Where physician education falls short

Many physicians blame lapses in medical school education with creating a generation of physicians who don't understand the "business of medicine." 

Eighteen physicians joined Becker's ASC Review to discuss where physician education falls short. 

Editor's note: These responses were edited lightly for clarity and brevity.

Robert Szabo, MD. Orthopedic surgeon at UC Davis Health (Sacramento, Calif.): Currently physician education is primarily one of progressive specialization. In orthopedics, for example, to become a hand surgeon, one first completes four years of medical school followed by five years of orthopedic residency, followed by a one-year hand fellowship. If education changed to a paradigm of early specialization, students would be introduced to the problems in their specialty that needed to be solved earlier, and look to partner with industry to improve products and services in an area within their expertise. An added value is the cost of education, which is subsidized by our government, would also decrease.

Rajiv Sharma, MD. Founder of Digestive Health Associates (Terre Haute, Ind.): Physicians need to also educate themselves about healthcare politics and basic things like hospital bylaws. Any relationship they enter in, they need to know who controls their paycheck. Biggest point of education should be understanding money flow, that is, who can turn their flow off and how they should hedge against it. That is why networking, making friends, being courteous to other doctors and their families, political fundraisers, business meetings, etc., are helpful. Because when someone else writes your paycheck, you very well need to accept the notion that one of you will play prey and the other one is the predator. You have to decide how big of a bite that is. 

Krishna Mannava, MD. Vascular surgeon at Fairfield Healthcare (Lancaster, Ohio): For physicians in medical school and residency training, there needs to be more exposure to the business side of medicine. This includes all the different practice models that are out there. This is as important as learning clinical skills, as this will empower trainees to think more holistically about job opportunities rather than taking whatever may be available. 

Naveen Reddy, MD. Gastroenterologist at Palm Beach GI (Jupiter, Fla.): It should start at the medical school/residency level. Academic programs shy away or even actively discourage discussion about the business and economics of medicine. I'm not sure if it is because the people in academics don't have the knowledge to discuss business/economics or feel it is an indelicate subject, but failing to address these issues is a disservice to their trainees and the future of medicine, as it leave graduates unprepared and susceptible to business people who will take advantage of them.

Elisabeth Lernhardt, MD. Internal medicine specialist in Penn Valley, Calif.: This question touches the core of why I would not choose to become a physician today! It is an industry, and physicians have to be squeezed into its mold. As COVID-19 exposed, we will not be effective healers if we are just puppets of the industry or the government.

Joe Greene, MD. Co-founder of Louisville (Ky.) Hip & Knee Institute: Knowledge is power. The more physicians educate themselves through discussions with physicians who are already in the industry and have been on some of the learning curves the better. Attending meetings such as Becker’s and specialty-driven meetings focusing on ASC management and development were critical for me before my partners and I started our ASC and private practice.  

Chandoo J. Kalmat, MD. Anesthesiologist at Zona Spine and Pain (Goodyear, Ariz.): Physician education should focus more on billing, coding, Medicare documentation requirements, training on how to read local and national coverage determinations, and also how to market your practice and have good customer service.

Henry Backe Jr., MD. Orthopedic surgeon and partner at Orthopedic Specialty Group (Fairfield, Conn.):  Physician education needs to teach and get students involved in translational medicine. It also needs to continue its close partnership with industry at the academy and regional-society levels. Additionally, learning the business of medicine and getting involved with hospital co-management programs is important. Physicians must also learn the concepts of bundled payments, population healthcare and shared risk.

Alyson Engle, MD. Assistant professor of anesthesiology and pain medicine, Northwestern University Feinberg School of Medicine (Evanston, Ill.): Physicians in training need more interaction with private practice doctors. Residents rarely get any interaction unless they personally know someone or reach out on their own. Hospital systems where the residents train require them to complete most all rotations within the hospital's systems. This results in a biased view of private practice and industry since medical students, residents and fellows have been told for years how unethical medicine is outside of the academic setting. Incorporating rotations and connecting physicians in training with private practice doctors would help minimize this bias. Moreover, younger physicians fear the unknown of the industry and private practice when they have not had exposure. Connecting residents and fellows early on with mentors in private practice can ease these fears and help them find the ideal place to practice while understanding the competition. 

Jack Bert, MD. Orthopedic surgeon at Woodbury (Minn.) Bone & Joint: Physicians need to educate themselves in regard to contract negotiations and be aware of the advantages and disadvantages of private practice vs. large system employment. Speaking with fellows in training programs, the majority of them have no clue about these topics simply because they have not had any instruction in business principles. The healthcare environment continues to change, and it is going to be critical for physicians to have a better understanding of what they need to be aware of and what questions to ask before they enter a private practice or large system employment career

Endrit Ziu, MD. Neurosurgeon in Jacksonville, Fla.: Training for the industry should start in residencies. Residents should be allowed and have contact with industry partners of the equipment that they use on a daily basis. For example, in spine, I was lucky as a resident to have visited, as well as experience, the product design and preparation at Globus spine facility in Philadelphia. It gives you a better understanding of what it takes to make a product, as well as how to better apply a product to your patient population. I encourage short fellowships for residents when they are provided by industry. We have to work together for the future of medicine; industry partners have to understand that, as well as training programs. 

Eric Mehlberg. Anesthesiologist at Comprehensive Pain Specialists (Golden, Colo.): Clinician instructors cocooned inside academia have no experience teaching private practice.  When I was training, there was an implication that those who went into private practice 'sold out.' Quite to the contrary, I can do what my current understanding of 'best' is for each of my patients. Medical education needs to focus less on meaningless test scores and case logs and grant trainees exposure to clinical environments they are interested in. 

David Johnson, MD. Gastroenterologist in Norfolk, Va.: Physicians will be held more accountable for expense and utilization of medical services. Development of best practice strategies for cost containment and efficiency will be very important, especially as some 'shared risk pool' programs evolve as a path for reimbursement.

Joseph Anderson, MD. Professor of medicine at Dartmouth Geisel School of Medicine (Hanover, N.H.): I think that physicians need more education on running a business, molecular medicine and being entrepreneurial.

Eugenio Hernandez, MD. Vice president of clinical affairs for Gastro Health (Miami): The primary goal of physician education should always be to provide quality and compassionate medical care, regardless of the setting. Instruction on the different employment models, business finance and long-term career planning will help better prepare future physicians for an increasingly complex healthcare system.

Alok Sharan, MD. Spine surgeon at NJ Spine and Wellness (East Brunswick, N.J.): One aspect of physician education which is severely lacking is the business of medicine and practice management. Once physicians understand this information, they can feel comfortable either running their own practice or going into private practice.

Ben Bradenham Jr., MD. Gastroenterologist at Gastrointestinal Specialists (Richmond, Va.): The identification and prevention of burnout has been an increasingly popular concept in medical education. This has manifested mostly as an effort to emphasize to medical students the importance of balance in their lives and to take care of themselves through exercise, etc. While helpful for some, I believe this effort will only go so far in preventing physicians from burning out and leaving the workforce early.

Steve Lucy, MD. Orthopedic surgeon at Sports Medicine & Joint Replacement (Greensboro, N.C.): There's really always been a lack of education on topics of how physicians should manage a practice — should you do private practice, what's the upside or what's the downside on an employment model? There's really not a lot of business taught in medical school, and I think there should be more and more of that. I'm not exactly sure how that will take place, because if you've got a hospital system, obviously, they're going to  encourage people to be trained for hospital.

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