[Editor's Note: This is a guest post from Jason Mizell, MD and Sarah Catherine Gutierrez, both of whom I met on a recent trip to Arkansas which I wrote about back in July. If you'll recall, Jason is the surgeon running the Business of Medicine class there and Sarah is an hourly rate financial planner specializing in young physicians who advertises on the website. I've been sending readers to her for years with lots of great feedback. There is a growing number of academic doctors publishing on this subject in the last few years, and I hope to see those numbers increase. This post is all about the Business of Medicine class, which I hope becomes standard curriculum throughout medical schools. I hope this post gives the idea more publicity so medical students start demanding it from their schools.]
As has been well discussed on this blog, physician financial mistakes and subsequent regrets are all too common. A link between these financial mistakes and the lack of education physicians receive in practice management cannot be ignored. It has been well documented that nearly all physicians enter practice with very little exposure to financial principles and practice management despite many years of education in medical school and residency.
This deficit is despite the fact that for a residency program to maintain accreditation by the Accreditation Council for Graduate Medical Education (ACGME), it must teach “specific knowledge, skills, behaviors and attitudes” related to practice management to their residents. CMS requires physicians to provide “accurate and truthful claims information” demonstrating compliance with federal regulations for coding and billing. Furthermore, there is a nationally growing emphasis on understanding healthcare economics to help decrease healthcare spending while improving patient care outcomes. Despite all this, these critical skills are rarely taught to medical students or residents. Additionally, the only area that is taught less than practice management is personal finance education. When these deficiencies in personal and practice management are combined, a young physician is significantly disadvantaged as they begin their practice and adjust to the challenges associated with a larger personal income [not to mention a growing debt burden-ed.]
Fixing the Knowledge Deficit
How do most physicians correct this knowledge deficit in practice management? Sadly, many physicians do not correct it at all. This leaves them unable to effectively manage or monitor the financial aspects of their practice. Physicians that attempt to learn these essential practice management skills must attend expensive and time-consuming courses, obtain secondary degrees, or attempt to learn through personal trial and error. All of these attempts cost new physicians significant time and money. Conversely, lack of education in personal finance often manifests much later when they realize their debt is too great and savings too little to retire when they would hope.
I became aware of this knowledge deficit in my own training when I started my first job at the University of Arkansas for Medical Sciences (UAMS). When the billing and coding staff began using terms such as CPT, ICD-9, and E&M coding, I suddenly realized I was massively unprepared for one of the most critical components of my career – actually running my practice. I quickly resolved to make sure this did not happen for the residents I would train. With the help of several of our UAMS faculty, we designed an intensive program beginning in 2011. Topics for the curriculum were chosen based on those considered critical to the development of a well-rounded surgeon, inadequately taught in resident education, or of special interest to our residents. Examples of topics included in the curriculum were billing and coding, updates on healthcare, setting up your first practice, use of EMR, and malpractice avoidance. Additionally we included topics related to their personal finances as well: retirement planning, personal investing, debt management, and estate planning. We surveyed our residents at the beginning of the course and found they were extremely interested but knowledge deficient in almost every topic.
The course was game changing for many of our residents. They were now leaving residency with the confidence and knowledge to start their practice and also were taking steps to get their personal financial life in check. Residents often stopped me in the hall to describe how they were beginning to pay down thousands of dollars in credit card debt, saving for their kids’ college tuition, and planning for retirement. The results of the pilot year have been presented and published.1-3 The feedback was so tremendous that a similar course patterned after ours was implemented at the Vanderbilt department of surgery.
Yearly resident feedback revealed the strongest interest was in personal finance, so we gradually dedicated more time to covering these topics. To handle the personal financial education piece more effectively we independently vetted Aptus Financial, a personal financial planning practice consisting of two experts: Dr. Andy Terry who is a chartered financial analyst (CFA) and has a PhD in Finance and Sarah Catherine Gutierrez who obtained her masters in public policy from Harvard, is a CFA and Certified Financial Planner (CFP). We wanted the content to be from experts in the financial planning field and non-conflicted. Because Aptus charges a fixed fee for financial advice rather than selling products or investing assets, it was an ideal fit for our curriculum.
Bringing It To Medical Students
Because we came to realize most financial mistakes were actually made during medical school, we adapted the resident curriculum and developed a new elective 20-hour Business of Medicine (BOM) curriculum to be offered each spring to 4th year UAMS medical students. For the new curriculum, we added lectures such as cash flow management, debt reduction, physician recruitment, contract negotiation, estate planning, tax preparation, buying a house, malpractice avoidance, and student loan repayment.
We found that at a time when most 4th year students have already mentally graduated and moved on, students in the BOM course were excited to learn and full of questions. Students on away rotations would video conference in so they would be able to participate and learn. Spouses often attended as well.
The end of course feedback for the BOM has been more staggering than our resident curriculum. [I didn't find that surprising, but I suspect many med school administrators might.-ed] Student knowledge and confidence in every topic covered has substantially increased, and anxiety over personal and practice management decisions has decreased dramatically. One hundred percent of students felt the knowledge gained from the course would be helpful to them, and 90% of students felt the course should be mandatory throughout medical school.
The usefulness of the program has not only been demonstrated by survey feedback, but also in enrollment and campus wide interest. The first class started with 74/160 students, increased to 96 students this past year, and currently 124 are scheduled for next year’s class. WCI's own Dr. Dahle was gracious enough to come speak during this past year’s course, and many students, residents, and faculty from all disciplines across UAMS attended or watched the online recordings, again showing the growing widespread interest in the course.
Hopefully with the advent of this student course, UAMS graduates will finish their education prepared for the coming personal and professional challenges that lie ahead. We hope to help them learn personal and practice management skills to be a successful physician…before becoming one.
- Mizell J, Berry K, “A Financial Management Curriculum for Surgery Residents,” wingofZock.org, posted July 2013
- Mizell J, Berry K, Bentley F, Clardy J, Turnage R. Money Matters: A Curriculum for Resident Personal and Practice Management. 9th Annual Academic Surgical Congress; San Diego, CA, February 4-6, 2014
- Mizell JS, Berry KS, Kimbrough MK, Bentley FR, Clardy JA, Turnage RH. Money matters: a resident curriculum for financial management. J Surg Res. 2014 Dec;192(2):348-55. doi: 10.1016/j.jss.2014.06.004. Epub 2014 Jun 11. PubMed PMID: 25005821.
What do you think? Have you been involved in something similar as a student or teacher? What worked and what didn't? Would you like your medical school to start a course like this? Comment below!