Medicine should welcome the fact that it’s a business

At the end of each day during my primary care rotation, my preceptor and I sat together and reviewed patient charts. Simon Craig, MD*, built his internal medicine practice from the ground up and is a pillar of the Connecticut community he has served for more than two decades. He is a physician, a clinician and a scientist. While he manages the day-to-day operations of his practice, he avidly denies being a businessman.

On one occasion, we were having a deep discussion about PA education during which I made a comment that business ideology should be taught as part of medical education. The look from his eyes went through me like daggers. What resulted was a fiery, passionate and off-the-cuff dissertation about how business and medicine ought to be entirely separated. I vehemently argued back. Prior to entering PA school, I was trained at the leading institution for entrepreneurship education, and started and managed several companies. I know business, and I recognize that our medical system would be stronger if healthcare providers knew it too.

Business is not evil. Of course, there are some aspects of business that are cutthroat. There are individuals looking to make a quick buck at the expense of others. Some companies operate with questionable moral grounding and others with seemingly no meaningful purpose at all. However, it would be irresponsible to deny that similar behaviors can exist in medicine.

To me, harnessing business values means thinking creatively to craft solutions for everyday problems. It is about delivering outstanding service while providing a scientific framework for doing so. It begs for efficiency and waste reduction. Perhaps, above all in our current healthcare climate, a good medical “business” is one that manages its costs — something we have profoundly failed at in healthcare.

In reflecting on my business education, there are countless examples of lessons learned which apply to the world of medicine:

  • The managerial accounting course explained how overhead expenses contribute to real costs. It is with those principles that I understand why a single tablet of acetaminophen costs $2 at a hospital and a container of 100 tabs costs about the same at Target. Understanding why specific pricing exists is paramount to brainstorming ways to reduce fees.
  • The services marketing course provided key insight into how important communication is within a service-based industry. We must never forget that at its most basic foundations, medicine is exactly that — a service, and one that is provided to thousands of patients each and every day.
  • The human resources management course detailed how the proper treatment of employees leads to better outcomes. Medical providers who enjoy the culture of their respective institutions work more effectively, embrace team-based medicine, and ultimately provide better patient care.

The list of parallels goes on.

Dr. Craig made a point that businesses exist to make money and his practice exists to treat patients. In his eyes, the two interests were completely misaligned. Herein lies one of the largest misconceptions of the art of business. While it is true that basic business principles are about improving the “bottom line,” nowhere is it dictated what must be done with those earnings. In medicine, those profits could (and should) be reinvested into patient care.

Case in point: Dr. Craig and I spent time together crunching numbers and discussing process improvements within his practice. It became apparent that Dr. Craig could actually hire a PA with the savings, thus improving his patients’ access to medical care.

There have been times in my PA education where I have been seen as an intruder by skeptics; an impostor looking to learn medicine only to turn around and profit from it. The truth is quite the contrary. I am proud of my business education, and it is because of that education that I feel prepared to not only be an excellent medical provider, but also an individual poised to contribute to the PA profession and the field of medicine. Rather than fearing business, we should all welcome and learn from it — and then utilize that expertise to effect positive change in our healthcare system.

* The name of the primary care preceptor has been changed.

Rich Bottner is a physician assistant student.  This article originally appeared in PAsConnect.

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