Thursday, August 18, 2011

Physicians Regret not learning Business Skills in Medical School

Once exposed to the realities of practical and sustainable healthcare delivery physicians are quick to regret not learning more about the business side of medicine at medical school. In a posting on Kevin.MD "How can doctors understand the business side of medicine?" Michelle Mudge-Riley echos a frequent sentiment amongst her colleagues

One thing I regret is not taking advantage of the Masters degree in Health Administration program at my medical school. At the time, I was focused solely on medicine and on being a doctor. I didn’t think the business side of medicine was all that important. In fact, I didn’t consider the business side of medicine at all.

While individuals may regret decisions on career pathway (the grass often appears greener on the on the other side of the fence) the article cited from the New England Journal of Medicine from February this year Advancing Medical Education by Teaching Health Policy makes the point that there has been a push for additional teaching as part of the medical student curriculum on health policy and health systems (from 1995) but more than 15 years later less than 50% of medical students "believed they'd been appropriately educated about topics such as medical economics and health care systems."

The science of Medicine is increasingly complex but so is the healthcare systems - new treatments need to be assessed not just from a clinical standpoint but an economic one. Comparing the effectiveness of treatments requires an understanding of economics and the practicalities of budgeting but the information and the skills have for too long been lacking in healthcare education and in day to day clinical practice. Patients and clinicians have been disconnected from the consequences of expenditure with third party payers responsible for managing costs. Much like the European Debt crisis where sudden access to inexpensive debt and limited immediate consequences of the use of debt created an unsustainable position or as one commentator put it  
"It was if Greece received an American Express Black (Centurion Card) 
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 but was not responsible for the charges".

Clinicians remain handicapped with the the medical curriculum that still lacks inclusion of foundational knowledge and fails to develop the necessary analytical skills that would equip the key decision maker with all the tools to help navigate the complex adjunct economic decision making process that must be a part of sustainable clinical medicine.

I applaud the proposed additions to the medical curriculum that includes the addition of four domains:
  • health care systems and principles,
  • health care quality and safety,
  • value and equity, and
  • health politics and law
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The downside is the additional information that is loaded into an already packed and expanding course. The other unfortunate consequences of these changes and the increasing variability between healthcare systems is the diminishing nature of international equity. Medicine used to be one of several professions that offered graduates opportunities to travel the world and work in other countries. This ease of international movement has already diminished as these systems, processes and curriculum have diverged making international experience harder for the newer graduates

Posted via email from drnic's posterous