APGO

Norman F. Angell, MD, PhD
Kings County Hospital Center, Brooklyn, NY

Study Objectives: Managing the business elements of a medical practice has always been necessary. However, increased complexity of the business of medicine requires that physicians have new skills and knowledge that have not been emphasized in medical school or residency. Residents soon must deal with understanding contracts, negotiating for jobs, the specter of medical malpractice, pressing personal finances such as debt, insurance, retirement plans, as well as the enormous challenges associated with the management and administration of a medical practice. The objective of this survey was to ascertain the status of business education in residencies, the level of interest in such education among residents, and the areas in which residents are most interested.

Methods: A 24 question survey was sent electronically via MonkeySurvey to 243 programs registered in APGO. Coordinators at these programs were asked to forward the web address to the program director and the residents of the program. The survey was distributed twice. The survey was anonymous, voluntary, and completion of the survey implied consent. Results are descriptive. Survey questions were loosely integrated into the umbrella of “business training” and studied three areas of interest. The first area was a focus on securing oneself professionally and financially, including career opportunity identification (e.g., contract development and negotiation, licensure) and retirement planning. The second area included practice management issues, such as management of insurance and finances. The third area of interest included questions concerning broader environmental forces which influence the healthcare system, including health policy and economic issues. Demographic data were also compiled. This study was approved by the IRB of Albany Medical College.

Results: 107 responses were collected. Eighty two percent of respondents were female and 18% male. The year in residency was distributed as PGY1 (29.2%), PGY2 (21.4%), PGY3 (23.6%), PGY4 (9%) and program director (16.8%). University programs educated 61.8% of the respondents while 20.2% studied in community programs and 18% were in combined programs. The job plans after graduation included single specialty private group (39%), multispecialty private group (24%), academic (28%), salaried position outside a private practice (8%) and administrative/ non-clinical (1.3%). 4.5% of residents had received a business degree prior to medical school, 80% of whom received a bachelor’s degree and 20% a doctoral degree. Only 5.7% planned to obtain a business degree after residency with 4/5 planning an MBA and 1 planning obtaining a Masters in Medical Administration. Two of the respondents who were planning or considering a business degree were program directors (1 MBA, 1 MMA). Currently a minority of programs surveyed provide business training (35.8%) and, those that do provide relatively brief exposure to business topics (<7 hours in total on

average). A small minority of programs presents the ACOG lecture series in business (21.4%) despite the fact that OB/GYN faculty provide almost all of the training (79%). Lectures were the most common form of education (85%) but informal instruction was common (53%). The topics most commonly presented were insurance (71%), employment contracts (61%), licensing and credentialing (55%), practice operations (48%), finding a position (45%), and practice finances (42%). Less common topics (20-40%, in decreasing order) were personal finances, healthcare policy, teamwork, communications skills, healthcare information systems, and selecting and using professional advisors. The vast majority of respondents desire business training (96%). Topics that residents would like covered are similar to those actually covered; employment contracts (83%), practice finances (81%), insurance (77%), finding a position (72%), and healthcare finance (72%) were most valued. Residents preferred lectures as the educational format (66%), although informal instruction (49%) and separate seminars (45%) were popular.

Conclusions: Residents express the need for training in business, but few programs provide this training and those that do devote a small amount of time to it, particularly in relation to the number of issues considered important to the residents. While a variety of venues are valued by residents, the traditional lecture format continues to be popular and is cost effective. Business training may be divided into three categories: (1) Professional growth and personal financial management; (2) Practice management necessities; (3) Healthcare system dynamics and trends. This order of presentation reflects the priority interests of the respondents. Nevertheless, research on curricular design would suggest reversing the order. An initial focus on healthcare system trends will establish a context for professional opportunities and growth and practice management knowledge and skill requirements. In all, once they have “a lay of the land” it will be easier to see where they can slot in professionally.

Key Words: Business, education, residents