01 August 2006

A Gap in Vocational Training

I've been interviewing a number of physicians in our summer hiring drive, and orienting the new crop of docs we have starting with us. It's really amazing. These are all highly accomplished, intelligent people who have trained for years and years to get to the point where they can finally enter the indsustry. On average, it's eleven years: 4 years of college, 4 of med school, and 3 of specialty training.

But they know nothing about the business of medicine. Not a thing. How charges are determined, how the documentation affects the coding, how the patient encounter turns into dollars of revenue, the differences between payers, contracting, etc.

How can it be that you can spend seven years of professional education and come out of it knowing nothing about the basic operations of the industry? It's not the students. They're bright and motivated, and usually pretty interested. And casting my mind back just a couple of years ago to when I came out of residency, I knew nothing about business either. It's the educators' fault, I think. During my seven years in acedemia, I was never exposed to any formal business training. Not once.

I don't know whether it arises from an ivory-tower academic disdain for mammon that the business side of the education is so neglected. Or whether it's because many of the instructors in medical schools have spent their entire careers in academics and actually know nothing about community-based medicine. Or whether the complexity and byzantine nature of the business just seems impossible to convey in the minimal time alloted so they don't even try. either way, it's a pity.

Hmm. If I were designing a curriculum for medical students (or better, residents) what subjects would it cover? It should be reasonable -- you don't need an MBA to practice medicine. Key topics might be:

  • Contracting (for individuals)
  • Malpractice (both Risk Management and Liability Insurance)
  • The basics of ICD-9 and CPT coding, and documentation
  • The RVU system and the mechanics of billing
  • Practice Finance
  • Contracting (third party payors & hospitals)
  • Health Policy (Macro)
It would be a start. It's pretty sad that it's possible to come out of what is essentially a vocational training program and know none of the above.


  1. Could it be that the overlap is unecessary? Perhaps only a brief overveiw would be enough. I mean, even a layperson can look up ICD-9 codes online.

    As a former office administrator for a medical practice, I felt as though that was MY job. Sure, the docs knew what codes they would use for what procedure (this was a private practice--do they even HAVE to know that in a hospital setting?), but I was the one who would implement everything. Even change the code to something similar, if the ins. company would pay!

    I think that with everything a physician has to know in general and specifically, giving them the extra burden of office management is just asking for burnout.

    However, perhaps the class on malpractice would be good--happens too often these days.

  2. The basics of documentation and billing are an essential skill for a successful member of any practice. Though most physicians have little or no interest in the business side of medicine, it is crucial to understand the importance of how our work is judged to have been of value. It is not enough to have a patient feel comforted, reassured, or get better. Yes, that is why we went into medicine: the patients. But if we don't have a firm grasp on how an insurance company s going to judge whether we deserve 0.7 RVUs or 1.4 RVUs of compensation, then in the long run we won't be as successful in being able to provide the best care possible to the most patients.

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