What We Didn’t Learn in Medical School and Residency

One of my favorite rants is “What we didn’t learn…”  I remember finishing my residency in internal medicine, thinking I had learned everything I needed to go out and cure patients, save the world, and get paid while doing it.  Boy was I wrong.  It was just the beginning!  Some of the lessons have come harder than others: I have had to learn that medicine is really a business, and that no matter how hard you try you can’t know everything.  So I thought I would come up with a manifesto on what we REALLY need to know.  So with out further ado:

1) Medicine is a business.  Get used to it.  Know that if you can’t keep the doors open, you can’t see patients.

2) Insurers run the world.  Get used to it.  Know which insurers reimburse the least and lose ’em if you can.

3) Learn all you can about coding and billing.  You deserve to paid for the work you do.  Most physicians undercode.  (Yes, I remember the 3 minute lesson I received as a senior resident:  “if the patient is complicated, code higher.”  Not exactly what I needed to know!)

4) Constantly look for ways to be effective and efficient.  Go through your day, minute by minute, and see what you can do differently.  Just try it.

5) Computers and EMRS are your friends.  Embrace technology because it is here to stay.  Get used to it.

6) Decide what is important to you, THEN pick what you want to do.  If you want shift work, think urgent care or hospital medicine.  If you want autonomy, consider a micropractice, if you want a guarantee think large practice or HMO.   Learn as  much as you can about each practice.  Remember, if you don’t like something, you can always change it!

7) Surround yourself with good people.  Have a good bookkeeper, accountant and attorney.  The flip side is, never blindly surrender your business/practice to someone else.  Understand financial statements, cash flow and personnel issues.  Don’t become one of those sad physicians that tells you their bookkeeper/accountant/office manager/partner/medical assistant ran off with receivables.  Ignorance is not a good strategy.

8)  Constantly learn.  Look for ways to learn from patients, staff and the slow lady yapping on her cell phone in the “fast” lane.  Some patients are there to teach you patience, and sometimes the slow lady reminds you to go the speed limit!

9) Remember two rules of medicine  (Thanks to M*A*S*H!)  First, patients die.  Second, doctors can’t change rule number one.

10) Breathe.  It’s tough to be a doctor in the trenches today, with the health care mess, Wall Street madness and the litiginous climate.  However, you ARE doing good!

May at least one person thank you today, to remind you that being a physician IS a worthwhile profession!


One Response

  1. Better yet, drop insurers altogether. There was an article recently about a family physician who uses a cash-only business model. He charges $45 up front for the visit and then charges extra for laboratory fees. He averages about $93 per patient, and only sees 16 patients per day. His only staff member is a medical assistant takes care of checking the patience in and answering the telephone. He has no coders and no office manager. Because of his low overhead, but he takes home well over $200,000 before taxes.

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