Business of medicine course at your med school?

[Equality]

Year after year in the AAMC Graduation Questionnaire, topics like medical economics, practice management, and law and medicine were generally perceived as inadequately covered in medical school.

In 2013, 63% of the respondents said Medical economics was inadequately covered
Law and medicine: 53% in adequate
Practice management: 50% inadequate

This in contrast to topics like "diagnosis of disease" that 94% of the respondents in 2013 said were adequately covered.

Obvious this is a huge gap in medical education.

Did any of you go to a medical school that actively tried to cover topics like private practice financial management, malpractice, different models of medical practice, hospital operation decision making, drug/device development process? Any courses (not separate degree programs) dedicated specifically to such topics?

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[Psai]

The real question is which schools aren't covering the diagnosis of disease adequately. That's the whole point of medical school.

 

[tantacles]

Year after year in the AAMC Graduation Questionnaire, topics like medical economics, practice management, and law and medicine were generally perceived as inadequately covered in medical school.

In 2013, 63% of the respondents said Medical economics was inadequately covered
Law and medicine: 53% in adequate
Practice management: 50% inadequate

This in contrast to topics like "diagnosis of disease" that 94% of the respondents in 2013 said were adequately covered.

Obvious this is a huge gap in medical education.

Did any of you go to a medical school that actively tried to cover topics like private practice financial management, malpractice, different models of medical practice, hospital operation decision making, drug/device development process? Any courses (not separate degree programs) dedicated specifically to such topics?

Malpractice, medical law, and drug development were covered somewhat in our curriculum. I didn't gain much out of having these topics covered, however.

 

[BurghStudent]

I think it's extremely important to cover these things in med school. Sure, we are becoming physicians. But honestly, there is enough fluff in the curriculum to make room for such crucial topics.

My impression is that medical schools don't have a separate course for these things, rather they might come up here and there, or in elective after-class activities.

 

[DocVapor]

I thought that this sort of thing was what MD/MBA and DO/MBA programs were for.

Frankly, I don't think doing any less than that is worth it.

 

[dadaddadaBATMAN]

I thought that this sort of thing was what MD/MBA and DO/MBA programs were for.

Frankly, I don't think doing any less than that is worth it.

Agree, at least in part. I can't imagine many things more painful than sitting through an econ. lecture after a morning of basic sciences.

Especially because I get the feeling that many of the practical things you need to know come with experience: or can be read independently of a formal class.

 

[NickNaylor]

I thought that this sort of thing was what MD/MBA and DO/MBA programs were for.

Frankly, I don't think doing any less than that is worth it.

I completely disagree. The majority of medical trainees will not end up working in a big academic center. Many will work in solo or small group practices. I don't see how the basics surrounding medical billing, legal liability, and the economics of healthcare wouldn't be relevant. No, you're not necessarily going to be making huge business decisions, but I think it's important to at least have an idea of how the money that's going toward paying you is "produced." The huge ivory fortress of protection will not always be there for many future physicians.


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[DocVapor]

I completely disagree. The majority of medical trainees will not end up working in a big academic center. Many will work in solo or small group practices. I don't see how the basics surrounding medical billing, legal liability, and the economics of healthcare wouldn't be relevant. No, you're not necessarily going to be making huge business decisions, but I think it's important to at least have an idea of how the money that's going toward paying you is "produced." The huge ivory fortress of protection will not always be there for many future physicians.


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I certainly think it is good to know. My point was more that to make an appreciable difference, you need more than the very basic overview that most of us would have time for. Even an MBA can be inadequate in most cases, even though it is the degree du jour nowadays it seems.

Edit: our hangup here might just be due to different definitions of what 'basics' entails.

 

[dadaddadaBATMAN]

I completely disagree. The majority of medical trainees will not end up working in a big academic center. Many will work in solo or small group practices. I don't see how the basics surrounding medical billing, legal liability, and the economics of healthcare wouldn't be relevant. No, you're not necessarily going to be making huge business decisions, but I think it's important to at least have an idea of how the money that's going toward paying you is "produced." The huge ivory fortress of protection will not always be there for many future physicians.


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The problem with this idea is where you put the time in. I have no problem with the idea of providing an optional seminar/lecture every week or two on healthcare issues, or providing lunch talks about it. What ticks me off is the idea of adding still more straw to my back, which is close enough to breaking as it is.

Another class isn't really feasible on top of our current workload, and honestly I would rather be tested on the things that are going to affect my patients as opposed to myself. I consider it my personal responsibility to become educated in aspects of ethics, law, culture and business as they will affect me.

 

[NickNaylor]

The problem with this idea is where you put the time in. I have no problem with the idea of providing an optional seminar/lecture every week or two on healthcare issues, or providing lunch talks about it. What ticks me off is the idea of adding still more straw to my back, which is close enough to breaking as it is.

Another class isn't really feasible on top of our current workload, and honestly I would rather be tested on the things that are going to affect my patients as opposed to myself. I consider it my personal responsibility to become educated in aspects of ethics, law, culture and business as they will affect me.

Agreed, but this is the kind of stuff that could be very easily added into the MS4 schedule.

I also agree that I don't think it's necessary. However, even if I wanted to learn about this stuff at my school I couldn't. Considering how integral this info is to, you know, having a practice, I think it'd be nice to at least make it available as an option.


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[Southplains]

We have a medical business elective course offered for M1&2's. I'm not in the course but I believe they have a different speaker each week that discusses a topic, and there are no tests or assignments. I'm not sure how helpful it really is beyond exposure to what you should be thinking about.

 

[mvenus929]

We have a two week health policy class at the end of third year, which does cover some things like malpractice, NP/PA role in healthcare, how healthcare is run in the US, and decision making in the administration of the hospital. It was a fairly useful course, I think.

We also had an optional elective during fourth year that covers the basics of judging the health of a business and the business model of evaluating decisions. However, it's offered at the same time as several 'prep for internship' courses through various departments, which was generally deemed a better use of time.

 

[PL198]

No, because these would completely detract from the whole mission of medical school. "Oh you mean we're supposed to make money as a doctor? But you've been telling me we were supposed to work for free for the last 2 years!"
^ Exactly how that would go over. You can't teach the business end(the actual business end) and still spew the social progressive stuff at the same time. Thus I'd rather them not fake some business bullcrap and just keep it how it is.

 

[DermViser]

I thought that this sort of thing was what MD/MBA and DO/MBA programs were for.

Frankly, I don't think doing any less than that is worth it.

Incorrect. Part of the reason that medical doctors are so oblivious to the things around them is due to the lack of this information. Very very medical schools have formal courses/rotations to take in which you can actually realize how billing, etc. works. Even if you wanted to take a course it's not offered. It's almost taboo to talk about reimbursement and billing as a medical student. Not at all surprising at an academic medical center in which you're pretty much allowed to lose money due to being an "educational" institution. Medical schools could EASILY make an MS-4 elective month, and teach what's important when it comes to documentation and billing.

 

[dadaddadaBATMAN]

Incorrect. Part of the reason that medical doctors are so oblivious to the things around them is due to the lack of this information. Very very medical schools have formal courses/rotations to take in which you can actually realize how billing, etc. works. Even if you wanted to take a course it's not offered. It's almost taboo to talk about reimbursement and billing as a medical student. Not at all surprising at an academic medical center in which you're pretty much allowed to lose money due to being an "educational" institution. Medical schools could EASILY make an MS-4 elective month, and teach what's important when it comes to documentation and billing.

From the sounds of things, you seem to feel you've picked up on some of this necessary information.

Do you feel it has become more obvious as a resident, or is it just that you have some prior experience/outside knowledge to draw from?

 

[DermViser]

From the sounds of things, you seem to feel you've picked up on some of this necessary information.

Do you feel it has become more obvious as a resident, or is it just that you have some prior experience/outside knowledge to draw from?

Definitely no outside knowledge.I think it's easier to learn in Derm, which is mainly outpatient based. Having cordial faculty willing to explain the minutiae of billing is very helpful. Like what's a Level 1 code, RVUs, etc.

I think it's much harder in inpatient specialties like Internal Medicine or Surgery, for example, bc so many things are going on, with so many obligations both educational and not, that it's difficult to find time to learn what you have to to get through residency, much less billing.

 

[dadaddadaBATMAN]

Definitely no outside knowledge.I think it's easier to learn in Derm, which is mainly outpatient based. Having cordial faculty willing to explain the minutiae of billing is very helpful. Like what's a Level 1 code, RVUs, etc.

I think it's much harder in inpatient specialties like Internal Medicine or Surgery, for example, bc so many things are going on, with so many obligations both educational and not, that it's difficult to find time to learn what you have to to get through residency, much less billing.

Thank you for the explanation!

 

[dyspareunia]

I completely disagree. The majority of medical trainees will not end up working in a big academic center. Many will work in solo or small group practices. I don't see how the basics surrounding medical billing, legal liability, and the economics of healthcare wouldn't be relevant. No, you're not necessarily going to be making huge business decisions, but I think it's important to at least have an idea of how the money that's going toward paying you is "produced." The huge ivory fortress of protection will not always be there for many future physicians.


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You're definitely right, but how many med students will honestly pay attention and put forth real effort in those types of classes? That's not to say that the perceived lack of student interest is a valid reason for med schools to leave out the business aspect, but maybe it plays a role.

Personally I have no business knowledge, but I know if my school had a course on it I wouldn't give it nearly enough time to actually gain anything from it. Perhaps it's a good class to have as a 4th year fluff elective (online modules, P/F exams, other things you can do while traveling for interviews).

At least from my point of view things like business (basic business) and ethics are common sense. You can teach me all the fancy words and concepts, but at the end of the day I am not going to retain anything about how to run a successful private practice from an MS1 or MS2 course.

 

[NickNaylor]

You're definitely right, but how many med students will honestly pay attention and put forth real effort in those types of classes? That's not to say that the perceived lack of student interest is a valid reason for med schools to leave out the business aspect, but maybe it plays a role.

Why would that be a good justification to not even offer the option? Regardless, then that's on those students if they choose not to be interested.


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[dyspareunia]

Why would that be a good justification to not even offer the option? Regardless, then that's on those students if they choose not to be interested.


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I said it might play a role even though it isn't a valid reason.

Edit: And most schools do offer an MD/MBA dual degree program.

Edit 2: Actually, I don't know how many offer an MD/MBA program.. but some do at least.

 

[DermViser]

You're definitely right, but how many med students will honestly pay attention and put forth real effort in those types of classes? That's not to say that the perceived lack of student interest is a valid reason for med schools to leave out the business aspect, but maybe it plays a role.

Personally I have no business knowledge, but I know if my school had a course on it I wouldn't give it nearly enough time to actually gain anything from it. Perhaps it's a good class to have as a 4th year fluff elective (online modules, P/F exams, other things you can do while traveling for interviews).

At least from my point of view things like business (basic business) and ethics are common sense. You can teach me all the fancy words and concepts, but at the end of the day I am not going to retain anything about how to run a successful private practice from an MS1 or MS2 course.

Uh...no.
There's a reason it would be taken during MS-4. Part of your medical responsibility is knowing why and how to bill, unless you wish to be fired.

 

[dyspareunia]

Uh...no.
There's a reason it would be taken during MS-4. Part of your medical responsibility is knowing why and how to bill, unless you wish to be fired.

I'm confused.

On one hand it sounds like you're saying MS4s need a business class so they can learn how to bill and not get fired (makes sense to me).

On the other hand it sounds like people ITT are saying "business of medicine" classes typically don't exist in med school curricula.

Obviously docs aren't getting fired left and right, so either there are classes being taught routinely, or MS4s are somehow able to learn the billing stuff without a class.

 

[Anastomoses]

Billing, psh. We need courses on taxation and laws. And those loophole thingamajigs Yglesias is talking about in that other thread.

 

[DermViser]

Billing, psh. We need courses on taxation and laws. And those loophole thingamajigs Yglesias is talking about in that other thread.

Have fun feeding yourself, when you don't know how to bill for your services. The govt. and third party payers will love you.

 

[PL198]

I still don't get how this is being debated. If a medical school would teach anything business related, it would be laced with "ulterior motives." They can't even teach ethics without making it a brainwash sesh, do you really think they could do business? Not to mention the concept of a PhD teaching business is like an endless loop of failure IMO.

 

[Wordead]

Why would that be a good justification to not even offer the option? Regardless, then that's on those students if they choose not to be interested.


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Uh...no.
There's a reason it would be taken during MS-4. Part of your medical responsibility is knowing why and how to bill, unless you wish to be fired.

You are both right that it is absolutely part of one's responsibility to understand billing and how to run a business (if you are going into PP). The problem with having all medical schools offer it, in my mind, is that you are now adding yet ANOTHER faculty member (who usually has questionable expertise in the area they are teaching anyway - see any ethics, cultural competency, health policy class) and there is no way to teach such a class so that it applies to everyone's future (primary care vs surgical, rural vs urban, academic vs PP). I think there just needs to be a few high quality programs targeted to your practice environment that you can learn from, be it online or in person.

 

[DermViser]

You are both right that it is absolutely part of one's responsibility to understand billing and how to run a business (if you are going into PP). The problem with having all medical schools offer it, in my mind, is that you are now adding yet ANOTHER faculty member (who usually has questionable expertise in the area they are teaching anyway - see any ethics, cultural competency, health policy class) and there is no way to teach such a class so that it applies to everyone's future (primary care vs surgical, rural vs urban, academic vs PP). I think there just needs to be a few high quality programs targeted to your practice environment that you can learn from, be it online or in person.

Even in academics, you have to know how to bill properly. Billing is universal.

 

[NickNaylor]

I'm confused.

On one hand it sounds like you're saying MS4s need a business class so they can learn how to bill and not get fired (makes sense to me).

On the other hand it sounds like people ITT are saying "business of medicine" classes typically don't exist in med school curricula.

Obviously docs aren't getting fired left and right, so either there are classes being taught routinely, or MS4s are somehow able to learn the billing stuff without a class.

I'm sure a lot of it is on-the-job training that you simply "figure out" once you get into practice. You have a point I suppose in that this seemingly works, but given that the AMA owns the freakin' copyright on billing codes you would think some education on how this works might be helpful. My only exposure to the distinction between level 1 vs. level 2 vs. level 3 visits as been incidental and looking at the forms patients carry around in outpatient clinics. Residents don't seem to get much education on this either as they seem pretty clueless.

Sure, you could solve this by hiring someone who's studied medical billing (lol - it's amusing this is even needed), but why not at least go over the basics while in medical school - if only for the sake of curiosity. A course on that has to be at least as useful as fluff like "art in medicine" and other tangential-at-best electives that are seemingly beloved yet wholly irrelevant to most day-to-day practice. I'm not saying the former shouldn't be offered because people have their interests. But if that sort of stuff is offered, why not something a bit more practical?

 

[dyspareunia]

I'm sure a lot of it is on-the-job training that you simply "figure out" once you get into practice. You have a point I suppose in that this seemingly works, but given that the AMA owns the freakin' copyright on billing codes you would think some education on how this works might be helpful. My only exposure to the distinction between level 1 vs. level 2 vs. level 3 visits as been incidental and looking at the forms patients carry around in outpatient clinics. Residents don't seem to get much education on this either as they seem pretty clueless.

Sure, you could solve this by hiring someone who's studied medical billing (lol - it's amusing this is even needed), but why not at least go over the basics while in medical school - if only for the sake of curiosity. A course on that has to be at least as useful as fluff like "art in medicine" and other tangential-at-best electives that are seemingly beloved yet wholly irrelevant to most day-to-day practice. I'm not saying the former shouldn't be offered because people have their interests. But if that sort of stuff is offered, why not something a bit more practical?

I completely agree. I do think it should be offered at some point, but I don't think many MS1-2s would get much out of it (too focused on "board relevant material") and from what I understand there is no time during MS3 so it would be best for an MS4 course. I've heard that MS4s have a few hours of lectures about loan repayment, which is a joke.. but maybe they could offer business stuff in that format if not in a full-fledged elective.

 

[PL198]

Now let's think outside of the box here. Why would medical schools and the presiding bodies not want medical students to understand billing? Oh that's right, so they can't practice on their own, where they would be responsible for such. When they work in a group with an office manager, they don't have to worry about these things nearly as much. Let's not beat around the bush here. It's for a reason. Everything in medical school is designed to turn doctors away from being entrepreneurs and completely into caregivers. All they want are politically un-informed, memorizing, empathetic people.

 

[DermViser]

Now let's think outside of the box here. Why would medical schools and the presiding bodies not want medical students to understand billing? Oh that's right, so they can't practice on their own, where they would be responsible for such. When they work in a group with an office manager, they don't have to worry about these things nearly as much. Let's not beat around the bush here. It's for a reason. Everything in medical school is designed to turn doctors away from being entrepreneurs and completely into caregivers. All they want are politically un-informed, memorizing, empathetic people.

Speaking of the importance of doctors fighting for themselves and learning about billing: http://www.medscape.com/viewarticle/824858_1?src=stfb
Remember, if you don't learn this stuff, there are more than enough people willing to take advantage of you.

 

[dyspareunia]

Now let's think outside of the box here. Why would medical schools and the presiding bodies not want medical students to understand billing? Oh that's right, so they can't practice on their own, where they would be responsible for such. When they work in a group with an office manager, they don't have to worry about these things nearly as much. Let's not beat around the bush here. It's for a reason. Everything in medical school is designed to turn doctors away from being entrepreneurs and completely into caregivers. All they want are politically un-informed, memorizing, empathetic people.

I'm pretty cynical, but med school must really suck for you if you seriously feel this way.

 

[DocVapor]

Incorrect. Part of the reason that medical doctors are so oblivious to the things around them is due to the lack of this information. Very very medical schools have formal courses/rotations to take in which you can actually realize how billing, etc. works. Even if you wanted to take a course it's not offered. It's almost taboo to talk about reimbursement and billing as a medical student. Not at all surprising at an academic medical center in which you're pretty much allowed to lose money due to being an "educational" institution. Medical schools could EASILY make an MS-4 elective month, and teach what's important when it comes to documentation and billing.

There is a difference between the basics of maximizing billing and the basics of economic theory and practice management, which is what the OP was talking about.

Clearly, we should have courses about proper coding for maximal reimbursement. Taking a couple hours (or even a month of classes) on starting/running a medical business properly via different practice models is woefully insufficient at best, and anyone that thinks otherwise is deluded.

 

[PL198]

I'm pretty cynical, but med school must really suck for you if you seriously feel this way.

What? You think you are presented an objective look at things such as ethics, national healthcare, etc? Really?

 

[maxxor]

The dental students at my school get business classes. The optometry students at the optometry school nearby get business classes. They even have a class with a many-weeks-long simulation on building a new practice.

It's high time medical school stopped being the bastion of the "save the world brigade". It's not a sin to make money; you need that money to save the world.

 

[DermViser]

I completely disagree. The majority of medical trainees will not end up working in a big academic center. Many will work in solo or small group practices.

That's very slowly disappearing and will probably end up being true only for certain specialties.

 

[DermViser]

The dental students at my school get business classes. The optometry students at the optometry school nearby get business classes. They even have a class with a many-weeks-long simulation on building a new practice.

It's high time medical school stopped being the bastion of the "save the world brigade". It's not a sin to make money; you need that money to save the world.

Yes, it's funny how dentistry looks at itself vs. the House of Medicine. I guess they prefer to live in reality.

 

[PL198]

Yes, it's funny how denistry looks at itself vs. the House of Medicine. I guess they prefer to live in reality.

I mean or the fact that dentistry is much more private practice oriented than medicine. Thus it's acceptable for schools to bring up the money aspect. Medicine though, god no. You better work from sun up to sun down and if you ask 1 time about pay, boy you need to re-learn the values of the profession. (sarcasm)

 

[DermViser]

I mean or the fact that dentistry is much more private practice oriented than medicine. Thus it's acceptable for schools to bring up the money aspect. Medicine though, god no. You better work from sun up to sun down and if you ask 1 time about pay, boy you need to re-learn the values of the profession. (sarcasm)

Medical specialties can be both private practice and academic medical center oriented. You can bet that even academic medical centers will shut down if they don't pay their bills.

 

[PL198]

Of course, but in those academic medical centers, the physicians aren't the ones balancing the books.

 

[maxxor]

There is no excuse for the lack of medical business education. We need it desperately.

 

[PL198]

There is no excuse for the lack of medical business education. We need it desperately.

Yes but you're assuming that an education in business from your medical school would be adequate or even beneficial, which I am highly speculative about. A lot of schools fail to even teach the basic sciences properly, so how are they going to throw in business and have that work?

 

[maxxor]

If they fail to teach basic sciences, how are they bestowing degrees?

The fact of the matter is that the academic leadership has abdicated the purse-strings, destroying their independence in the process. They need to fix that mistake.

I'd say at the bare-minimum, cover medical billing and reimbursement.
Teach people how they get paid.
Show them the costs of how much a daily CBC/Chem7 is.
Show how many patients a primary care doc needs to see in a day just to cover overhead.

 

[Wordead]

Even in academics, you have to know how to bill properly. Billing is universal.

If you re-read my paragraph I didn't dispute this. Just the method of delivery.

 

[DermViser]

I'm sure a lot of it is on-the-job training that you simply "figure out" once you get into practice. You have a point I suppose in that this seemingly works, but given that the AMA owns the freakin' copyright on billing codes you would think some education on how this works might be helpful. My only exposure to the distinction between level 1 vs. level 2 vs. level 3 visits as been incidental and looking at the forms patients carry around in outpatient clinics. Residents don't seem to get much education on this either as they seem pretty clueless.

Sure, you could solve this by hiring someone who's studied medical billing (lol - it's amusing this is even needed), but why not at least go over the basics while in medical school - if only for the sake of curiosity. A course on that has to be at least as useful as fluff like "art in medicine" and other tangential-at-best electives that are seemingly beloved yet wholly irrelevant to most day-to-day practice. I'm not saying the former shouldn't be offered because people have their interests. But if that sort of stuff is offered, why not something a bit more practical?

That's bc it's much easier to make a course in "Art in Medicine" or "Medicine in History" or "Professionalism and Communication" then it is actual useful **** where you have to hire someone.

 

[DermViser]

Of course, but in those academic medical centers, the physicians aren't the ones balancing the books.

You're right. They just get called into the office for having lower billing in comparison to their peers and what is stated in their contract.

 

[DermViser]

If they fail to teach basic sciences, how are they bestowing degrees?

Simple. They know med students will study on their own independently and get the resources they need, bc they don't want to fail an exam that could affect their residency prospects.

 

[Psai]

I'm sure a lot of it is on-the-job training that you simply "figure out" once you get into practice. You have a point I suppose in that this seemingly works, but given that the AMA owns the freakin' copyright on billing codes you would think some education on how this works might be helpful. My only exposure to the distinction between level 1 vs. level 2 vs. level 3 visits as been incidental and looking at the forms patients carry around in outpatient clinics. Residents don't seem to get much education on this either as they seem pretty clueless.

Sure, you could solve this by hiring someone who's studied medical billing (lol - it's amusing this is even needed), but why not at least go over the basics while in medical school - if only for the sake of curiosity. A course on that has to be at least as useful as fluff like "art in medicine" and other tangential-at-best electives that are seemingly beloved yet wholly irrelevant to most day-to-day practice. I'm not saying the former shouldn't be offered because people have their interests. But if that sort of stuff is offered, why not something a bit more practical?

My mom is in medical billing and I don't think there's any way that there can be a class that's relevant and useful to medical students. It's possible to learn from books but there's a lot of weird rules and designations for things. The best way to do it is to look at charts and have someone go through it with you so you can figure out how to do it properly. Also, they update the international statistical classification of disease every ten years or so which may make the knowledge obsolete for medical students by the time they are getting their first job as an attending. We have enough to worry about without thinking about how to code for our diagnoses and procedures.

 

[NickNaylor]

My mom is in medical billing and I don't think there's any way that there can be a class that's relevant and useful to medical students. It's possible to learn from books but there's a lot of weird rules and designations for things. The best way to do it is to look at charts and have someone go through it with you so you can figure out how to do it properly. Also, they update the international statistical classification of disease every ten years or so which may make the knowledge obsolete for medical students by the time they are getting their first job as an attending. We have enough to worry about without thinking about how to code for our diagnoses and procedures.

Again, I'm not advocating for an associates program in billing crunched down to 2 weeks. A simple overview of a few different case scenarios and how they ultimately translate into $$$ would suffice. Add to the fact that residents don't do billing themselves and I think this point is accentuated. It's not about turning medical students into billing coders. It's about educating medical students about how the sausage is made. Arguing for or accepting ignorance with respect to how you get paid is asking for abuse in my view.


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[hoopie]

My school has an optional fourth year course that goes over the business basics that a soon to be doctor should know. Goes through the basics of different practice settings, how doctors get paid, medical legal stuff, just general financial advice. Was very valuable and unbiased. Doesn't sound like many programs have this, at least not being represented in this thread.