Practice Management in Residency

[Boner]

For those that choose general internal medicine as a career pathway, do any programs integrate some sort of practice management aspects into the residency curriculum? Is this more likely to be found in a community program vs. an academic program? I know some programs offer a generalist "pathway," but I'm not sure if they offer some management work within that pathway.

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[dragonfly99]

You know, that is a VERY good question.
I think most residencies do a poor job of teaching this.
I think you are right that if you go to a community program that is more primary care oriented they are more likely to teach you this. If that is your career goal, I'd go for a cush private hospital/community program that will treat you well (i.e. not ridiculous amounts of call and ICU time) but not a weenie program (i.e. one that says they "screen out all the patients with mental health issues" from the primary care resident clinic, like one place where I interviewed). And be sure to ask during your interview whether they integrate this into their curriculum (they'll probably say yes at every place, but if you probe further or ask the residents you'll find out more details).

 

[elwademd]

i did a community program for im (loosely affiliated with a university). i had a 4 week course on practice management that i feel i learned a lot in.

overall, from medical school to residency, there is typically a poor job of teaching the business side of it. we typically understand the medicine, how to do it, when to apply it (or when not to), but we don't truly learn how the practice of medicine leads to making money (or losing it).

i wouldn't necessarily endorse choosing a program based on the presence (or absence) of practice management... simply because most programs probably do little to nothing.

with that said, if you're really interested, you really should think about an mba for health professionals or mmm (masters in medical management).

 

[Boner]

I appreciate the responses. To follow up, will the average grad have enough knowledge/savvy to potentially open up his/her own practice coming from a program that does offer some management electives/seminars (without some masters level work in business)? The future is pretty hazy regarding the business of medicine, but I am interested in potentially having a small practice (3 providers). Basically, what I'm getting at is where does one learn these sorts of business aspects without having to obtain a masters degree? Consultants, hiring practice a manager, reading, etc...?

 

[elwademd]

I appreciate the responses. To follow up, will the average grad have enough knowledge/savvy to potentially open up his/her own practice coming from a program that does offer some management electives/seminars (without some masters level work in business)? The future is pretty hazy regarding the business of medicine, but I am interested in potentially having a small practice (3 providers). Basically, what I'm getting at is where does one learn these sorts of business aspects without having to obtain a masters degree? Consultants, hiring practice a manager, reading, etc...?

all of the above, lol.

i think some of it comes down to what you think you want to do, what you really want to do, sacrifices you're willing to make, things you absolutely have to have, things you can deal without.

some docs join a large group first just to get their feet wet, earn money without being the one responsible for the office; and then transition into private practice. some never leave large group. others start out on their own.

obviously, there are pros and cons to each of the approaches.

one thing to start doing is to read medical economics ( http://medicaleconomics.modernmedicine.com/ ). you should be able to get it for free once you're a resident (that's how i got it).

there are a ton of things that are required to run an office that you won't learn in residency:
where to open up shop
how to advertise
how to hire
how to fire
hourly wages for your employees
billing
contracts with different insurance carriers
lease or buy equipment
relationship with labs
referrals- both to your group and from your group
hospital privileges vs hiring a hospitalist group
malpractice insurance- for you, your partners
how are the finances divided between you and your partners

there are tons of reasons that it can be successful, and for the same reasons, it can be the beginning of a lifelong headache.

its good that you're thinking about it now though.

there are people who are healthcare consultants that could probably help to answer many questions, and lead you in the right direction. some are free, and some aren't.

 

[dragonfly99]

Agree with elwa's advice about reading Medical Economics. They send it to me for free...but I think only started after I was out of residency.

Running your own practice right out of residency would be a tall order. In addition to that, whether or not it would even be a viable option might depend on what state you are in (i.e. super high HMO penetrance like some areas of California might make it hard for a small private pratice to make any money....). Well, I am talking about primary care...I think there are some larger urology and ortho groups that do VERY well in various states. The smaller medical practices seem to be going the way of the dinosaur, but you never know...in 5 years the whole landscape might be different.