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Residency training programs need to add business education

By James M. Saucedo, MD, MBA, and Lalit Puri, MD, MBA

Survey shows support among residents

As the delivery of health care becomes increasingly complex, physicians are expected not only to adapt to declining reimbursements and rising costs, but to maintain leadership roles as well. Unfortunately, physicians rarely, if ever, receive formal instruction in business principles as part of their medical training, even though they see, on a daily basis, the effects of policy on individual patients.

As with any professional field, business administration has its own language and perspective. This is never clearer than in a hospital setting where physicians and administrators all too often dismiss each other as not truly understanding the other’s responsibilities. This is a failure to recognize that both physicians and administrators are pursuing the same goal: delivering quality health care to the community.

As early as 1987, the call went out for physician-executives to act as liaisons between the administrative and the clinical personnel of a hospital. Clearly, many organizations recognize the value of such a perspective; in 1997, the American Hospital Association reported that 46 percent of hospitals, 55 percent of group practices, and 78 percent of managed care organizations employed physicians in positions of leadership. More recently, a 2011 study of the top 300 hospitals in the United States found that the best hospitals are typically run by medical physicians, not managers—with overall quality scores for physician-run hospitals about 25 percent higher than for other hospitals.

Interestingly, the changing economics of health care may also be contributing to the growth in and need for physician leaders. In particular, changing attitudes and healthcare reform may be paving the way for increased participation by physicians in hospitals.

Business education resources
The deficiency of business education in training physicians, however, leaves many doctors ill-prepared to navigate these turbulent waters. Studies have found, for example, that many physicians feel powerless, frustrated, and jaded, which could prompt many to take early retirement or switch to other careers.

This issue has long been recognized, as evidenced by a growth in joint MD/MBA programs, physician enrollment in executive MBA programs, and various business seminars and courses directed to physicians. Interestingly, compared to conventional medical students, students in MD/MBA programs tend to be less nervous and feel more prepared to handle the changing healthcare field, suggesting that supplementing medical education with practical business information may be key to improving cooperation and satisfaction.

The AAOS has a series of online practice management modules and primers available for download and offers additional resources, including compact disks, a self-assessment examination, and several texts (published by the Medical Group Management Association and primarily covering group practice management). In addition, it sponsors two practice management courses directed to physicians currently in practice, as well as a half-day practice management symposium for residents in conjunction with the AAOS Annual Meeting.

To date, however, no study has addressed resident attitudes and behavior with regard to these various resources. Neither has there been an organized attempt within the orthopaedic community to share a program’s experiences with integrating business education into residency training.

A resident survey
Faced with this reality, our program began to develop and integrate a formal business lecture series into our education curriculum. At around the same time, we created and distributed a short survey to Chicago-area orthopaedic residents to help us understand resident attitudes toward business education.

The survey asked residents about the importance of business knowledge to the practicing orthopaedist and about their attitudes toward the delivery of that knowledge (Fig. 1). An e-mail link gave them access to an online survey tool (SurveyMonkey.com, LLC, Palo Alto, Calif.).

The survey did not ask for demographic information or identification of the resident’s program. The following four questions were asked:

  1. How important is business knowledge to the practicing orthopaedist?
  2. Do you want to learn more about business principles?
  3. How likely are you to use online resources to learn more about business concepts?
  4. How likely are you to attend in-house lectures to learn more about business concepts?

The survey was left open for approximately 14 days. Program coordinators at each institution were asked to distribute the survey to each resident (first through fifth year), and each received at least two follow-up e-mail reminders and one phone call reminder.

Although the response rate was less than optimal (46 of a potential 151 responses were received, or about 30 percent), the results supported our suspicion that residents were indeed interested in business education. Based on the top two tiers (agree or strongly agree), approximately 91 percent of respondents believe that business knowledge is important to the practicing orthopaedist, and about 95 percent of respondents expressed a desire to learn these concepts.

Regarding the delivery of that knowledge, 57.8 percent of respondents said that they were likely or very likely to use an online resource. On the other hand, 97.8 percent of respondents said they would be likely or very likely to attend in-house lectures. These results provided the spark necessary to continue the process of integrating business education into our curriculum. Through this process, we found that we had created a curriculum that we believe any program can emulate.

As with any nonvalidated survey, ours had certain limitations—small sample size, limited location, low response rate. Without demographics, we were unable to measure the response rate of the various programs or to determine any correlations between training year and attitudes. It is very possible that the majority of responses came from our own institution.

But at least on a preliminary level, it indicates that residents seem to want to learn more about business concepts and would be more likely to obtain that information if it is delivered directly to them.

James M. Saucedo, MD, MBA, is a PGY-4 resident, and Lalit Puri, MD, MBA, is an assistant professor, joint reconstruction, at the Northwestern University Feinberg School of Medicine, department of orthopaedic surgery.

Editor’s note: This is the first of a two-part series on business education in residency training programs. Next month, the authors will discuss a specific business education program for residents.

Additional Links:
Resident Practice Management Lecture Series

AAOS Practice Management website

AAOS discounts on MGMA practice management publications

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AAOS Now
August 2011 Issue
http://www.aaos.org/news/aaosnow/aug11/clinical10.asp