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)