Purpose As the cost of health care continues to rise, cost containment practices have a growing impact on physician ability to survive financially while continuing to provide appropriate patient care. Medical educators have been slow to integrate these issues into medical curricula. This study was conducted to evaluate the frequency with which physicians in practice deal with these issues and how well our program prepares them.
Methods Physicians who graduated from our medicine and medicine pediatric residencies from 1995-2005 were surveyed. They were asked to rate on a 5-point Likert scale preparedness (1 = poorly prepared, 5 = very prepared) and frequency of performance (1 = never, 5 = very often) of several skills, including billing and coding and administration/office management. For the purpose of analysis, being well prepared and a skill being frequently performed were considered to be ratings of 4 or 5. Graduates were also asked to list issues with resource allocation they dealt with on a routine basis and their strategies for overcoming these issues.
Results There were 112 surveys returned for a response rate of 52%. On the specific item related to billing and coding, 85% of respondents reported that this is a frequent practice and only 24% felt that residency prepared them well. The item regarding administration/office management elicited a similar response; 61% reported frequent practice while only 6% felt their residency prepared them well. The most frequent themes of resource allocation were formulary restrictions and obtaining approval for diagnostic testing or care. The most frequently reported strategies were phone calls and letters to third-party payers.
Conclusion At our program, graduates report that they are poorly prepared for some of the business tasks essential to their professional lives. These striking data reinforce the importance of incorporating these issues into medical curricula.
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