Medical students should complete a four-week rotation at a business school to learn the skills necessary to succeed in a changing health care landscape, Robert Pearl, CEO of Permanente Medical Group, and Alexander Fogel, a Stanford University School of Medicine student, argue in NEJM Catalyst.
Medical schools already emphasize team-based care, Pearl and Fogel write, but "graduating students still lack the fundamental business and leadership training needed to effect the changes required and simultaneously maximize quality and reduce cost in clinical practice."
According to Pearl and Fogel, future physicians—regardless of whether they work in a large health care system or helm a private practice—"will need fundamental knowledge and skills in three key business disciplines: leadership, teamwork, and data analytics." And students need to learn these skills now, they add, noting that the Medicare Access and CHIP Reauthorization Act (MACRA) will push all physicians "to participate in new models of care."
"Luckily, most medical schools have a nearby source for evidence-based teaching on these topics: the adjacent business schools on their campuses that have been studying and teaching these concepts for decades," Pearl and Fogel write. They propose that "medical schools, in conjunction with business school faculty, develop an interdisciplinary four-week clinical rotation during the fourth year of medical school."
According to Pearl and Fogel, the ideal curriculum would combine "components of didactic teaching sessions and hands-on experience" with the overarching goal that students "identify and solve real problems facing the school's hospitals and clinics." They write, "By the end, students would have developed the business skills needed to lead multi-disciplinary teams, serve as contributing team members, and apply data analytics to improve clinical practice."
"Leading medical teams is as complex as performing a surgical procedure," Pearl and Fogel write. Future physicians navigating the shift toward team-based care will need more than just intelligence and medical expertise—they also need "[t]raining in evidence-based leadership skills." Pearl and Fogel explain that while most medical schools in the United States don't provide such training, "business schools offer these courses as part of their core curricula."
As the health care system shifts from fee-for-service to value-based care, physicians need these leadership skills to address a host of "contentious issues" such as "salary, incentives, relative performance, metrics, and contract negotiations," Pearl and Fogel write. Business school courses would help physicians evaluate their strengths and weaknesses as leaders, while simultaneously teaching them how to create "environments where innovation and diversity are likely to flourish."
Learning to work on a team
"As essential as team leadership skills are, physicians need to understand the importance of being effective team members," Pearl and Fogel continue. They explain that many business schools use simulations to help students understand what makes a team thrive or fail, learn how to develop team culture, and set goals.
According to Pearl and Fogel, "These abilities require emotional intelligence and deep understanding of interpersonal dynamics—concepts and skills that are essential to maximizing quality, increasing patient safety, and improving clinical performance."
To control costs and increase quality while caring for a "demographically older and more diverse population," physician leaders will have to tackle challenges such as optimizing procedure scheduling, "right-sizing" provider networks, and maximizing information technology.
Consultants and administrators can't address these challenges alone, Pearl and Fogel write. Rather, they contend that "[p]hysicians will need to own this process to create the effective, organic change that comes from those closest to patient care and is most trusted by fellow doctors." Further, they point out that as EHR use increases, "knowing how to develop and use data analytics may be as important for the emerging generation of doctors as learning to diagnose cardiac murmurs using a stethoscope has been previously."
According to Pearl and Fogel, business schools teach students "mathematical, computer-driven approaches to applying data analytics to operational problem-solving" and train them "to identify opportunities for increased operational efficiency." Moreover, business professors over the past decade have used hospitals and clinics as case studies—providing exactly the sort of knowledge that would enable medical students to "learn from the experiences of these different institutions and incorporate the key concepts into their clinical practice."
Among other challenges, future physicians need the skills to curb patient wait-times, conduct statistical analyses to spot trends in patient quality outcomes, and identify the most cost-effective treatments for a given patient. Addressing these issues "requires innovation and continuous improvement," Pearl and Fogel state, neither of which "happens without leadership and data." And according to Pearl and Fogel, the need for "this type of expertise" will only increase "[a]s a growing percentage of medical care is provided using modern technology, including telemedicine and digital health."
Making space for a business curriculum
The medical school curriculum has space for a rotation at a business school, Pearl and Fogel argue. Citing the "elective rotations" in the fourth year of medical school, they write, "This would be the optimal time for an interdisciplinary 'business of medicine' elective that would make the fourth year of medical school more valuable to students."
Moreover, medical students in the fourth year could quickly put those skills into practice when they begin their residencies. "Done well, this educational experience would help participants to contribute more effectively to their residency programs, and after graduation in their clinical practices," Pearl and Fogel write. "Over time, the experience would benefit the health care system as a whole" (Pearl/Fogel, NEJM Catalyst, 11/3).
Learn more about the changing physician workforce
Concerns about physician burnout have made national headlines, and the stresses facing health care providers continue to grow. Vendors that want to work with physicians need to understand this new clinical environment before they can succeed.
Check out the infographic to get a breakdown of the changes that are impacting the physician workforce. You'll also learn four new rules of engagement to help suppliers and service firms realign their offerings with the realities of health care providers.