[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.
Jason Mizell, MD
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.
Sarah Catherine Gutierrez, CFP®
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.
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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!
I started a 3 hour practice management series for my Anesthesia Residency this year and am giving Grand Rounds on public policy updates tomorrow. I appreciate including the references in this article. I’ll be taking a look.
A challenge with personal finance is that it can be quite personal.
You’re quite right regarding personal finance. I’m seeing a trend though of students being ok with disclosing personal information to help others out. It’s nice to see them passing along recommendations they get from sites like the WCI.
Great job, team. It’s high time we allow medical students and residents to talk (and care) about money. It was, and probably still is, generally frowned upon to openly discuss money, because we’re all supposed to be held to the highest standard of altruism.
With the rising student loan debt, and increasing complexities in the business of medicine, I hope to see more examples of classes like this one.
Cheers!
-Physician on FIRE
This is what I was going to say. It’s taboo to talk about money in medical school because everyone should be there only because they “want to help people” or “contribute meaningfully to society”, not because they want to make a good living doing something they find interesting and intellectually stimulating. So teaching or learning about financial things goes against all that.
We had one lecture on loan consolidation (back in 2005 when rates were still low before jumping to the artificially high 6.8%). That was the extent of my financial education in med school.
Until this course, we had just one lecture on students loans as well (it’s required as part of exit counseling for graduating students…otherwise I think it wouldn’t be given at all in most medical schools). Students never seemed to learn much from it unfortunately. Now we have the students bring their computers to class and pull up their personal information and walk through each scenario available. Much more interactive and educational for them.
Maybe one way to “sell” this type of class to medical school administrators who feel it’s taboo to talk about money is to point out that doctors who have their financial house in order have more time, energy, and focus to take care of patients. Being financially independent allows me to see fewer patients and spend more time with the ones I see. I can concentrate on practicing without worrying about paying my student loans or mortgage. IMO, a financially secure doctor can practice better medicine.
I couldn’t agree more!
I absolutely agree with that.
Isn’t an RVU or a wRVU a way to talk about money without actually talking about money? That just shows how taboo it is in terms of compensation – no?
Great job. This is truly needed. Maybe an encore career opportunity for some of us too.
+1
Thanks for the encouraging feedback. I often have to fight the feeling of enjoying this more than my actual career in surgery 🙂
I have found that practicing physicians many years out are often times far from financially secure. I find that they are embarrassed to talk about it. Perhaps an online course would help them. I have recommended WCI but I doubt they go to check it out. I think some people start making a high income and go a little crazy for a while and then the reimbursement drops and retirement is impossible. Very preventable problem with education.
Very common. Hard to know how common because so few talk about it.
How about taking the class online where many more could benefit?
We are working on that actually. I’ve approached our college of medicine about providing funding for this venture. More to come soon hopefully! As you might expect though, the lawyers get a little uneasy though when I mentioned posting their content 🙂
This would be awesome! Please let us know if you do decide to have an online course!
Will do!
How about a cloud funding program for this. I am sure several here would be willing to chip in. And a good point about legal issues being different in each state.
The alternative is to just let the market solve the issue. There is a lot more incentive to develop this sort of thing when those who put the work in to do it actually see the rewards of doing so.
We completed our first series of seminars on personal finance and other related topics this year for the combined Peds and internal medicine residents/fellows at our university (about 250 residents, not sure how many fellows showed). We collected a lot of data and will be writing a manuscript on it soon (WCI — I am working on getting the first one published).
It was a huge hit and we already want to continue and expand it for next year. I’ve given lectures to our MS4’s and surgery residents as well and would like to expand what we do. I read Dr. Mizell’s manuscript when it came of and it’s a great template. Moving things to the MS4 class will have a great impact. My compliments to him and his colleagues for their wonderful initiative.
Thanks for the kind words. We’ve already noticed how the students who completed the course and stayed at UAMS to train are more savvy with billing and coding, etc.
As an MS4 I think a class in personal finance would be EXTREMELY helpful, especially right as students head out into residency. I’ve learned from this site that the time to start aggressive financial saving starts in residency and is paramount the first few years out of residency (but I would guess most of my classmates are unaware of this). Our school has brought several financial speakers in over the last few years but they are mostly from local banks and I think we all feel that they are trying to sell us something. I was never sure if they were giving accurate information. To have financial/business information from a relatively unbiased source would be great.
I was fortunate enough to have my core 3rd year rotations with a residency program that had a strong emphasis in the business of medicine (coding especially). It opened my eyes to a whole new side of medicine. With medicine set up the way it is, coding correctly is paramount to a successful practice. While it may be thought of as a taboo topic, I think being able to apply sound business principles would allow physicians to be more efficient, hopefully leading to more time with patients and perhaps less frustration with the system and eventual burnout.
I hope more schools and residencies follow Dr. Mizell’s example. Perhaps schools could pool resources and take the class online.
I’m quite thankful that our speakers have really done an amazing job of being unbiased. It’s really hard to find people who want to just help students and residents, rather than trying to get something out of it. When there’s even a hint of using the venue as an advertisement, the students pick up on it immediately and quickly discount the content of the lecture.
Just learning to save 10-15% of salary as a resident and investing it in an sp500 fund would be a great first step
These classes should be ubiquitous. There’s good news, though: I was at a hospital-wide journal club last night and a surgery intern asked why I only worked part-time. I told him to live like a resident for a few years after residency and pay everything off.
He replied, “Yeah, they keep telling us that. Don’t buy a new car or a new house, pay off your loans, don’t do anything crazy.”
The seed has been planted!
Excellent! Nice for them to see your example of it really working and paying off.
Any chance these lectures are available online for people not at UAMS. Great Stuff!!
See above. We’re working on it!
I definitely think med schools should devote a lot more time to business education and personal finance education for docs. Would be a great counterweight to the influence of hospitals
I am an anesthesia resident at UAMS and actually audited a few of Dr. Mizell’s BOM classes and they were clearly well-received by the MS4’s in attendance. I wish there had been something like this at my medical school. It seems especially prudent for someone like myself blazing my own trail in medicine. I’m making the most money I ever has as a resident and cannot even comprehend even the lower end of attending salary. It was that realization that sparked my own interest in personal finance and drove me to learn about it. I stumbled across this blog as a 3rd year med student and have been a dedicated reader since. I’ve since been reading other physician financial blogs, especially people from my own walk (Hello POF!), and feel much better prepared to act a responsible steward of my future salary for my family. Big thanks to WCI for starting the conversation as it were. Cheers!
Hello, back!
Very smart of you to audit sessions of the class. Do you know if any other residents joined you?
I know one of my best friends in anesthesia who is also interested in increasing his financial literacy was with me. I did not recognize any other residents during the classes I audited. However, you know being more or less confined to the OR, there could have been some I just simply do not know.
I’ve tried to spread the WCI gospel (too strong?) to all my colleagues who will listen, but there seems to be a fairly sizable contingent of folks who just are not into for one reason or another. The usual argument is they don’t have time to learn about this stuff now and they will do it later. These are the exact people that Dr. Mizell is referring to above.
They will say the same thing about coding then in a few years it will appear to be all they care about.
There were a few residents at the lectures, but several have since requested to view Dr. Dahle’s lectures (which we recorded). The course has been adapted and rolled out for the ophthalmology residents as well, and at the request of the residents and program director I’m giving a talk next month for neurosurgery grand rounds summarizing some of the principles. Word is getting around.
Hopefully you’ll be able to make this lecture series available online for other programs to begin using as it would be an invaluable resource. I know I’d be willing to give the lectures at my program.
Gospel is probably too strong, but I do feel a bit of missionary zeal to increase financial literacy among physicians and other financial professionals. Whether they then make the same financial decisions as me is much less relevant.
As a medical practice administrator for many years working in consulting and interim management, I think physicians lose a certain amount of leadership strength when they are not taught the business side of practice management. With physician employment at an all time high, physicians are now working in increasingly bureaucratic settings. There are many non medical individuals making decisions on how a practice runs. On one hand that is what is given up by becoming employed. However, without some business and leadership training a physician comes out of residency not really understanding how a private practice should run and what is or should be ultimately their call. I advocate that physicians be a part of leadership and this includes understanding and providing input to the business side of a medical practice. But, I often find that further education is needed to make this successful. I think it would be fabulous if this education began in the residency programs.
So impressed with Dr. Mizell and Ms. Gutierrez. Sarah (if I may call you that), I always smile when I see your picture. You look like you such a warm and engaging personality! Maybe I can scoot down to Little Rock and we can meet sometime I visit family in Searcy – I’d like to learn more from both of you. Bravo to you both.
Thank you! I guess I need to take a new picture that would be more warm and engaging like SC 🙂 Would be glad to meet up sometime if you’re in the area!
Jason, I hate to tell you this, but you’re no match for Sarah lol. She is just a little doll – plus you’re a guy. Everybody has their strong points and your picture looks both compassionate and intellectual, which is what we mortals want from a doctor. (Actually, I KNOW you are after reading this article.) No need to change a thing.
This is brilliant! Thanks for paving the way towards this very important goal. So surprised you’ve been doing this way back from 2011. Wish you much success in your endeavor!
Thanks so much!
I would LOVE to and GLADLY pay to take an online course like this offered by WCI. We would live to have access to something like this but unfortunately nothing is offered in our area and we want to make sure the education and advice is sound. This is an immediate need for all physicians and those in training, but it will take years for residencies and schools to start implementing. I would LOVE to see WCI offer an online course as I have the utmost respect for WCI.
Well done Jason! 🙂
Jason,
I’m a surgeon as well and moving to Little Rock at the end of the year. I’m coming in from Louisiana, and we have several mutual friends. I was told to look you up when I got there. To my surprise, here you are featured on one of my favorite websites WCI!
As a UAMS graduate, I wish that a finance forum had been available to us when I was going through. Congratulations to you for pushing this much needed information out to our student doctors. So many bad financial decisions are made at the end of medical school and beginning of residency (credit cards, homes, cars etc.). Keep up the great work!
Would be glad to chat sometime. Feel free to email me at [email protected]. Hope the move goes well!
I was fortunate that in 1982 LSU SOM New Orleans had a senior short course entitled “Transition to Practice” & Ortho Pharmaceutical through ACOG offered “Prep for Practice”. Our Med school class was an introduction to personal & business finance from a 10.000 Ft view. The prep for practice was practical information down to mapping office space & patient flow. At the time, I don’t think I fully appreciated the importance. However, it prompted me to learn more. Basic savings from my mother armed with additional investing research armed me. I started an IRA & investment account in my early residency & these actions set the road to financial independence. We also have always lived below our means deliberately! Now, I work because I love what I do & want to continue. Along the way I have shared with students & residents lessons learned! Kudos to you on this awesome course!
Our program began at Johns Hopkins in 2013 and is the best MBA level business course for physicians in the market. Physician business professionals who know what rank and file colleagues need to know.
https://meded-stat.com/courses/business-of-medicine-pocket-mba-for-physicians/
Hmmmmm…..I’m curious how you determined yours was the best, because I know several people who would disagree with you since they think their programs are the best.