Why the Lack of Business Education?

[drSUBLIME]

While most of us will enter the challenging business world of private medical practice, how is it possible that our "professional education" does not provide one note on how to run a business? Please , someone respond. I mean we can deny our financial pursuits all we want, but we will all need to make a living in the future.

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[146233]

Excellent point. I suspect the BOM folks have something to say about this.

 

[easilydoctor]

Conflict of interest may arise? They probably feel that the average doctor isn't struggling to pay bills and make ends meet. Not to mention, most don't even have time to use their incomes on personal pursuits and a fat paycheck with not much to spend on leaves a decent retirement savings.

 

[LadyWolverine]

Conflict of interest may arise? They probably feel that the average doctor isn't struggling to pay bills and make ends meet. Not to mention, most don't even have time to use their incomes on personal pursuits and a fat paycheck with not much to spend on leaves a decent retirement savings.

Certainly it is not a conflict of interest to be taught to understand how a business (for example, a private practice) operates. Being business-savvy doesn't just mean "making ends meet" - it may mean running a practice, sitting on a board of directors at a hospital, or even just understanding how to manage personal debt and income in order to keep yourself functioning. I agree with the OP that future physicians are woefully underprepared (and even, in some instances, a bit delusional) for the business aspects of medicine. It pays to be knowledgable.

We were actually given a lecture a few weeks ago (as MSIIs) about business practices and how they relate to medicine, and it was quite sobering. There is a lot that we don't understand, but it's worth investing some time in learning about it, because it seems that the ignorant physician is easily turned into a pawn these days. Protect yourself, because you can't expect anybody else to.

 

[cowboy71]

Doctors do need to have business training and while some limited amount should start in medical school that isn't the ideal place to get all of the training. Once a person has chosen their specialty and is in residency then a more focused and thorough education can be obtained. This education must focus on much more than personal and office financial management, which is what most people think of when talking about business. Even the BOM website is focused only on personal issues such as debt managemet and insurance. During medical school and residency a physician should get a background on healthcare economics and the US healthcare system, including the evolution of the system to what we have today. This should include a macroeconomic view of the industry and how public policy effects the system.

Once in a chosen specialty more detailed education can come for that specific field. Education in service operations management, healthcare marketing (advertising is only a part of marketing for those who don't know the difference), billing, office staff management, and accounting can then be added. This education is definitely part of the six core competencies of residency training empasized by the ACGME, however most residencies do a mediocre job at best in preparing a resident to run a successful and efficient practice after residency. The skills that an anesthesiologist needs to efficiently manage an OR versus a pathologist running a lab versus a physician in an office-based practice will vary significantly. Yes, it is true that this is not a physician's primary responsibility and that is why managers are hired. However, all aspects of the practice would run better if all physicians had more education in these matters. Patient care and satisfaction would improve tremendously.

Of course personal finance education would also be of great importance.

 

[BusinessofMedicine]

First I'd like to introduce myself as a representative of BOM.

On behalf of BOM members, we are excited about the opportunity to help other medical students through local BOM chapters, the BOM website www.businessofmedicine.org, and this forum. If BOM can help guide students to appropriate resources or provide additional insights through SDN threads, we are happy to do so.

 

[BusinessofMedicine]

This is an excellent thread.

While some medical schools seem to agree with flindophile, others are starting to adopt cowboy71's position and incorporating supplemental courses during M1/M2 years.

The landscape on this issue is far from clear.

Based on student responses, BOM believes that there is a growing demand for additional resources and information on a wide range of business/economic/financial topics as they relate to the practice of medicine. We encourage medical students to begin to explore these topics early in their careers. BOM is an excellent resource and forum for students to consider the gaps in their understanding of career development, debt management, health policy, and malpractice without sacraficing valuable time in the classroom or clinic.

 

[mdjobexchange]

I definitely fall in to the opposite camp than flindophile. I agree that getting a complete understanding and training on how to run a practice would potentially take up a significant amount of time during med school, which would detract from medical eduction. Some degree of business education is necessary. I think basic ideas of what accounts receivable are, what overhead is, what typical benchmarks are for a practice, where to get information on these issues (such as MGMA,) what is Medicare, what is Medicaid, etc would be very useful. I have asked numerous doctors I know who are out in practice what the difference between Medicare and Medicaid is and over 50% give incorrect answers.

I think many doctors are embarrassed to ask about some of these issues when they finish training, because it is hard to admit, that after 20 years of education, they know nothing about business. Unfortunately, medicine is now a business and if you don't know anything about it, you will get taken. Just in the last 6 months, I have talked to 2 physicians who have had over $500,000 each stolen from their practices over a period of years. Why did this happen? Neither physician could read a profit/loss statement, nor had they asked their office manager for one. Either they were too busy to deal with it, or they didn't know what one was. The office managers easily saw that the docs were not watching the books and it was easy pickings.

At the very least, a one semester course covering basic terminology, how a business functions, and resources for starting a practice would be useful. This way, physicians could at least converse intelligently about business issues.

 

[supercut]

the reason business education isn't included in med school (or residency) is the same reason many things are the way they are in medicine..."because we've always done it that way".

Also, it didn't used to matter as much. Used to be, the doctor submitted a bill to patient and'/or insurance company, and it was paid promptly and without arguement. Now many patients believe that they should not have to pay a single penny out of their own pocket for medical care. Insurance companies (and the government) play all kinds of games to avoid paying doctors and hospitals for services already rendered.

Many doctors choose not to become very well educated in the business of medicine. They say, "that's what I pay my office manager for". I disagree with this philosophy. While certainly your office manager can and should be taking care of the day to day details, it is up to the physician to make sure that everything is done, and that things are run in order to maximze effiency and profit. Plus how the physican documents what is done in his or her notes determines to a large degree what he or she gets paid for that encounter. Sometimes it's just a matter of how you word something that can get you paid more.

I think that practice management education belongs in residency, not medical school. You need some experience under your belt in order to make practice management education meaningful.

 

[mdjobexchange]

Perhaps it should be an elective? Medical schools have some pretty bogus required courses. I know I had a required course that had a title along the lines of "Social Medicine." We learned how to draw family circles and understand group dynamics. It had a bunch of fuzzy crap in it. We spent quite a bit of time in this course and its purpose was to try and get us to go into primary care.

I would have liked an option to take a "Business of Medicine" course versus that complete waste of time. Just about every physician, regardless of their specialty needs to understand what an RVU, CPT code, and DRG are. Medical schools regard their curricula as sacred, but they don't necessarily know what is best for a doctor heading out into the real world.

Knowing a little about non-compete clauses, medical billing, and malpractice insurance would have been way more useful to me than learning the Krebs Cycle for the 12th time.

 

[drSUBLIME]

This is an excellent thread.

While some medical schools seem to agree with flindophile, others are starting to adopt cowboy71's position and incorporating supplemental courses during M1/M2 years.

The landscape on this issue is far from clear.

Based on student responses, BOM believes that there is a growing demand for additional resources and information on a wide range of business/economic/financial topics as they relate to the practice of medicine. We encourage medical students to begin to explore these topics early in their careers. BOM is an excellent resource and forum for students to consider the gaps in their understanding of career development, debt management, health policy, and malpractice without sacraficing valuable time in the classroom or clinic.

This organization is slightly suspicious in my book. It claims to be non-profit, however has links and is closely associated with many lenders and loan advisors that are FOR profit. The company, Graduate Leverage, is known among financial aid experts to use decietful tactics to get students' business and they are a prominently associated company with Business of medicine. Just a heads up.

 

[drSUBLIME]

http://www.oag.state.ny.us/press/2007/oct/oct11a_07.html

 

[123880]

Many people are successful at business without any formal business training. There are many ways to take courses here and there if you decide that you need some formal training; however, I would think carefully about whether it is best to be your own half-baked expert or to seek the advice of an good accountant or financial planner. In any case, I think it is best to delay any business training until you have more of a direct need. As a med student, you are probably 5 years away from having to make any business decisions. So, it is a waste of time to take this material as a med student. Your priority should be to learn medicine. Then, if the need arises, you can decide whether decide what you need in the way of training or advice.

The problem I have with this line of thought is that a) after getting out of med school, most doctors don't want to go enroll in yet another school for another stream of courses and b) some doctors don't realize they lack the knowledge to run a business.

For those who want to enter a private practice, the opportunity is there, right out of school. These new doctors don't have to pass a test showing they understand how to run a business. Lenders are freely available to give equipment leases, capital lines of credit, and other business-related loans.

I suppose there is nothing wrong with having electives; however, given that it is 5 years before anyone will use it, I think it is much better to get this training closer to the time you will need it. This seems there would be a good opportunity for someone to develop a business offering practical online training for people who are just about the real world

The option of having business classes as electives is a better scenario than online courses, unless someone spends the time and money to fully develop the online offering. Too many online classes these days are just an easy way to say you've taken a course without having to expend the effort to really learn the material. If medical schools offered at least an initial elective in medical school and finished the education off during residency (as supercut mentioned), the doctors would be more savvy from the beginning.

Cowboy71 and Mdjobexchange made excellent points wrt what an education in the business of medicine would entail. IMO, too many doctors place absolute faith in the people they hire, believing that no one would DARE rip them off. That's the worst thing a doctor can do. Ultimately, it's his/her name on the door and bottom line.

Whatever goes wrong, the doctor is going to be held liable. If you suddenly realize you don't have money because your billing manager has been ripping you off for years, it's still your responsibility to make sure the bills get paid. Do you really want to learn that lesson on the back end? Or would you rather have learned somewhere early on what steps you can take to be an effective business owner?

Flindophile, having been a business professor, you may be the exception to the rule since you've been exposed to the principles of business. Other students barely have the total knowledge to manage their own finances much less a business. Having gone from their parents' home to college to med school, there hasn't been much real world experience to glean the insight to be an effective business owner. Anything that can be done in the beginning is an advantage.

Just my $0.02.

 

[Coastie]

While most of us will enter the challenging business world of private medical practice, how is it possible that our "professional education" does not provide one note on how to run a business? Please , someone respond. I mean we can deny our financial pursuits all we want, but we will all need to make a living in the future.

Socialists and liberals run medical schools.

 

[dctruth]

we received a short business course (not practice management) course in chiropractic school 20 years ago at life university's "school of chiropractic", largest chiropractic school, and holder of the longest primary care doctorate (more than md/do/pt/dpm/dds/etc. @ 5000 hrs.), now provides business and practice management from independent firm integrated into curriculum.

yes, please take it from a DC (400 pv/week, 500k gross), it was very hard/ difficult from the start (almost didn't make it!) and a good way through, before i was able to feel i was going to make it and became comfortable.

no i don't do "achey breaky" or "shake and bake", nor behave like a pt. i convert all to chiropractic primary care.

especially today, allopathy needs both, business and practice management.

trivia: there are many chiropractors that see several hundred pv/week/ solo.

the largest solo practice of any type of doctor on the planet earth and sees more patients/day/week than many u.s. hospitals (not kidding) is whom? and what type of doctor? how many pv/week?

answer: dr. robert schiffman, doctor of chiropractic, 3000 pv/week/3 million/gross, and still growing. office: 10,000 sq.ft., 30 employees, too much to list.

he and i meet three times a year at the same seminar that he teaches, and i still don't know how he does it?

though the sdn does not list chiropractic as a degreed health care professional in its forums (it is amazing, to me and my friend, neighbor, and patient, james earle jones, that the second largest primary health care doctor and fastest growing primary doctor is overlooked?), i wish ya all a happy holiday!

dctruth

 

[BusinessofMedicine]

This organization is slightly suspicious in my book. It claims to be non-profit, however has links and is closely associated with many lenders and loan advisors that are FOR profit. The company, Graduate Leverage, is known among financial aid experts to use decietful tactics to get students' business and they are a prominently associated company with Business of medicine. Just a heads up.

In response to the opinion above, BOM is NOT closely associated with any of the groups listed at www.businessofmedicine.org

Some BOM members have found Graduate Leverage services and loans useful therefore it was selected to be listed.

We respect the views and opinions of all SDN members. I'd like to reassure you that BOM makes every attempt to provide the most high yield resources to medical students regardless of the organization's profit status.

The BOM website and chapters are funded solely by individual medical school student councils. Any additional questions or inquiries can be directed to [email protected]

-The Business of Medicine

 

[rkamsterdam]

While most of us will enter the challenging business world of private medical practice, how is it possible that our "professional education" does not provide one note on how to run a business? Please , someone respond. I mean we can deny our financial pursuits all we want, but we will all need to make a living in the future.

isn't this why god created the health care administration degree and offer a pretty lucrative salary?

Anyone can steal from you. hiring the right people is paramount, ones you can trust, and thats more a matter of personal, psychological judgement skills on behalf of the doctor. Still, some business training may be helpful in averting this risk, though I agree with flindophile's line of thought.

 

[HolisticHealth]

If doctors don't understand the business of medicine, how are they ever going to get control of their careers and do what is best for the patient? Right now, insurance companies/drug companies basically get to decide who gets what treatment based on eligibility or drug costs etc. If doctors don't learn how all the different business strategies play into the health care system, they are not only going to lose out on their own paychecks (as has been brought up already), but will lose out on the ability to help patients which is the whole point of medicine. They need to learn how to operate their own business so that there is enough money to keep it open.....they need to learn the business behind a hospital to continue to improve the system....and they need to learn the business of insurance/drug companies to get more control over what they can prescribe..... In order to care for the patient with the best resources you absolutely need business training.

 

[Caboose]

I'm in my first year and every term I take a business seminar in my community unassociated with the school. Sucks to take a weekend, but it's condensed, it organizes me, gives me an outline and a direction.

While it's true that your practice will be tailored to you, there are certain core skills. I'm converting my monthly bills to Quickbooks so I can be more comfortable managing my practice. For marketing purposes I have begun to write newletters on healthcare issues relating to common causes of illness during the four seasons and by the time I get out I plan to have established and booked 20 patients. Direction.

It's one weekend so it doesn't take that much away from my education, I can research topics I'll learn more about anyway while connecting with other docs who proof read it and I don't have to worry about a grade for the class. I personally want to learn these things, but it doesn't take priority over physiology or core sciences.

That's how I'm going about it. Business is very important because you can't help anyone if your practice fails. My $0.02 at 6.8% interest.

Caboose.

 

[Blanco]

Hey you people ROCK!! First of all I will like to say I will be a doctor but as a stepping stone for me and my family I am pursuing nursing as a student at a CUNY college in NYC. I stand with 57.5 credits and a 3.6 gpa with honors, deans list and all that good stuff, except and without volunteering and research experience. I am new to The Student Doctor Network.. So patience with me please...

Ok that said,
When I finish my nursing degree I am planning to do a Bachelor in Biomedical Engineering which enables me to do premeds. My whole motivation towards this degree is that 1-- the course descriptions are hot-interesting 2-- I would like to be part of the body of people that change the practice of medicine-- just some of the things I could do with a BME degree 3. do research - prob open up own pharmaceutical company.

But the reality is that my true intentions with medicine is to give care to those in need like in some places in U.S. of America and outside, especially outside of U.S. of America for example like in the Dominican Republic - Haiti - Africa ect.....Missionary work is what I see my self doing as soon as I am ready in all aspects to offer FREE medical care. My focus is to become a surgeon and offer free surgeries that will save lives not Beverly Hills people self esteem. Money is a big factor in such goal. So I ask my self how is BME going to help me with my missionary work ? I think BME will be more of a hobbie -- I love reading about the new researches being done that will in fact in the future revolutionize the way "we" as future doctors will practice medicine. Nothing is carved in stone on my future scholastic life but one thing is for sure my nursing degree and practice for the next 3 to 5 years.

Then I will go back to school to complete premeds. As a surgeon I will be making alot of money. I have no type of money managment skill. I am a terrible money saver and invester. I know nothing about money except on how to make and waste it. I am not in medical school and I dont have premeds completed....Sooo... first ? What would prepare me for entrance into medical school after becoming a nurse? #2 What would prepare a future surgeon with such missionary plans ? If I were to get a B.A. in Business what type of business major would help me prepare and be savy towards my goals/ plans. Again some plans are in general- missionary work / private practice / invest money in medicine for nonprofit and profit business? Everything is a business overall, even saving lives !!!!!

Anyone can respond ?

 

[Xerxes1729]

At my school, we've had sessions on Medicare vs. Medicaid, documentation and billing, and the structure of the healthcare system. They also arranged for us to take relevant classes in the business or law schools if we want, with no extra tuition.

 

[vendetta319]

At my opto school, we take weekly "business of optometry" classes in collaboration with the business school next door. These business classes are pass/no pass, and even though its very easy to pass this type of class without showing up, almost everyone shows up anyways. The business courses aren't rigorous compared to normal ones, so it doesn't distract anyone from their opto studies, and the topics could be relevant to many health professions: business plans, investments, private practice accounting, cpt codes, insurance policies, ... etc. I only wish they started this program earlier so they can polish the curriculum. I'm guessing dental schools probably have similar programs.

Seems like this would be helpful for med students, especially those thinking about private practice, but it would be hard to implement basic business classes at all the 129 med schools in the US.

 

[deuist]

I question the need for MDs to dilute their medical education by taking business school courses.

My medical education has already been watered-down enough by courses on racial inequality and medical informatics. I would love to replace those classes with some accounting and marketing 101.

 

[deuist]

Someone posted this link to my blog: http://www.certifiedmedicalplanner.com/

It bills itself as an online lecture series about medical business. I know nothing of the program and refuse to comment on its effectiveness.

 

[AmoryBlaine]

I see this stuff about the business of medicine as just another one of those things that some people think should be an integral part of medical education.

The problem is that everyone wants a slice of the pie. Everyone thinks their pet topic is vital and should be included in the education of a doctor. I have heard multiple patients with rare diseases lament "they don't even teach about this in medical school."

Right, that's because we have a finite amount of time into which to cram tons of important information saddled with plenty of BS. I for one would be greatly in favor of taking out all the "communication skills" mumbo-jumbo and replacing it with finance stuff but then the kids over in pre-allo might get their tails in a knot for suggesting that we remove such a humanistic endeavor.

I would like to know more about idea for specific cirricula but just as I don't think my silly "how to talk to patients" class made me any better at talking to patients I wouldn't trust a medical school to give me a solid business education either.

 

[deuist]

I would like to know more about idea for specific cirricula

Asked and answered:

...
While I don’t suggest that we all go out and get MBAs, I do think that there needs to be some instruction on how to run a business so that physicians can learn to accurately charge for their services. Fourth year medical students would be the best candidates to reap from such a system. I envision a month-long Kaplan-style course where students are taught for 40 hours a week in various business topics. The courses would be condensed, focused on medicine, and would provide real-world instruction for how a doctor should conduct his clinic. And if you think that working for a hospital as either a hospitalist or an emergency physician will shield you from needing to know about business, the only person you’re deceiving is yourself. The physician who knows how to properly bill for his time will be able to generate more revenue for the hospital, thus making him a more valued employee.

For the month-long business course, I envision something similar to the following schedule:

week 1—mornings: economics, afternoons: management
week 2—mornings: accounting, afternoons: marketing
week 3—mornings: finance, afternoons: business law
week 4—medical billing

A video series of these courses could be available online along with a condensed textbook so that practicing physicians and residents could also study this subject. While everything would be taught in one month, there is no need to water down these subjects. Consider an undergraduate management course. Usually, a semester-long class is taught in 40 one-hour lectures. When I took management, I was continually frustrated by how slow the material was being taught. Certainly physicians can cram all of that information and more into 20 hours. Further, by making all of the subjects centered on medicine, doctors would be more likely to enjoy pursuing these classes. Just imagine learning how to balance books, create advertisements for your practice, resolve conflicts amongst your employees, how to pick better assistants, and the laws regarding incorporation of a company.

With this knowledge, physicians would have a more employable skill set. I would imagine that anyone who sets up such an online course would have no shortage of doctors willing to pay to learn those skills.

 

[HMSBeagle]

Maybe they don't teach us business because medicine does not follow the normal business rules because there is no free market in medicine except for plastics, derm, some ophtho and concierge medicine.

 

[yohimbine1]

Having done both an MBA and an MS in Clinical Epidemiology, I would say that Clinical Epidemiology, Health Policy, or Health Admin would probably do more to address your concerns than an MBA. Still, I would question whether it is appropriate to divert time in medical school to these purposes. Medical schools should stick to medicine. Your education should not stop when you leave medical school -- and that is a perfect time to explore these topics. There are many, many ways to get this kind of education to fill your specific needs. There is no reason why medical schools should be doing this.

I think what flindophile says makes sense. They would do a poor job of teaching business anyway, and many students would do a poor job of learning it. They wouldn't have the right mindset for it. Leave the business to those best suited to it.

I question the need for MDs to dilute their medical education by taking business school courses. Certainly, business affects medicine; however, so do lots of other things. There is already too much to learn without diluting the curriculum with lots of extras.

Many people are successful at business without any formal business training. There are many ways to take courses here and there if you decide that you need some formal training; however, I would think carefully about whether it is best to be your own half-baked expert or to seek the advice of an good accountant or financial planner. In any case, I think it is best to delay any business training until you have more of a direct need. As a med student, you are probably 5 years away from having to make any business decisions. So, it is a waste of time to take this material as a med student. Your priority should be to learn medicine. Then, if the need arises, you can decide whether decide what you need in the way of training or advice.

I am not against getting some business background but I believe med school is the wrong place to do it.

Well stated

 

[radslooking]

I disagree. I think a rudimentary class in the business of medicine should be a requisite part of medical education. Far too many doctors are being taken and are pawns by a much larger system. Patient care comes first, but you shouldn't have to be a sucker to do it. People salivate over docs because of their lack of business sense and high salaries. If you want to make it an elective...fine. I know I would have taken it. Even just a two week course in your fourth year or in residency would be worth it. At least it would give you an idea of what to expect.

IMO, as medical schools are run by liberals and socialists they probably don't want to encourage this sort of thing, as they feel it will turn even more students to the higher paying specialties. unfortunately, they'd probably be right.

 

[radslooking]

I see this stuff about the business of medicine as just another one of those things that some people think should be an integral part of medical education.

The problem is that everyone wants a slice of the pie. Everyone thinks their pet topic is vital and should be included in the education of a doctor. I have heard multiple patients with rare diseases lament "they don't even teach about this in medical school."

Right, that's because we have a finite amount of time into which to cram tons of important information saddled with plenty of BS. I for one would be greatly in favor of taking out all the "communication skills" mumbo-jumbo and replacing it with finance stuff but then the kids over in pre-allo might get their tails in a knot for suggesting that we remove such a humanistic endeavor.

I would like to know more about idea for specific cirricula but just as I don't think my silly "how to talk to patients" class made me any better at talking to patients I wouldn't trust a medical school to give me a solid business education either.

agree 100% with the communication baloney. This is PC garbage that does nothing to improve interaction, and in my estimation, actually probably makes things worse by teaching us to be stiff and use scripted responses to things. It is a tremendous waste of time. The only thing useful I see is teaching students that different cultures view diseases differently and interact with physicians differently. That's fine, but "teaching" me how to be empathetic? Nonsense.

 

[radslooking]

screw you guys, im going to develop a curriculum for this and start selling it myself. See you in St. Bart's suckers!

 

[nicksain]

if someone wanted to a) create a BOM course or b) wanted to gain a basic understanding of basic business practices in medicine --

what would you guys use as your textbook?
(trying to see if there is any recommended reading out there.

 

[drSUBLIME]

I have created a venue to have these discussions with other medical students at my school: Medical Student Business Association. Here is our blog: http://msbany.blogspot.com/