Thought I'd wade back in here. Totally agree with the striking lack of business training in medicine. Honestly, though, most university-based training programs are horribly run businesses, anyway. Not sure they're the best ones to train us, lol! It ends up being on-the-job training, essentially, and it's not as bad as you might think. Seems that more and more fresh docs are going to employment route to avoid grappling with the increasingly complex business climate, but I can't really blame them. This isn't the same medicine our mentors practiced back in the day.
That is unfortunate though because 98% of "business" is simply common sense. Medical students seem to think that unless you have the business acumen of Donald Trump or Warren Buffet, you will be doomed to a life of financial ruination if you attempt to buy or run a private practice. That is simply not so. Obviously, practices are businesses and you have to have a basic understanding of profit/loss and that sort of thing but it's not difficult.
I think with respect to medical practices, it's more about process analysis than things like inventory control or logistics.
Personal example.....I got referred to see an allergist. So I check in and the receptionist hands me a massive stack of paperwork to complete and asks for my insurance card to make a copy of. So I dutifully fill out the massive stack of paperwork but I left the section for insurance with it's request for me to once again enter my full name, birthdate, group ID number individual ID number etc. etc. blank because she was going to make a copy of my card.
I take the paperwork up to her and she snarks at me that she needs that section filled out. "Oh, ok....I thought you were going to make a copy of my card." So I take my card, copy all the information from the card onto the sheet, return it to her AND THEN SHE MAKES A COPY OF MY CARD AND PUTS IT IN MY FILE RIGHT NEXT TO THE SHEET I JUST FILLED OUT! Right in front of me!
So what's the lesson about process here?
1) Why weren't the forms emailed to me or made available for me to fill out online and bring in with me or have them printed off at the office?
2) Patients hate filling out tons of paperwork. Why are you demanding that I print out all my insurance information (in my messy handwriting) when you are going to make a copy of my insurance card anyways?
The best part is that when I presented for the followup, she demanded that I fill out the COMPLETE STACK OF PAPERWORK AGAIN because my first appointment was in November and the second was in February and since it was a "new year" the "office policy" was that the complete stack of paperwork be filled out again, IN IT"S ENTIRETY.
I told them absolutely nothing had changed and I was curtly informed that that was "the policy." Well my policy is to not waste 20 minutes of my day filling out needless paperwork and I walked out. I'm never going back to that guy. And the doctor was nice. I liked him. But I don't need that aggravation. Most patients don't.
That's the kind of thing you need to think about when in private practice. Process.
Interestingly, though, our local medical society performed a survey of physician satisfaction a couple years ago that included designation of employed or private practice status and time at that status. The most satisfied physicians, on the whole, were those who were employed. However, when you drilled down into the data, that feeling switched after being employed for 3+ years. Not surprisingly, that's when hospitals and HMOs typically renegotiate contracts and put the screws to you. Yes, you don't have to worry about the business end, but you also have no control over the business end. In the long run, I think you're much better off in private practice, even with all the changes on the horizon.
Personal anecdote from residency. We had a VA eye clinic with one particularly toxic technician. Because the ancillary staff were all VA employees and unionized, she was nearly untouchable. Took a few years of continued complaints to finally get her fired. Personally, I find much more stress in lack of control than in the day-to-day of being in control. That said, there are some who will feel differently.
I wish I could like that 1000 times because that's exactly it. As the practice owner, I can set my hours, I can paint the walls purple, I can hire/fire who I want, I don't have to wear a tie if I don't want, I can buy what equipment I want and I hammer a much fatter check at the end of the month than I ever did as an employee. Are there certain negative aspects to being in the Captain's Chair? Of course, but those negatives are miniscule compared to the negatives of working for someone else.
