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While the traditional characteristics of empathy, responsibility, and clinical acumen persist as the foundations of an excellent physician, these tenets alone are no longer sufficient in providing the best care for patients in today’s healthcare system.
In response to growing complexities in medicine, the role of the physician has evolved to not only care for individual patients, but also to critically evaluate and maximize the value that patients perceive through their care (Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business School Publishing; 2006; What Does It Mean to Be a Good Physician Today? NEJM Catalyst Innovations in Care Delivery. 2016), to consider operational and financial aspects of care delivery (Otolaryngol Head Neck Surg. 2020;163:397-399; Arch Intern Med. 2001;161:1261-1266), and to lead teams that innovate in clinical care and practice management (Six Tests for Physicians and Their Leaders for the Decade Ahead. New England Journal of Medicine Catalyst Innovations in Care Delivery. 2020).
In other words, the modern physician exercises the principles of the business of medicine to provide comprehensive care for patients in today’s healthcare system.
Business Plans
Traditionally, medical education has emphasized diagnostics and treatments and has overlooked business training. Over time, physicians have often been sidelined in administrative decision-making—evident in the growing administrative personnel and associated costs that accounted for 34% of U.S. healthcare spending in 2017 (Ann Intern Med. 2020;172:134-142). Instead, to develop a more effective healthcare system, clinicians, as key stakeholders who are knowledgeable about patient care and uniquely positioned to identify granular operational deficiencies, should be among the primary decision makers.
To earn a seat at the table and have the opportunity to self-advocate, however, physicians must not only be clinically well-versed, but they also must be proficient in the areas of leadership, care delivery, and practice management.
Earning a formal degree such as a Master of Business Administration, nonetheless, isn’t required or practical for most physicians. Instead, a focused study of relevant business of medicine topics may better serve the specific needs of the modern physician. In the era of the COVID-19 pandemic, asynchronous learning, or remote study that’s completed within the learner’s schedule and time frame, has been increasingly used as a flexible alternative to traditional in-person classroom environments. Several online resources exist to empower physicians with the knowledge required to autonomously advocate for patients, physicians, and a more effective healthcare system. These resources highlight medically relevant business content, with teachings from world-renouned thought leaders.
To earn a seat at the table and have the opportunity to self-advocate, however, physicians must not only be clinically well-versed, but also proficient in leadership, care delivery, and practice management.
The following discussion expands on available resources for medical students and physicians interested in understanding and developing business perspectives and skills through an asynchronous learning format, including a new offering we’ve developed (see “Business of Medicine Curriculum and Suggested Resources”).
Business of Medicine Domains
A focused study of the business of medicine for physicians should include at least three practical domains: leadership, healthcare delivery, and practice management. In addition to content learning in these three domains, experiential learning and practical application are critical in skillset development. Similar to traditional classroom settings, asynchronous learning platforms are complemented by the application of knowledge in the real world through reflective writing and exercises and the implementation of changes and experiments in practice.
Leadership. The onset of the COVID-19 pandemic reaffirmed the need for clinical leadership in both the hospital and public policy settings (Six Tests for Physicians and Their Leaders for the Decade Ahead. NEJM Catalyst Innovations in Care Delivery. 2020). In the near future, physicians will be expected to lead diverse groups to improve patient outcomes through multidisciplinary teamwork, coordinated care, and alternative healthcare delivery models, all while reducing healthcare costs.
Developing leadership skills is a continual process that requires thoughtful and deliberate practice with constructive coaching. Experiential learning allows for an evolving and dynamic skillset that defines effective leadership. Business of medicine training provides foundational knowledge in the fields of behavioral science, communication, and sales, with a focus on three practical topics: influence, networking, and career development.
Care Delivery. With the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, the U.S. healthcare system began a fundamental shift away from rewarding volume (fee-for-service models) and toward rewarding value (value-based and bundled models). Since then, physicians have been held increasingly responsible for high-quality, low-cost outcomes in an effort to maximize value for patients and reduce systemic waste (Otolaryngol Head Neck Surg. 2020;163:397-399; Arch Intern Med. 2001;161:1261-1266). Physician leadership and input in the restructuring of care delivery is critical in improving the patient experience, designing sustainable systems for both patients and clinicians, and advocating for physicians’ needs.
Business of medicine education should emphasize an understanding of the past, current, and future state of the U.S. healthcare system, with discussions on healthcare spending, metrics, and value-based healthcare delivery and payment models. Design, implementation, and behavioral economic principles that emphasize human-centered solutions are vital instruments in developing solutions for patients within the evolving healthcare system.
With foundational knowledge in care delivery, physicians will have the ability not only to advocate for their patients, but to do so in a way that uses a patient-centered design to better understand the underlying motivations that determine their experiences and actions. Physicians who understand these underpinnings can develop more effective care delivery models that drive superior patient outcomes.
Practice Management. Finally, the practice management domain rounds out the broader concepts of leadership and care delivery with realistic tactics for building a successful practice that optimizes both patient care and physician career satisfaction.
Practice management begins with the development of a strong referral system, which is driven by physician communication, outreach, and networking. While the discussion of practice financials in medical training has traditionally been taboo, financial stability is a prerequisite for providing excellent patient care. Financial insecurity limits a physician’s time, resources, career satisfaction, and opportunities for innovation, which can cause downstream effects in patient care.
Education in the business of medicine for physicians should discuss strategies used to achieve a financially successful practice; this provides foundational support for innovation in healthcare delivery and the patient experience. Approaches to developing a financially successful practice include expanding referrals and patient reach, providing patient-centered and profitable services, optimizing reimbursements through effective billing, and expanding clinical services using in-office procedures, testing services, electronic commerce, and social media. Taken together, these factors play a critical role in the development of a thriving practice and provide the groundwork for the improvement of delivery and outcomes.
The well-rounded physician with both clinical expertise and a business perspective will be best poised to navigate the evolving U.S. healthcare system in the years to come. As asynchronous learning opportunities become more prevalent as a result of the COVID-19 pandemic, physicians have a tremendous opportunity to fill in medical education gaps with practical teachings from the business sector.
Business of Medicine Curriculum and Suggested Resources
BUSINESS DOMAIN: LEADERSHIP
TOPICS
- Leadership development
- Negotiations
- Sales and communications
- Behavioral science and psychology
- Entrepreneurship and innovation
- Mentorship
- Career development through committee and society leadership
SUGGESTED RESOURCES
Web and Podcasts:
- Headmirror.com’s Business of Medicine Course (with free CME opportunity). 2021. https://www.headmirror.com/business-of-medicine-course-curriculum.
- Ginzel, LE. Video Resources. Choosing Leadership; 2018. https://choosingleadershipbook.com/resources.
- Taylor, B. The Best Entrepreneurs Are Missionaries, Not Mercenaries. April 11, 2016. Harvard Business Review. https://hbr.org/2016/04/what-separates-highimpact- entrepreneurs-from-those-who-dont-make-a-big-difference.
- NEJM Catalyst Leadership Podcast. Accessible online and via podcast platforms. https://catalyst.nejm.org.
Texts:
- Cialdini RB. Influence: Science and Practice. Harper Collins College Publishers; 1993.
- Ginzel LE. Choosing Leadership: A Workbook. B2 Books, an Agate imprint; 2018.
- Ericsson A, Pool R. Peak: Secrets from the New Science of Expertise. Houghton Mifflin Harcourt; 2016.
- Stone D, Heen S. Thanks for the Feedback: The Science and Art of Receiving Feedback Well (Even When It Is Off Base, Unfair, Poorly Delivered, and Frankly, You’re Not in the Mood). Penguin Books; 2015.
- Duckworth A. Grit: The Power of Passion and Perseverance. Scribner; 2016. Epley N. Mindwise: Why We Misunderstand What Others Think, Believe, Feel, and Want. Vintage Books; 2015.
- Ury W, Fisher R, Patton B. Getting to Yes. Random House; 2003.
- Shell GR. Bargaining for Advantage: Negotiation Strategies for Reasonable People. Penguin Books; 2006.
- Wortmann C. What’s Your Story? Sales Engine; 2006.
- Bok S. Lying: Moral Choice in Public and Private Life. Knopf Doubleday Publishing Group; 2011.
- Osterwalder A, Pigneur Y. Business Model Generation: A Handbook for Visionaries, Game Changers, and Challengers. Wiley; 2013.
BUSINESS DOMAIN: CARE DELIVERY
TOPICS
- Measuring and improving the patient experience
- Behavioral economics in medicine
- Value-based healthcare and bundling
- Design and implementation science
- U.S. health insurance market
- U.S. healthcare spending
- Operations management and healthcare metrics
SUGGESTED RESOURCES
Web and Podcasts:
- Schneider EC, Malina D, Morrissey S. Fundamentals of U.S. Health Policy—A Basic Training Perspective Series. New England Journal of Medicine. 2020;383:486-487.
- Medicare Payment Advisory Commission (MEDPAC). Reports; 2020. http://medpac.gov/-documents-/reports.
- NEJM Catalyst Leadership Podcast. Accessible online and via podcast platforms. https://catalyst.nejm.org.
- Healthcare Topic. Harvard Business Review Magazine. https://hbr.org/topic/healthcare.
- Foundational Resources. Health Care Payment Learning & Action Network; 2020. https://hcp-lan.org/foundational-resources/.
Texts:
- Teisberg EO, Porter ME. Redefining Health Care: Creating Value-based Competition on Results. Harvard Business School Press; 2006.
- Thaler RH, Sunstein CR. Nudge: Improving Decisions About Health, Wealth, and Happiness. Penguin Publishing Group; 2009.
- Kahneman D. Thinking, Fast and Slow. Farrar, Straus and Giroux; 2011.
- Kumar V. 101 Design Methods: A Structured Approach for Driving Innovation in Your Organization. Wiley; 2012.
- Erwin K. Communicating the New: Methods to Shape and Accelerate Innovation. Wiley; 2013.
- Lovejoy WS, Hopp WJ. Hospital Operations: Principles of High Efficiency Health Care. FT Press; 2013.
BUSINESS DOMAIN: PRACTICE MANAGEMENT
TOPICS
- Networking, practice-building, and referrals
- Patient and practice benefits of expanding clinical services
- E-commerce
- Scribes, advanced practice providers, and clinical workflow
- Billing, reimbursements, and RVUs
- Social media as a research and patient engagement tool
- Practice and hospital reputation
SUGGESTED RESOURCES
Web and Podcasts:
- Participant Use Data File. American College of Surgeons National Surgical Quality Improvement Program (NSQIP); 2019. https://www.facs.org/quality-programs/ mbsaqip/participant-use.
- Otolaryngologist Compensation Report 2020. Medscape; 2020. https://www.medscape.com/slideshow/2020- compensation-otolaryngologist-6012750.
- Volpp KG, Mohta NS. (2018). Patient Engagement Survey: Social networks to improve patient health. NEJM Catalyst (subscription required). https://catalyst.nejm. org/doi/full/10.1056/CAT.18.0285.
- Coding Corner: Example of Specialty Academy Coding Resource. American Academy of Otolaryngology–Head and Neck Surgery; 2020. https://www.entnet.org/ content/coding-corner.
- Headmirror’s ENT in a Nutshell Podcast: Business of Medicine Series. Accessible online and via podcast platforms. https://www.headmirror.com/business-of-medicine.
Text:
- CPT Professional 2020. American Medical Association; 2019.
Dr. Nassiri is a neurotology fellow at the Mayo Clinic in Rochester, Minn. Dr. Haynes is a professor of otolaryngology and hearing and speech sciences, chief of the Neurotology Division, and program director of the neurotology fellowship at Vanderbilt University Medical Center in Nashville. Dr. Carlson is a professor of neurosurgery and otolaryngology and chair of the division of otology in the department of otorhinolaryngology at the Mayo Clinic.
The authors have declared the following conflicts of interest: Dr. Nassiri and Dr. Carlson have received research funding from Cochlear Americas. Dr. Haynes is a consultant for Cochlear Americas, MED-EL, Advanced Bionics, and Anspach.