Your question made me think of an article in diagnostic imaging I read last month. Food for thought. It is below.
-------------------------------------------------------------------------
Real-world radiology covers suits, contracts
Clinical skills hardly worry residents preparing for private practice
By ERIC TREFELNER, M.D.
Good morning, Dr. Trefelner. Welcome to Louisville. I am Dr. March, and I will be administering this first and most important part of your oral boards today. Don't be nervous. I don't want you to even think about the fact that if you fail this section, the past 26 years of your life will have been totally wasted. Are you ready?"
"I'm not so sure."
"Good. Take a look at this case. What is wrong with it?"
"This isn't a case. It's some type of form."
"Yes. What type of form? And what is wrong with it? We have to hurry. We have to get through a lot of cases, and you don't have much time."
"I've never seen one like this. I thought we were going to be shown imaging studies."
"Let me give you a hint to speed things up. It is a CMS-1500 claims form, but that hint is going to cost you points. Now what is wrong with it?"
"I don't know. Aren't you supposed to be showing me images? Can I please have a case with images on it?"
"Oh, all right. Here's a mammo case."
"Thank goodness. It is clear that there is a cancer in the left breast that has developed since the previous film."
"Okay. Now take a look at this. What would you do next?"
"This is some type of legal form. It has my name on it. Wait a second-this is a malpractice suit! Why is my name on this?"
"Well, you did see the cancer, but you failed to see the microcalcifications on the initial films. So now you are being sued. What would you do next?"
"Why is my name on this suit? None of my mock boards did anything like this."
"This woman with the breast cancer is on the phone and wants to talk to you. What would you do next?"
"I d-d-d-don't know. I've never been sued before. The room is spinning."
"Eric, you are not doing well so far. You're pale and shaking. Do you need to lie down? Take a look at this case."
"Why aren't you showing me pictures? This looks like some type of contract and financial spreadsheet."
"Good, Eric. You are doing better. It is a capitated contract. Should you sign it?"
"Are you a real examiner? I was never taught about these things in medical school or residency. You're supposed to be showing me imaging studies. Show me a case with pictures!"
"Calm down. You want a picture, here is a picture."
"This is some guy coming out of a bar. What does this have to do with radiology?"
"Pretend that man is a senior partner in your new group, and he is coming out of a bar right across the street from the hospital. People have seen him and smelled alcohol on his breath. Now the hospital administrator wants you to do something. What are you going to do?"
"I, I . . . ."
DING DONG DING.
"Sorry, Eric. That's the bell and our time is up. I was really looking forward to hearing your response to this last case."
"But, but, but . . . ."
"Let me walk you out the door. Next applicant?"
SUPERRADS, APPLY HERE
I realize now how poorly prepared I was for private practice. The greatest challenges I faced had nothing to do with reading films. What kept me up at night were psychotic phy- sicians, enraged customers, intrusive government, Byzan-tine contracts, unintelligible legal documents, the under- handed negotiators, and financial statements that would baffle Stephen Hawking.
Wouldn't it be great if you hired a freshly minted resident or fellow and then learned that this person knew how to read a contract, analyze a financial statement, negotiate smartly with insurers and administrators, handle a dissatisfied customer, and buy a senator? We need to set our own curriculum regarding what we want our future partners to know about the business side of our practices. Taking the time to do this can cut down on costly errors.
Residency programs are required to have a well-defined curriculum, to evaluate residents' progress in acquiring the necessary skills, and to test and document core competency. When we hire a resident, we expect that the resident can do radiology work competently. Most other professional service firms, in law and accounting for example, expect new staff to have additional years of on-the-job training to learn the nuances of their profession, with goals set along the way. I have yet to see a radiology employment contract that demands the same of radiologists.
Why do groups shy away from making such requests? Many radiologists think of themselves as smart doctors and feel that commerce is beneath them. And many resist new ideas, especially outside their areas of expertise.
Imagine you have just been hired by a radiology group and told they would like you to start doing brain surgery on the side. Most would recoil at the suggestion because of their lack of training in brain surgery. Others would accept the assignment with relish, being so overconfident as to believe they have the skills to do anything. If the group really needs someone to do brain surgery, the first response is not at all helpful, while the second could only be disastrous. The prudent person might respond gamely but ask to be provided with the necessary education.
Replace brain surgery with business skills like legal, finance, customer relations, negotiating, and contract evaluation, and you have the situation many practices face. We ask for volunteers to serve on practice-related committees or, worse, give the assignment to the person who drew the short straw. Some groups make such committee service a rotating yearly assignment to minimize the objections, but this doesn't help anyone develop true mastery.
If a group wants to hire someone with IR, nukes, or mammo skills, it looks for someone who has done a fellowship. Do we look for people with an MBA or law degree, or even someone who has taken some courses in these areas? Generally no. Would it add value for the group? Yes. Why not encourage people to acquire these skills?
With the advent of Web-based education, people can now take MBA-level courses and even earn their degrees online. Organizations such as the American College of Physician Executives provide Web-based seminars and classes for physicians addressing these topics, even offering what might be called an "MBA lite" degree.
The challenge will be getting radiologists to take advantage of these opportunities. Groups will have to accept the idea that these efforts would add value. They will have to create incentives with time or money for people to take on added educational responsibilities. Flexible scheduling may be necessary to accommodate study demands.
If we truly want to build a better radiologist, we must change our cultural identity, accept new career goals, and make some sacrifices. Knowledge is power. The group with the greatest confidence in its decisions will be able to react to new opportunities and challenges, rather than dithering. I would have far more confidence hearing a complex contract was a good deal from a partner who had some training in finance rather than one who will hyperventilate at the mere sight of it.
