How to Spend your M0 Summer (or at least an afternoon of it)

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repititionition

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I am way nontraditional. I did a bunch of stuff on the business side of health care for a long time before deciding I wanted to be on the other side of the coin. In one of my current ventures I own a business with a number of physicians (I am the only non-physician owner). In another I work with academics to actually "do" health policy, and in another I work for providers and facilities to make them more efficient. All of my experiences have given me a somewhat unique amount of knowledge and insight in to our broader health care economy - its financing, administration, and delivery.

Traditional students have sought me out for some of this expertise, and I have been something approaching amazed at just how little the average pre-med knows about the "system" part of our health care "system". I have often tried to figure out how to get them up to speed on the basics - vast as they are - so that they could engage in meaningful dialogue during interviews, contribute effectively as a business intern, or get involved in health policy.

With that in mind, I've created a brief wikipedia reading list. While it's centered on our financing system, our financing system(s) is (are) what drives everything else in this country. Read it all and you will certainly be in the top 1% of your class when it comes to a) issues that will be VERY relevant once you are out on your own, outside the shelter of academia and b) your ability to get involved and lead on issues that you find important to you and the future of the field.

It's going to seem dry (it is), it's going to seem boring (also true), and it's going to seem completely irrelevant to why you want to be a doctor. And while thats' true - it may have nothing to do with why you WANT to become a doctor - it will have much to do with actually BEING a doctor.

In total, this might take you from 1-4 hours to read and digest. It's worth it.

http://en.wikipedia.org/wiki/Health_care_finance_in_the_United_States
http://en.wikipedia.org/wiki/Medicare_(United_States)
http://en.wikipedia.org/wiki/Specialty_Society_Relative_Value_Scale_Update_Committee
http://en.wikipedia.org/wiki/Diagnosis-related_group
http://en.wikipedia.org/wiki/Resource-Based_Relative_Value_Scale
http://en.wikipedia.org/wiki/Relative_Value_Units
http://en.wikipedia.org/wiki/Bundled_payment
http://en.wikipedia.org/wiki/Capitation_(healthcare)
http://en.wikipedia.org/wiki/Fee-for-service

Also... Every Medical Student should also own and read a copy of "The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System". It's exceptional. Even more so when you consider that it was written by an MS-3 and MS-1!!!

Bonne lecture!
 
repititionition said:
I am way nontraditional. I did a bunch of stuff on the business side of health care for a long time before deciding I wanted to be on the other side of the coin. In one of my current ventures I own a business with a number of physicians (I am the only non-physician owner). In another I work with academics to actually "do" health policy, and in another I work for providers and facilities to make them more efficient. All of my experiences have given me a somewhat unique amount of knowledge and insight in to our broader health care economy - its financing, administration, and delivery.

Traditional students have sought me out for some of this expertise, and I have been something approaching amazed at just how little the average pre-med knows about the "system" part of our health care "system". I have often tried to figure out how to get them up to speed on the basics - vast as they are - so that they could engage in meaningful dialogue during interviews, contribute effectively as a business intern, or get involved in health policy.

With that in mind, I've created a brief wikipedia reading list. While it's centered on our financing system, our financing system(s) is (are) what drives everything else in this country. Read it all and you will certainly be in the top 1% of your class when it comes to a) issues that will be VERY relevant once you are out on your own, outside the shelter of academia and b) your ability to get involved and lead on issues that you find important to you and the future of the field.

It's going to seem dry (it is), it's going to seem boring (also true), and it's going to seem completely irrelevant to why you want to be a doctor. And while thats' true - it may have nothing to do with why you WANT to become a doctor - it will have much to do with actually BEING a doctor.

In total, this might take you from 1-4 hours to read and digest. It's worth it.

http://en.wikipedia.org/wiki/Health_care_finance_in_the_United_States
http://en.wikipedia.org/wiki/Medicare_(United_States)
http://en.wikipedia.org/wiki/Specialty_Society_Relative_Value_Scale_Update_Committee
http://en.wikipedia.org/wiki/Diagnosis-related_group
http://en.wikipedia.org/wiki/Resource-Based_Relative_Value_Scale
http://en.wikipedia.org/wiki/Relative_Value_Units
http://en.wikipedia.org/wiki/Bundled_payment
http://en.wikipedia.org/wiki/Capitation_(healthcare)
http://en.wikipedia.org/wiki/Fee-for-service

Also... Every Medical Student should also own and read a copy of "The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System". It's exceptional. Even more so when you consider that it was written by an MS-3 and MS-1!!!

Bonne lecture!
Click to expand...
Oh wow! Thanks! This will be really helpful.
 
repititionition said:
Traditional students have sought me out for some of this expertise, and I have been something approaching amazed at just how little the average pre-med knows about the "system" part of our health care "system". I have often tried to figure out how to get them up to speed on the basics - vast as they are - so that they could engage in meaningful dialogue during interviews, contribute effectively as a business intern, or get involved in health policy.
Click to expand...
The problem extends all the way to med students, residents, and even full-time physicians. It's a systemic problem.
 
moop said:
The problem extends all the way to med students, residents, and even full-time physicians. It's a systemic problem.
Click to expand...

It also isn't unique to premeds. A lot of other fields don't take into account the financial aspect of their career (besides Finance, Business, Accounting and such). It isn't exactly fair to blame premeds for not knowing this. Heck, we're told to not even worry about Step exams until second year, matching or specialties until 3rd year and I guess billing/healthcare system in general until it actually directly affects us.

I do appreciate your links, truthfully, the data is very hard for people to get a hold of.
 
I would recommend this, known as the "bible of health policy" in policy wonk circles:
http://www.amazon.com/Understanding-Health-Policy-Sixth-Edition/dp/0071770526/

Nathan Moore is great and really friendly in real life (met him at a talk once), but his book is just a little too simplistic to justify as the go-to reference in the field. Bodenheimer & Grumbach present enough context and details without overwhelming you, and it's far superior than Wikipedia, though the latter is better than nothing, of course.
 
This is actually a good list of often confusing and esoteric terms for healthcare. This is a great idea for fresh students. I imagine there is also probably a brief primer that explains how these terms fit into the bigger picture somewhere too.
 
darklabel said:
It also isn't unique to premeds. A lot of other fields don't take into account the financial aspect of their career (besides Finance, Business, Accounting and such). It isn't exactly fair to blame premeds for not knowing this. Heck, we're told to not even worry about Step exams until second year, matching or specialties until 3rd year and I guess billing/healthcare system in general until it actually directly affects us.

I do appreciate your links, truthfully, the data is very hard for people to get a hold of.
Click to expand...

Not sure I follow - most people who major in finance, business, accounting, or economics don't understand the "financial aspect" of their careers either, though that term is pretty vague, so we may be talking past on another.

Unless you have a series 7/6/63 license, you're not really dealing day-to-day with regulatory issues in finance. Unless you are a SOX compliance officer, you probably aren't dealing day-t0-day with regulatory issues in accounting. Etc. etc. etc. Most people in most industries know just enough about their regulations to stay out of court, and the fields mentioned above are little or no different.

Medicine is different. We have a huge workforce that is acutely impinged and bound by regulation, by market and governmental forces, in a way that - forget not going to court - fundamentally affects nearly every minute of work that they do -- and yet the vast majority simply either a) "outsource" the knowledge (to a "business manager" in their practice, to a professional association, etc.) or b) know just enough to make sure that they get paid and don't break the law.

Each alternative has problems. Letting a business manager hold a bunch of seemingly arcane knowledge about your practice is bad business planning on a number of levels. Allowing your professional association to represent you without understanding exactly what they stand for means potentially giving money to goals and ideology you fundamentally disagree with (the AMA is a classic example in this regard...), and just "getting by" means that you're going to be the piece of the system that gets squeezed - and this lack of understanding has meant that NO piece of the health care economy has been squeezed like the physician over the last 20 years.
 
repititionition said:
Not sure I follow - most people who major in finance, business, accounting, or economics don't understand the "financial aspect" of their careers either, though that term is pretty vague, so we may be talking past on another.

Unless you have a series 7/6/63 license, you're not really dealing day-to-day with regulatory issues in finance. Unless you are a SOX compliance officer, you probably aren't dealing day-t0-day with regulatory issues in accounting. Etc. etc. etc. Most people in most industries know just enough about their regulations to stay out of court, and the fields mentioned above are little or no different.

Medicine is different. We have a huge workforce that is acutely impinged and bound by regulation, by market and governmental forces, in a way that - forget not going to court - fundamentally affects nearly every minute of work that they do -- and yet the vast majority simply either a) "outsource" the knowledge (to a "business manager" in their practice, to a professional association, etc.) or b) know just enough to make sure that they get paid and don't break the law.

Each alternative has problems. Letting a business manager hold a bunch of seemingly arcane knowledge about your practice is bad business planning on a number of levels. Allowing your professional association to represent you without understanding exactly what they stand for means potentially giving money to goals and ideology you fundamentally disagree with (the AMA is a classic example in this regard...), and just "getting by" means that you're going to be the piece of the system that gets squeezed - and this lack of understanding has meant that NO piece of the health care economy has been squeezed like the physician over the last 20 years.
Click to expand...

I was agreeing with you but just saying that it isn't unique towards premeds and up and that people going into other fields don't necessarily understand real world practices when it comes to the business and financial side of things (such as engineering majors). I excluded accountants, finance and business because I (erroneously?) believed they know enough to handle finances properly within their daily life when it comes to their own careers.

I wish I had taken basic accounting and some business classes but in my college Accounting is a class that usually makes-or-breaks people. Would you suggest physicians study for an MBA or not worth it?
 
darklabel said:
I wish I had taken basic accounting and some business classes but in my college Accounting is a class that usually makes-or-breaks people. Would you suggest physicians study for an MBA or not worth it?
Click to expand...

An MBA is not worth it unless you plan to use those letters after your name. It is also not worth it unless it comes from a T10 school.

I think that the general person and/or medical professional can benefit greatly from a basic course in economics as well as personal finance. I studied business in undergrad and those are basically the only classroom concepts that I think have transferred well.
 
darklabel said:
I was agreeing with you but just saying that it isn't unique towards premeds and up and that people going into other fields don't necessarily understand real world practices when it comes to the business and financial side of things (such as engineering majors). I excluded accountants, finance and business because I (erroneously?) believed they know enough to handle finances properly within their daily life when it comes to their own careers.

I wish I had taken basic accounting and some business classes but in my college Accounting is a class that usually makes-or-breaks people. Would you suggest physicians study for an MBA or not worth it?
Click to expand...

A top-tier MBA is worth the cost (real and opportunity), provided you have a very concrete goal for leveraging it (consulting/investment banking/major HC admin).

A solid, mid-tier MBA (especially those that are physician-focused or executive programs that would allow one to study concurrently with a medical practice, reducing or eliminating the opportunity cost) is worth it if you believe that you want a mid-career out from clinical work (hospital admin, become a non-clinical business guy in in a group practice, though this would work only for a few specialties)or have an entrepreneurial bent and the inclination to learn in a formal setting.

Any other MBA is simply not worth it.

Both mid-tier (generally speaking, I know personal examples to the contrary where having the letters from a locally respected program did open doors) and low/no tier MBAs can effectively be replaced by a reasonable amount of self study.

Truly the most important class anyone can take in college (I'm biased, but I believe it) is microeconomics/theory of the firm.

Not only is it fundamentally the study of the nuts and bolts of "business", it can be leveraged in myriad ways: microeconomics is the gateway to game theory and behavioral economics (useful to understand business strategy, competition, and marketing/sales) and the foundation of business finance.

A "bootstrap" business education/"know enough to be dangerous" MBA substitute would include courses in:

-Microeconomics
-Theory of the Firm
-Managerial Accounting (just get the basics - e.g. understand the big 3 financial planning and reporting documents)
-Banking and Finance (covering financing instruments/options)
-Operations Analysis/Industrial Engineering

If you genuinely "get" these topics at a 201-type course level... you have the skills (at least the hard skills... soft skills are another issue entirely) to build a company from scratch to perhaps $5-10 millions in annual revenue. Beyond that, specialization becomes imperative.
 
The point is not about financing or accounting or any of the business stuff y'all are talking about. The point is that in MOST fields, people tend to head into a field with a clear knowledge of what the structure of that field entails. Consultants know who's above and below them, bankers recognize their position in the chain of financial intermediaries, and so on. In medicine, however, where the barriers to entry are astronomically higher than those in the aforementioned industries, premeds can bumble around into residents and then physicians without a slightest clue about the system that they work in. The focus is all on studying, jumping hoops, doing research, focusing on the micro aspects, nothing about the macro.

This goes beyond DRGs, RBRVS, FFS, FMAP, and all that financing stuff. It's things like knowing what Medicare/Medicaid covers, why health insurance is set up the way it is, what the current debates in health policy are and the role a single physician can play. Get the drift? I could go on for hours.

"The system is broken." Well, a big reason it's remained that way is that shockingly few of those in the field who are arguably best positioned to try and fix it even know WHAT'S wrong with the system to even begin to know where to start fixing it. The average physician has no clue where all this talk with PCMHs and ACOs is going, or why the issue was even brought up in the first place. How do we expect such caregivers to then later do well when they work in such an institution? The logic is nonexistent.

(It's even funnier when the profession complains about non-physicians trying to fix things for them in policy by saying they know nothing about being a doctor lol.)

Interested in opinions from older people, though. @gyngyn @Planes2Doc perhaps?
 
I thought this was going to be a thread about how to have fun in Missouri.
 
How should the MS -4's spend their summer?
 
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I think the OP brings up some brilliant points. I was an economics major in undergrad, and I still honestly don't understand most things about the business side of medicine. I don't know why pre-meds or medical students aren't being given the opportunity to learn these much-needed things. The Wikipedia articles are a good start, but there needs to be more...

Now this made me think of something kind of funny. A majority of traditional pre-meds are biology or other science major. A majority of what they learn in college is either beyond the scope of clinical medicine, or has nothing to do with it altogether. Yet, they aren't required to spend any time learning the business side of things. Instead, they jump through endless hoops where the message is clear: Money is evil. Doctors who want to make money are evil. Trust me, I heard this garbage being spewed from fellow classmates and you see this on SDN where people who go into residencies like derm get crap from other people.

The OP brings up a terrific point which few of us think about, but we all should!
 
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Bump, great timing of articles for any bored M0's.......inform yoselves. Has anyone read the heath care handbook?
 
Cuze said:
Bump, great timing of articles for any bored M0's.......inform yoselves. Has anyone read the heath care handbook?
Click to expand...

The Health Care Handbook was a great basic intro to the healthcare system, and an easy/fast read.
 
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