What they don’t teach you in medical school

Episode 1: What They Don’t Teach You in Medical School

Our medical schools have long operated on the notion that the doctor has to be the Knower of All Things, the repository for all knowledge, the final be-all, end-all decision maker about what’s to be done for the patient. And, for all of you who’ve attended a Morbidity and Mortality conference, you know what the stakes are. Make a mistake, and someone could die. This gets hammered into our physicians throughout your education and continues on into your careers.

By contrast, where I live in the consulting world, “I Don’t Know” is a perfectly acceptable answer, as long as it’s followed by “Let me find out for you.” But NOT in medical school. We teach our clinicians to keep their mouths shut when they don’t know the answer. We stifle curiosity.

The Emperor has no clothes, folks. We’re not teaching our clinicians to be curious. We are systematically stomping that right out of you. Stern attending physicians who demand correct answers on the spot and don’t give any leeway have been the hallmarks of our medical education system for years. Let’s hope that there are those of you physicians who are naturally curious, and that your natural curiosity survives eight years of being stifled and suffocated.

In this country, we do a fabulous job of training clinicians to be good doctors – we give you the latest and greatest diagnostics, cutting edge pharmaceuticals and world class technology. And we completely fail to train you about business. In eight years of formal education, there are no classes on finance, leadership, or contract negotiations. Nothing about managing people or leading change. What does this mean?  It means when you leave residency and go into practice, you are effectively stepping into multi-million-dollar businesses without any training in how to operate them. And, on top of that, you’ve been soundly discouraged from asking questions for the past eight years.

One of the graduates of our Physician Leadership Project put it so well after we’d gone over the basics of financial statements and financial reporting. She shared openly with her classmates. She said: “I’ve been a member of this pediatric group for 9 years, and a partner for 7. And for the past 7 years, every quarter, a packet of papers would land on my desk before the board meetings. Some of the pages had numbers on them, and I would always go to the board meetings and pretend like I knew what the numbers meant. But now I do.”

So what kind of stress does that pretending create for you? We know that all of you are intelligent and well-educated people. We expect that you’ll just be able to figure it out. I’ve seen so many physician leaders over the years putting this unrealistic expectation upon themselves and their colleagues. I’ve met a few who have gone for an MBA, which helps, but it also takes an additional 2-3 years on top of an educational path that has already been time-consuming and expensive.

Is it really necessary that we train you in business skills? I would assert that it is. The national statistics show more than 83% of medical practices will be embezzled at some time during their history. This number is unacceptably high, and reflects this gap in your education. Physicians, by your very nature, are trusting people, in many cases to your detriment.

What does this lack of training cost? If we think about embezzlement, the following statistics are sobering:

Healthcare organizations lose an average of $437,000 annually due to employee theft according to a recent report from the Medical Group Management Association. That same report stated that nearly 29% of schemes lasted more than five years. These losses can involve theft of funds, merchandise or property, check or credit card fraud, or fraudulent billing. There are so many ways to take advantage of a busy medical practice, and a group of physicians who’ve been taught not to ask questions.

When we think about a lack of business training leaving you bewildered about your own revenue stream, the costs get even higher. Our current medical reimbursement system includes a dizzying combination of codes, claim edits, denial rules and conversion factors which the majority of physicians simply don’t understand. BUT we’ve taught you not to ask questions, or to appear that you don’t know. So, you soldier on, try in vain to pick up a few tips from friends and colleagues, and you keep seeing patients. You keep working hard.

Undercoding for a patient visit basically gives you less credit for your time and can cost up to $50 per visit in lost revenue. While $50 may not seem like much, over your entire career, this can amount to up to 6.4 million dollars. 6.4 million dollars. Because we didn’t train you.

Now, you may be asking yourself, “Don’t I make enough money? Compared to some of my patients, I’m doing really well financially. Should I really worry about all of these missing dollars?” I am here to urge you to value your time. You’ve spent so many years of your life getting educated and trained, and many of you have come out of training with hundreds of thousands of dollars in debt. Add to that, salaries and reimbursement in many subspecialties have been falling. Costs are rising and physicians are getting squeezed. Compared to other highly educated, highly trained professionals in our society – attorneys, architects, accountants, you are losing ground. Rapidly.

Add to this the effects of the pandemic, which I’ve said is the ultra-marathon that none of us trained for. As a physician, you are in the midst of a healthcare crisis that will have effects for decades, a firestorm of politics, fake news and “medical experts” touting one magical cure after the next, and a news media that has politicized medical and scientific findings. What’s the impact of this stress? One physician dies by suicide in the US every day, making it the highest suicide rate of any profession, and more than twice the rate in the general population.

And you are the people who are supposed to be taking care of all of us!

How much more stress can we put on you as a society? If our systems, schools and legislators continue lowering your pay, and continue to make it harder and more expensive to get a medical degree, and then harder and less attractive to go into practice and succeed, what then? If we continue on this path, all of the young smart people coming through school now will give up on medicine and go and be investment bankers instead. This might be great for Wall Street, but the question remains: who will take care of us?

Instead, I want to give you knowledge, I want to give you power, I want to give you your curiosity back.

In my 30 years of running medical practices, I’ve learned a lot about business, and a lot about what we haven’t taught you about business. This podcast is intended a gift back to a community that has been good to me for 30 years.

And this podcast is for you. My goal is to give you bite-sized, digestible pieces of knowledge culled from the last 30 years spent working in the business of medicine. Some of these will be solocasts where we focus on one topic, and once or twice a month, I’ll invite an industry expert to take a deeper dive with me on a topic that will be important to you and the running of your practice.

My commitment is to bring you resources, experts, and answers so that you can achieve mastery over the financial and business aspects of your practice. Together, we can fill in that educational gap.

You can find more information online at MedicalMoneyMattersPodcast.com and I welcome you to tune into the next episode of this podcast. You can also purchase a copy of my book, Physician Heal Thy Financial Self, which is available on Amazon. You can subscribe to the Medical Money Matters Toolkit here.

I want to close out this inaugural podcast by congratulating you for taking the next step in your professional development, and for making the commitment to learn about the financial and business aspects of your practice. I look forward to being on this journey with you, and I send you my heartfelt gratitude for all that you do for your patients all day every day.