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How to Succeed in the Business of Medicine

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As a baby boomer, mine is the last generation to approach our careers, financial prospects, and life in general with the assumption that we will do better than our parents. These days, we not only worry about outliving our retirement nest eggs, but also about the very real possibility that our children – whether they be GenXers or millennials – may not be able to do as well, much less reach or surpass the standard of living that we have enjoyed.

For those who do try to better themselves through education, will they be able to make it pay off? After the student loans are paid off?

Most doctors go into the practice of medicine because they feel a calling to help, to heal, and to serve. But it’s gotten more complicated. Whether they’re in private practice or working for a hospital, it’s increasingly important for physicians to understand the big picture and the business side of the industry, so they can do their parts to help their institutions be successful in a delicate and often volatile economy.

My son just started medical school. Right now, he’s just worried about making it through the next eight weeks. Me? I’m thinking about his longer-term prospects. So when I was invited as a representative of MD-UPDATE to sit in on “The Business Side of Medicine,” a non-clinical course in the U of L School of Medicine curriculum for all residents, I jumped at the chance. The course, designed and developed by Dr. Bonnie Mason, founder and CEO of Beyond The Exam Room™, is designed to help residents make the transition easier by focusing on practical topics such as how to analyze and negotiate an employment contract, personnel and practice management, financial planning, debt management and elimination, and the newest implications of healthcare reform.

The “Other Side” of Medicine

Mason developed the course to give residents something she didn’t get in medical school – the business skills needed to maintain financial viability as they transition into an increasingly complex industry. Mason is now in the process of expanding her CME-accredited program into partnerships with universities like her alma mater, Morehead School of Medicine, as well as hospitals and physician groups and associations.

I can relate. I had to learn the “other side” of behavioral health the hard way. I graduated into the middle of a recession, so out of expediency, I entered the corporate world — and found myself better off from learning to live in the bottom-line, results-oriented world of commerce and business. It helped me avoid becoming a bobble-head therapist and gave me the entrepreneurial skills I needed to start my own private practice. It also made me more effective with my clients, most of whom are professionals or executives themselves, because I’ve lived and worked in their world.

When Mason’s surgical practice was derailed by rheumatoid arthritis, she “repurposed” herself with a stint at the Kellogg School of Management that resulted in a graduate certificate in executive education. The result is an ability to communicate business concepts in a way that physicians can understand, digest, and apply, so they can understand financial reports, budgeting, and managing revenues and expenses as well as deliver excellent patient care.

Show Me the Money

Business skills, even for hospitalists, are relevant because many physicians sign their first contracts without consulting a financial or legal advisor and leave that job within two years. U of L Vice Dean for GME and CME John Roberts says, “We give the residents a sample employment agreement and have an expert panel of attorneys help them analyze the terms of the contract, such as termination, malpractice, noncompete, benefits, and compensation.”

The Greater Louisville Medical Society (GLMS) has been an official partner with U of L since the course was started four years ago. “We’ve learned a few things since the program’s inception,” says Bert Guinn, CEO of GLMS. “The art of contract negotiation has been the most popular aspect of the program. Having seasoned physicians and attorneys teach our residents what to watch out for and what to fight for when negotiating is really important.” For example, residents can role-play negotiating a higher base salary, a more robust sign-on bonus, more vacation weeks, or the ability to moonlight within or outside of an organization.

Deron Bibb, MBA and vice president of Practice Management Services at iHealth Solutions and a volunteer expert panelist observes, “Eager to get out from under their student loans or caught in the crosshairs of government intervention, I see a ‘run for shelter’ mindset to employment by hospital systems, but it rarely is. I find myself reminding physicians that they are the primary revenue producers for the hospital system. My message is ‘Don’t expect the hospital system to make your best interest or job satisfaction a priority’”

Money Isn’t Everything

Mason emphasizes that it’s important to cover all the bases in an employment contract so the focus on compensation is balanced by taking into account key contractual items, such as the noncompete clause, the termination clause, and liability insurance – things that can make your life miserable if you don’t pay attention to them up front.

For physicians experiencing burnout, who wish they had been more in touch with what was important to them when they were first starting out and are now exploring how to reinvent themselves so their jobs better reflect their priorities, the main concern may be negotiating time off or more flexibility and the ability to manage the total number of work hours.

“Business skills to understand the other side of the industry are crucial, and I think it really gives our residents a leg up on residents from schools that do not provide such training,” says School of Medicine Dean Toni Ganzel. “We are now working with our CME unit to see how we can expand to include practicing physicians. Whether you’re transitioning into or between practices, it’s really about being better informed so you make better decisions.”