Building Business Sense

Date: February 1, 2014

When Amir Dorafshar first joined the faculty in the Department of Plastic and Reconstructive Surgery, his residency and fellowship training had him fully prepared to care for patients. But when it came to the business aspects of running his practice, well, that was another story.

“At the end of the month, I’d get these reports from the billing people, and it was like they were written in a different language,” he recalls. “I was shocked, because making sense of the money aspect of the practice was a big issue now, but in all my training no one had really talked about it.”

The experience is not unique to plastic surgery. Historically, medical education has paid scant attention to business skills, but that may finally be starting to change. At least two residency programs in the School of Medicine have added formal business training to their curricula in recent years.

The birth of the program in Plastic and Reconstructive Surgery can be traced to a day when Dorafshar shared those frustrations about his lack of business training with friend and colleague Bahar Zarrabi. A senior administrative coordinator in plastic surgery, Zarrabi was then in the part-time MBA program at the Carey Business School.

As part of a Carey class project, she soon helped to develop a one-day symposium for plastic surgery residents on the business of health care.

“When residents are trained, they’re given the tools they need to become great physicians,” she says. “But especially when they’re in private practice, they’re expected to go out into the real world and staff an office and hire people and train people and do the finances—all of these things that are major components of business education that physicians never learn unless they self-seek it,” she notes.

Meanwhile, another plastic surgery faculty member, Carisa Cooney, was working on a grant application that would fund development of a proposed future redesign of the department’s residency program. When she heard about Zarrabi’s work, Cooney asked for permission to incorporate it. Last spring, the proposal was awarded a $45,000 Residency Redesign Challenge Grant from the School of Medicine’s Institute for Excellence in Education.

Then, last summer, the current residency program adapted Zarrabi’s work into a new series of educational sessions, “Business Thursdays.” Scheduled four times a year, the classes are led by various business experts and cover topics such as negotiating skills, managing staff, and leadership. “We’ve only had two of them so far, but it’s already generated a lot of excitement,” Dorafshar says.

In Anesthesiology and Critical Care Medicine, residents have been learning business skills for five years now. Program director Deborah Schwengel says that the management and leadership lessons taught in the program are meant to mirror skills taught in corporate leadership development.

“It’s extremely important that residents understand the practice management side and understand leadership,” says Schwengel. “We’re at Hopkins, and this is a place where we expect our residents to go out and be in leadership positions. We need to give them the skills to do that.”

There are a number of challenges facing programs trying to add some business training. Funding is somewhere between difficult and impossible to come by, so there are no stipends available to attract presenters from academia and the business world. Funding also stands in the way of developing rigorous survey and other tools that might measure what works and what doesn’t—and inform quality improvement efforts.

“We have no budget—isn’t that the way it always works in graduate medical education?” Schwengel says with a laugh. “And so we scrounge for a little bit here and there. We’re lucky that we have a couple of people in our department with MBAs—they’ve been a big help.”

Back in plastic surgery, Dorafshar says that the business training program has already been presented in conference settings, adding, “We’d like to get this out into the wider world, other residency programs here at Hopkins and other institutions.” —Jim Duffy