All the problems
Medical education currently contrasts the “morality” of medicine with the “immorality” of money. An essential element of medical training is ethics importance and responsibility of clinical work. Concerns about profit-driven decision-making, the “greedy” pharmaceutical industry, and “exploitative” insurance companies paint the health care industry as contradictory to our mission as health care providers. As a result, teaching about how money flows in medicine is excluded from many curricula. This lack of knowledge deprives students of the opportunity to prepare for the daily reality of practicing medicine, where dollars and cents determine the procedures and medications patients can receive, where the economics of wages determine the nurse-patient ratios and where economic pressures drive hospital consolidation and consolidation. management structures.
Medical education must embrace the fact that health care is a business and incorporate lessons about money into medical education. To improve the patient care environment and the work environment for the entire healthcare team, future physicians must understand the fundamentals of how money works in our healthcare system.
Ignoring money in medical education leads to complications at four levels: (1) the physician, (2) the patient, (3) the hospital, and (4) the health care system.
The physicist
Physician compensation is a complex subject. While the average doctor does $350,000 per yearproviders branching out into specialties like family medicine and preventive medicine — which are facing critical shortages — are making the rounds $125,000 less than this average. Although this salary is significantly higher than the median income in the United States, it is in the context of average debt for medical school graduates in more than $250,000 during 8 years of schooling. This debt has an impact on the choice of specialtycan lead to a delay in loan repayment decadesand influences life decisions like buy a house or have children. Therefore, doctors and trainee doctors need to understand where their salaries come from and how to manage their personal finances. Such knowledge can improve effective debt management by medical students, minimize financial uncertainty for underpaid residents, and improve agency among the participants.
Additionally, without a basic understanding of how money flows through the health care system and how hospital administrators make decisions, doctors feel helpless in a system they cannot understand. This leads to greater frustration, causes physicians to abandon clinical care, and increases Burnout.
By teaching medical students how money flows between loans, salaries, and patient payments, they can make informed decisions at every stage of their medical journey to stabilize their financial situation, combat burnout, and dedicate more time for patients.
The patient
In a 2020 survey, three-quarters of doctors felt obligated to initiate discussions about patients’ out-of-pocket costs, but only half of them understood how their patients’ deductibles worked. In addition, patients prefer doctors discussing costs of care and patients’ knowledge of health insurance increase effective use of primary and preventive care services. By increasing physicians’ knowledge about how patients will pay for care, they can reduce patient uncertainty and ensure that treatment plans are feasible.
As a concrete example, about 18% of adults not filling their prescriptions due to cost concerns. A doctor who knows their patient’s insurance coverage can develop a cost-conscious treatment plan to improve compliance. This training should begin as early as medical school because students have more time during patient encounters than physicians, allowing them to properly educate patients and make clinical decisions based on the financial realities of their care.
The hospital
By understanding how money affects health care, doctors can begin to turn the tide. Physicians can use monetary incentives to their advantage to advocate for change within the system, and they can take on leadership roles that balance clinical priorities with the financial priorities of the health system. For example, a doctor could argue that adopting a new AI platform for note-taking could save $1,000 per day by estimating both the labor cost of the doctor’s time and physician, as well as the loss of clinician time spent on administrative tasks. This case would be more compelling to hospital leaders than the traditional physician case for improving the quality of care and lifestyle of providers. While these last points should be reason enough, the reality of our system is that money talks. Thus, teaching future doctors to speak this language will contribute to progress towards a values-based and patient-centered health system.
The health system
In light of historic and ongoing health disparities exacerbated by the COVID-19 pandemic, the American Medical Association has argued that health systems science is an essential component of the training of medical students and practicing physicians. We agree with their sentiments and hope that integrating health systems education into medical school curricula can teach students how money is operationalized throughout our health system. health. Doctors can be seen as “pions“whose actions are driven by financial pressures and non-clinical decision-makers. Giving them strategic knowledge about how the purse strings are pulled in health care can turn them into knights, or even members of the royal family, with the power to claim medicine as a righteous rather than a virtuous service. Of course, education alone cannot transform our fragmented, profit-driven system into a well-oiled machine, but it can equip doctors with the tools to act rather than acquiesce.
The solution set
As physicians begin to develop their professional expertise and juggle mounting debt, we encourage medical schools to integrate education about money in health care into their core curriculum. This could take the form of a comprehensive program introducing health system stakeholders and incentives (similar to the American Medical Association program). Health Systems Science Program), or more integrated approaches, such as including lessons on how to advise patients payment for training in clinical skills.
Although an integrated and comprehensive educational approach would be the best way to ensure that every future clinician understands the key elements of finance, most medical school curricula are overload, and this approach may not be feasible in all cases. As an alternative, we either offer flexible study program options, such as internships focused on health systems innovationor research opportunities in economy or health systems. As another alternative, medical schools can financially and administratively support extracurricular opportunities for students to engage in these same topics, such as personal finance workshops, shadowing opportunities with hospital administrators or series of lectures given by physicians in non-clinical roles.
While no single solution can close patient insurance gaps, reduce physician debt and burnout, or completely fix America’s broken health care system, educate future doctors about the monetary realities of health care will enable the next generation of providers to begin to address these challenges.
Ryan Leone, M.Sc., is a medical candidate at Vagelos College of Physicians and Surgeons at Columbia University in New York, a U.S. Army officer and former presidential management officer who worked on health policy and operations at the Department of Defense and the State Department. Kensington Cochran is a medical candidate at Vagelos College of Physicians and Surgeons at Columbia University in New York. She is also a market researcher at Rock Health and previously worked as a business analyst in the healthcare sector at McKinsey and Company. Kellen Mermin Bunnell is a third-year medical candidate at Emory University School of Medicine in Atlanta. She is co-founder of Georgia Health Professionals for Reproductive Justice and the National Student Bioethics Association, and an advocate for health equity. Maya Roytman is a first-year MD and MS doctoral student in bioethics and health policy at the Stritch School of Medicine at Loyola University Chicago in Maywood, Illinois. Opé Akerele is a medical candidate in a joint program between the UCLA David Geffen School of Medicine and the Charles R. Drew University of Medicine and Science in Los Angeles, as well as an MBA candidate at the UCLA Anderson School of Business in Los Angeles .
Disclosures
The authors are members of DM+, a vibrant community of medical students with interests beyond clinical medicine, including biotechnology, venture capital, and health policy. The opinions expressed are those of the authors and do not reflect any organization, company, or institution with which they are affiliated.
