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Is Learning the Science of Medicine Enough?

by Harrison Cotler, med student

“Why a career in medicine?”

It’s a question I’ve been asked repeatedly: at my first medical school interview; by family and friends; even by the patients with whom I interact as a current med student. For me, the answer is obvious— a desire to care for and help others. When I close my eyes, it is easy to imagine myself clad in a white coat (the attending length, not the short coat I have now), stethoscope draped around my neck prepared to help every patient, and solve any medical mystery that comes my way. My daydreams never include visions of sorting through bills or figuring out the proper way to code. In school we study the science of medicine, not the business of it, but now I question: What do I need to know to succeed as a physician? Is learning the science of medicine enough?

Medical institutions are evolving the way they prepare the physicians of tomorrow. It’s in mHealth, HIT, the ability to access relevant information when you need it. That’s becoming an integral part of the curriculum as it becomes increasingly more prevalent in care. But there’s an essential part of practicing medicine successfully that’s not yet being addressed: the business of medicine.

When I was younger, people would talk about how great the medical field is. They would say "No such thing as a poor doctor" or "Have you ever seen a doctor's office out of business?" As a medical student, I’m already aware that this is myth. At lunch the other day, a physician joined our medical student table. In the course of conversation, he offered, "I really hope you guys have a plan.” He described both the nobility in practicing medicine and the difficulties that come down from government mandates and insurance company rules. ”You'll make it, but it’s not going to be easy."

How can medical students properly prepare to be successful at delivering the best possible care to our patients, running a practice or department, and understanding a contract without understanding the business side of it all?

As students, we find ourselves primed to enter a medical world currently in a major state of flux. In school I’ve learned that being a physician today is drastically different than it was twenty years ago. Diagnostic tests are less invasive and more accurate, new protocols and practices have been established that would have seemed like science fiction, and the government and insurance companies mandate protocols and demand we learn to treat patients quicker and cheaper. While medicine is still a science and an art, these changes have drastically impacted the way physicians must practice. They have transformed medicine into a business, and have created a need for a generation of physicians equipped to handle this new style of practice.

With this health care "renaissance," it makes sense that medical institutions would evolve to better prepare the physicians of tomorrow. We are now taught how to access the most accurate and up to date information all in the time it takes to walk from one patient room to another. It is almost impossible to find a medical student on a clinical rotation without a tablet or phone loaded with a Epocrates or other medical reference apps. In fact, a recent survey found that in 2013, 54% of med students used tablets in their training, an increase of 31% from 2012. And over a third of students currently turn to mobile devices first for answers to a clinical question. The addition of mobile health makes us better clinicians and patient advocates, but if we are not taught the business of medicine, we will not be able to cost effectively treat our patients and ensure our success as physicians.

While some schools do offer courses, most still follow the traditional method of teaching the basic sciences followed by clerkships. A small, but growing number of schools and professional organizations are working to make up this gap by offering seminars and lectures outside of the normal class schedule and at conferences, but this only scratches the surface, and many students do not have the time in an already hectic schedule. Another option is a dual degree program. With the addition of an extra year of school, a student can earn both a medical degree and a Masters in business. And while this is a suitable option for some, it comes with a huge price tag compared to just attending medical school— an extra year of tuition and the loss of one year at your peak earning potential.

Learning and understanding the business of medicine can no longer be an afterthought. If the goal of medical school is to develop well-rounded physicians and to equip us with the tools necessary to best care for our patients, teaching business, finance and leadership is a must. As a medical student and future physician, it is an injustice that as a consequence of the short-sightedness on the part of medical schools, we find ourselves in the position of leaving our training underprepared for the realities of running a practice or department. We will always thrive in the practice of medicine. However, as we continue our transformation from students to the physicians of tomorrow, it is imperative we enhance our understanding of the business of medicine, thus enabling us to succeed in all aspects of medical practice.

Harrison Cotler is an Epocrates user and a third-year medical student at Rowan University in New Jersey. He also received his Masters in Business at Georgian Court University prior to starting medical school.

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