioritize medical training. Medical training should never be sacrificed for business courses. Rather, business courses should be required material as well. I’m not talking about full-blown MBA stuff, I’m talking about 1-2 courses that cover the basics (accounting, management, entrepreneurship, etc.). What’s the value of having the talent/knowledge necessary to be the world’s finest surgeon if nobody knows you exist (ie no marketing) or if the operation you work for can’t schedule or bill patients correctly or keep the facilities in proper shape? We live in a world where business provides the stages for skilled professionals to perform. The skills must be required in order to ensure a stable and healthy environment in order for your skills to be presented and paid for appropriately. Otherwise, you’re knowledge and abilities risk going to waste.
http://www.facebook.com/dane.gruenebaum Dane Gruenebaum
I agree whole heartedly and chose to earn an MBA during my first two years in medical school, which has provided me with some foresight I feel some of my colleagues lack.

How can doctors understand the business side of medicine?

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