My beloved PCP gave up his practice to become the medical director of the Peace Corps, and has been replaced by a young woman fresh out of residency. She seems generally competent medically, but I’m appalled at her seeming inability to run a practice. She has no people skills, management skills, etc.
Do doctors get any business training during residency?
*Do doctors get any business training during residency? *
No, not generally.
I haven’t gotten any and won’t. From my experience, the expectation is that I will join a group practice and learn from the older doctors how to run it.
That’s why people hire office managers. They run the office. The MD treats patients.
Yup. An office manager (or at LEAST a competent administrative assistant) is pretty much necessary to running a medical practice. Even a small one. Someone has to bill patients’ insurance and administer the practice’s business insurance policies (work comp, GL, property). Even if the clerical duties don’t require a whole lot of time, it’s a huge waste of time for a doctor to do any of the administrative shit themselves. A competent office manager would probably cost less than $20 an hour in this economy. A doctor’s time is worth MUCH more than that.
I hope this doc has, at a minimum, paid a consultant for some business-running expertise. There are costly mistakes around many corners for anyone who has no idea how to run a business. File a work comp claim for one of your employees (or yourself) late? Bam, fined by the state. Didn’t know you needed to take out a work comp policy and a worker gets hurt? Bam, stuck with the bills. Pay your GL policy late and a patient slips and falls in the lobby? Bam, lawsuit. Harass a litigious patient about their overdue bill an *inch *beyond what the law allows? Bam, FDCPA violation and civil judgment against you. Fuck up your company’s taxes? Bam, bam, bam.
The doctors getting training in the business of medicine are not getting set to run their own small offices and frankly the era of the autonomous doctor running his or her office on their own, or as a small group has pretty much already set. We are either parts of large groups that hire management teams to handle the business aspects, or we hire services that do that for us and other groups, or we work for other organizations.
Look for her to sell to a hospital in the near future.
It’s corporate practice to begin with. The previous doctor happened to have a brass set big enough that he ran the office as he saw fit, and when he left, the corporate apparatchiks took it back/over.
I was just hoping she’d grow a pair of her own.
My doctor has his own solo practice. He has two employees: a nurse and an office manager.
Solo practices definitely still exist, but DSeid is right; more and more are being bought up by hospitals. We don’t get any training in residency, although there ways to seek it out throughout med school and residency. Generally speaking though, I’m not sure when I’d have the time to do so. I have some friends who took a year to do an MBA but they are more interested in hospital administration or health research than clinical practice.
Little Nemo I apologize if I came off as implying that they do not exist at all anymore. They do. But they are fewer and fewer and competing at an increasingly greater disadvantage. It’s hard to pull off. I say this with some regret as I am a dinosaur. I was reared in the era of doctors as more autonomous creatures. Now for both better and worse (and it is both IMHO) we MUST function as coordinated members of teams, ceding much decision-making power for items from clinical protocols to how the clinical process flows to how our phone triage and scheduling works to others. Again, I am old enough to still want to be part of those decisions and to appreciate the value of what I am losing; the newer generation has never known it. They are coming out expecting to be, choose your descriptor based on your POV, good team players … cogs … 9-to-5 ers … corporate citizens … whichever. But they do not have the expectation of being able to be their own boss and the responsibility that comes with that. The op’s previous doc I am sure was also of my era and bristled at some of which comes with being part of a larger group, some of which is not great decision making as those who make the decisions are often removed from the clinical flow that best informs the choices and which tries to use the same screwdriver no matter what the screw looks like or even if it’s a nail … the stress of using that brass set all the time may be why he decided to move on to another challenge. Finding the balance between local and centralized decision making that results in the best care outcomes and greatest patient satisfaction for the least cost will, no doubt, be a continued work in progress.
But to the op itself. There are those who get Masters in Health Administration along with MDs, or already have one and get the other. And there are MDs who give up a large portion of their clinical life to work more on the administration side of the process (i.e. they go to the Dark Side :)). But medical schools do not typically have standard curricula on how to run an office and those who get that additional education are aiming for running the large organizations, not being autonomous clinicians in their own small practices.
There are also some places that are doing joint MD/MBA programs (LGT a former workplace that I knew has one. There are other programsas well that I assume operate similarly.)
Since the OP has been answered, I’ll mention that lawyers similarly do not receive training in practice management during a standard law school curriculum.
Nitpick: We are told in ethics class as a matter as a principle that using client funds for our own expenses can cost you your license, but the mechanics of maintaining a separate client account are barely mentioned.
I didn’t mean to look like I was disputing you. I agree with what you said but was just offering a piece of data on how small a doctor’s practice can be.