A physician not knowing her business: A cautionary tale

The future of our health care system, lies with you, dear medical students and residents. While medical school and residency training does a pretty good job giving you didactic and clinical training, they might do a better job teaching you how to avoid the potential mess you will encounter once you complete your training. Perhaps the most shocking thing I encountered after completing residency training was how non-clinical administrators placed so much emphasis on “revenue generation” and not quality care of patients. Unfortunately years later, she encountered medical directors who held those same warped values.

As hospitals continue to buy physician practices, more of you will become employees rather than independent practitioners which might present a conflict with respect to the quality of care for your patients. By allowing a hospital to buy a practice, the physician gives up his or her right to admit to other hospitals that might provide better services. Your practice will become a business although you have received ostensibly very little business training in medical school.

In the name of revenue generation, you might be asked to see more patients than you were trained to see, inflate services on your claims bill or be tempted to earn money in an ethically-challenged way.

A cautionary tale

A physician had a booming obgyn practice in a remote town. She allowed her accountant and office manager access to her unique identifiers such as  her DEA number, business checking account number, Medicaid number, etc. She never got involved in the business of her practice because she was too busy taking care of her patients.

One day U.S. marshals armed with guns knocked on her door and carted her off to jail. She had been accused of defrauding the U.S. government out of over a million dollars unbeknownst to her.  She wore an orange jumpsuit for a week behind bars until her parents posted bail. She was a divorced mother with an adolescent child and a son who was a decorated war hero in the military.  She had graduated from an Ivy League school at the age of 19. She was now a convicted felon who lost her medical license, her freedom and her medical career.

When she was released from jail, she was informed by her attorney that her accountant had died. She didn’t. She was later informed by her probation officer that the accountant had entered a witness protection program. The moral of the story is that you, as a physician, must protect your medical license, your career and the safety of your patients. Sometimes it’s easier said than done.

Linda Burke-Galloway is an obstetrician-gynecologist and author of The Smart Mother’s Guide to a Better Pregnancy. She blogs at her self-titled site, Dr. Linda Burke-Galloway.

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  • SteveCaley

    Ugh.
    There are people who will make a dime by hijacking your credibility and status as a physician; then drop a dime on you to close it out.
    Since physicians are regarded as less trustworthy than killah thugs, the community may well turn on the doctor that has been serving them.

    • Suzi Q 38

      Sad.

  • John C. Key MD

    So true. Two decades ago the “best accountant in town” cost me my whole retirement savings due to ignoring filing dates and requirements for my plans. I learned my lesson…or at least the lesson I took home was to keep my finances simple enough to understand them myself from then on.

    I sleep much better now, just me and TurboTax.

  • querywoman

    I knew a woman with a master’s degree who became a minister in her middle age. She was at my large church for years as an assistant, then she went to my mother’s smaller church as the pastor.
    She had only worked as a wife and mother.
    My mother told me that donations fell when the woman minister came.
    One day a utility bill wasn’t paid, or maybe it had been cut off. The minister didn’t know why.
    A woman who worked in the church office had been draining money out of the church kitty for years, even before this pastor came. She had stolen plenty and got several years in prison.
    The woman minister was not paying enough attention to the day to day stuff. A small church is like a small business.
    Too bad the minister had never really worked for pay before!
    There’s a reason why several people usually count the collection plate in most churches!
    This lady doctor didn’t pay enough attention to her business details.
    Never trust other people too much!

  • Patient Kit

    I do not understand how doctors can get through such an extensive education — undergraduate during which most know their goal is to become a doctor, med school and residency — and come out on the other end clueless about the healthcare system they will be working in.

    How do new docs come out of all of that education unaware that “revenue generation” is such a big factor in our system. I mean, residents work for years inside hospitals where they are surrounded by the system. And what about reading news about the system they are working so hard to enter, especially now when we are in the midst of the biggest healthcare system changes in this country since 1965?

    I’m not saying that doctors need MBAs. But how can they get through so much education and experience and not learn how things work — for doctors and for their patients. Why doesn’t anyone teach them? Why aren’t they interested enough to find out on their own? How do new docs go through all that and find out, only after they are done with residency, that healthcare is a big profit-driven business?

    • guest

      It’s hard to understand unless you are a doctor yourself.

      When you are a doctor, the volume and complexity of the information that you need to know, and continue to learn for the rest of your life, and the cognitive work that is required to apply that information every day to care for people, is probably more than for almost any other job.

      The vast majority of doctors are left with barely enough brain power left over to have some sort of personal/family life. Adding an entire extra dimension of expertise, or even having the mental energy to notice subtle trends or undercurrents going on around them that don’t directly have to do with their doctoring, is not possible for a lot of them.

      • Patient Kit

        I guess I can understand that, to a point. There has to be a limit to how much new info any single human being can absorb at a time and docs in training to have a lot to learn. I get that and am actually in awe of it. I’ve thought more than once: How in the world did my awesome doc learn all that he needs to know to be such a good doc plus speak five different languages? Seriously, how does a person learn all that? Amazing really.

        That said, what a heavy price to pay for not absorbing anything about the business and politics of the healthcare system young docs are working so hard to become a part of! To somehow remain clueless about the system until AFTER you’ve invested many years of hard work, personal sacrifice and money, explains a lot about why many docs are in such a tailspin now that they do know how things work.

        It also explains a lot about how docs lost their power in this system and allowed it to become a bigger and bigger business with little resistance from docs. I guess I naively thought docs went into med school with their eyes wide open or, at least, that residency in hospitals were an eye opener. I guess I was wrong.

        And the current generation of docs in training? Same thing? They have no clue about what they are getting into either? The ACA, for example, is not even on their radar? No clues about the many barriers that may cause patients to struggle to be able to access the system and see them or stay with them? No clue that their will be pressure to generate revenue? At the same time, if med students are choosing not to go into primary care, they must know something about the system, yes?

        • guest

          Remember that there are also very strong cultural pressures for doctors to be clueless about the business aspect of medicine. We are socialized to believe that a truly professional doctor “doesn’t worry about money too much,” and that it is very unbecoming to be concerned about issues regarding reimbursement.

          Even now, professional societies and the ACGME are formalizing statements about “professionalism” and medical ethics that include language such as “Maintaining and passing on medicine to future patients, physicians, and society as a public trust, not a merchant guild.”

          Such language implies that doctors should commit themselves to providing a public service. The difference between doctors and other public servants like police officers or firefighters, however, is that we don’t have unions to protect our interests.

          All of these are reasons that doctors are easy marks for cynical corporate exploitation. When the clerical worker who used to complete some of your paperwork is let go, and you are expected to stay late at work to get it done and are told “it’s all for the good of the patient,” there’s no effective answer to that. A very savvy physician may realize that his extra work is actually benefiting the company who let the clerical worker go, but it’s completely impossible to point that out or protest, without looking like you’re “not concerned about the welfare of your patients.”

          I would say that a lot of medical students these days are a little more savvy than their elders and they realize that there’s this no-win dynamic going on in their profession, which is why many of them are looking for other things to do with their medical degrees than practice medicine.

    • B Viner

      As a resident, you have exams to prepare for, experience to gain and all the day to day patient care duties. You are salaried and it doesn’t matter to you how the business side works. Besides, if you were taught that, you wouldn’t have anything to relate it to until you joined or started a private practice. Coding is just one aspect of O&G and I went to a 3 day coding conference put on many times a year by ACOG. By the third day, you have everything jumbled in your head. It’s too complicated. Needs major simplification.