Many orthopaedic surgeons would agree, at least on an intuitive level, that we, as physicians, should understand the business of our chosen profession, and as a community, we seem to want to understand this perspective. But when does this realization occur? Based on the results of a short survey of Chicago-area residents, residents are already thinking about these issues. (See “Residency training programs need to add business education,” AAOS Now, August 2011.)

Although there is no substitute for “real world experience,” the earlier in their careers that physicians are exposed to the economic realities and management dimensions of the medical profession, the more effectively they can navigate those waters. According to Joel I. Shalowitz, MD, MBA, FACP, of Northwestern University’s Kellogg School of Management, “The opportunity costs at this stage (residency) remain reasonably low and an advantage of delivering business education during residency is that management skills are acquired closer to the time of application.” In other words, exposing residents to business skills is not premature, and such knowledge may help ease the transition from physicians-in-training to physicians-in-practice.

Our survey found 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. Although multiple resources are available, residents do not seem as likely to use them. To address this demand, we developed the Business of Orthopaedics Lecture Series curriculum to address topics such as the following:

• the history of managed care
• the history and structure of Medicare and Medicaid
• legal matters in medicine
• contract negotiations and communications
• an overview of running a practice
• hospital operations
• leadership

Developing the curriculum
The program had two goals: to fill the business education gap in our specific residency program and to create a model for delivering business education that nearly any program could adopt. The business curriculum created covers topics that are essential to the practicing orthopaedist.

To determine content, we asked second- through fifth-year residents what they felt least prepared for and most nervous about. We also asked attending physicians, with and without MBA degrees, what they wished they had known before finishing their training programs. This process enabled us to revise and reformulate the curriculum, which was then distributed to others—including a business school professor, an executive at a large healthcare organization, and at least two attending physicians with graduate business educations—for comment and feedback.

A grant from the Orthopaedic Research and Education Fund enabled us to invite business school professors from the Kellogg School of Management to deliver some lectures. Because not every residency program would have access to such funds, we attempted to identify resources available to most academic medical centers.

Every program has a new attending physician who can recount his or her recent experiences with contract negotiations, a hospital administrator eager to explain inventory management and finance, and a practice manager willing to clarify billing and coding. We have found that using these available resources greatly benefits our resident participants.

Separate post-lecture surveys enable residents to grade the importance of that topic to future practice and provide them with an opportunity to suggest improvements. Although the information “hits the mark” most of the time, there is often room for improvement. This educational initiative is a continual work in progress that gives all stakeholders the opportunity to participate. The post-lecture assessment provides the feedback necessary to evaluate and improve the lecture series as well as to maintain relevance and buy-in.

Advancing the profession
Many opportunities are available for physicians interested in business education. According to the Association of American Medical Colleges, at least 53 combined MD/MBA programs were available in 2010. In addition, the AAOS has a number of resources—online, in print, and in courses—and other orthopaedic residency programs either formally or informally provide residents with business education concepts.

Such programs are increasing. A similar program integrated into the department of pediatrics at Children’s Hospital of Michigan has shown promising results, and the family practice residency programs at the State Universities of New York have been providing practice management training for residents for more than 40 years.

Clearly, business education can be formally integrated into residency training, and we believe that it should be. Even if a program’s curriculum cannot accommodate additional lectures, programs can invite speakers from health administration programs to lecture on business-related topics at grand rounds events.

Healthcare reform is changing the face of health care and requiring physicians to have a new set of skills. According to Ronald Bucci, PhD, a corporate director of Forum Health in Ohio, “To survive and succeed in this new era, medical people and healthcare institutions in the medical world must perform efficiently and effectively. The healthcare field now works like a business, and the players must act as businesspersons to survive.”

More than a decade ago, Joan M. Kiel, PhD, associate professor in the department of health management systems at DuQuesne University, lamented that even “as the healthcare industry has changed, medical education has not.” Until medical schools more consistently fill this gap, residency remains one of the last few opportunities to prepare young physicians for the bitter realities of modern practice.

By incorporating business education, residency programs have the potential to make medicine once again a fulfilling career and to better prepare residents for future leadership positions. Physicians who have a business background will bring a unique perspective to the boardroom, understand the effects of policy, and offer intelligent solutions to the problems faced by society.

If we can create such a model for balanced education—one that represents a more comprehensive training experience for residents—we can begin to truly transform the way health care is delivered and, in doing so, better serve our communities.

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.

Bibliography

1. Vanelli MR: Disenfranchised doctors need new skills to compete. Manag Care, 1999;8(1):45-48.

2. Nash DB: The physician-executive: Part 1. The younger doctor: Growing demand for an emergency subspecialty. Consultant 1987;27(11):97-98, 101-102, 106 passim.

3. Kiel JM: Enhancing health administration competencies for physicians: An evaluation of medical school curricula and education for physicians. J Health Adm Educ 1999;17(1): 41-49.

4. Greene J: The 1997 Hospitals & Health Networks leadership survey. Hosp Health Netw 1997;71(15):26-30, 32-36, 38-40.

5. Chuck JM, Nesbitt TS, Kwan J, Kam SM: Is being a doctor still fun? West J Med 1993;159(6): 665-669.

6. Massachusetts Medical Society. Physician satisfaction survey 2001. Accessed by Parekh, e.a.A.

7. Parekh SG, Singh B: An MBA: The utility and effect on physicians' careers. J Bone Joint Surg Am 2007;89(2):442-447.

8. Sherrill WW: Dual-degree MD-MBA students: A look at the future of medical leadership. Acad Med 2000;75(10 Suppl):S37-S39.

9. Gunn EP: MBA programs switch to big-picture approach. Accessed by Parekh, e.a.J.

10. Patton GA, Gardner RM: Medical informatics education: The University of Utah experience. J Am Med Inform Assoc 1999;6(6):457-465.

11. Shalowitz JI, Nutter DO, Snarr JF: Medicine and management: A combined educational program. J Health Adm Educ 1996;14(3):305-313.

12. Association of American Medical Colleges. AAMC curriculum directory. Accessed by Parekh and Singh 2006 June 5.

13. Larson DB, Chandler M, Forman HP: MD/MBA programs in the United States: Evidence of a change in health care leadership. Acad Med 2003;78(3):335-341.

14. Association of American Medical Colleges. AAMC curriculum directory. Accessed 2010 November 20.

15. Babitch LA: Teaching practice management skills to pediatric residents. Clin Pediatr (Phila);2006;45(9):846-849.

16. Kolva DE, Barzee KA, Morley CP: Practice management residency curricula: A systematic literature review. Fam Med 2009;41(6):411-419.

17. Bucci RV Has managed care changed the skills required for physicians to practice medicine? Manag Care Q 1999;7(4):20-24.