Anesthesia Training Shorts Practice Issues
Most anesthesiologists believe residency programs do a poor job of training young doctors in practice management, according to results of a recent survey of the specialty.
“Physicians are trained well in clinical sciences, but we don’t get a lot of training in some of the business and practice management areas that are also an important part of being a physician,” said study author Philip Kalarickal, MD, MPH, clinical assistant professor of anesthesiology at Tulane University School of Medicine, in New Orleans.
Dr. Kalarickal and his colleagues convened a working group of practicing anesthesiologists, including some on the ASA committee on practice management, to compile a list of topics that they believe should be an important part of any curriculum in practice management (abstract PM19). The researchers then mailed a survey to the entire ASA membership, asking them if they had received adequate training in these areas, and collected responses from May through October 2011.
More than 3,600 clinicians responded, for a response rate of 12%. The majority said they did not believe residency programs included enough training in practice management.
“Our working hypothesis was it would indeed be the case that there were deficiencies,” Dr. Kalarickal told Anesthesiology News. “But I was surprised at how strong they were.”
For instance, between 68% and 88% of respondents said they thought residents were inadequately exposed to billing issues; 71% said there was not enough training in insurance reimbursement.
However, the majority of all participants—at least 84% in every bracket of experience—agreed that training in practice management could help improve patient care and outcomes, quality, safety and containment of health care costs.
More than half of respondents said they believed residents got enough exposure to the topics of quality assurance/improvement and scheduling in the operating room (OR). And residency program directors were least likely to say that training failed to address issues in practice management.
That makes sense, Dr. Kalarickal said, for obvious reasons. “Their perception is that they may be doing a better job than they actually are.”
Dr. Kalarickal said he hoped the findings will encourage program directors to look more critically at their curricula, and add more time and expertise to program management. “We hope that residency programs, based on this, recognize that there is a need for more training in these areas.”
David Mackey, MD, professor in the Department of Anesthesiology and Perioperative Medicine at the University of Texas MD Anderson Cancer Center, in Houston, said he agreed with the gist of the survey findings. Anesthesia trainees are not getting enough exposure to practice management, said Dr. Mackey, who was not involved in the study. “I think trainees understand this better than program directors do.”
Health care has changed dramatically in recent years, Dr. Mackey added. Programs need to help anesthesiology residents transition from simply working in the OR to taking on a broader role in health care by leading and managing the delivery of procedural services in integrated systems. “Current anesthesiology trainees who believe they are going to make a comfortable living just providing OR anesthesia, I think are going to be sorely disappointed with their careers.”
Private practices, especially at places like Mayo Clinic and the Cleveland Clinic, are transitioning to integrated health care delivery more easily than traditional academic centers, Dr. Mackey noted. He recommended that leaders of private practices form a standing group to create a practice management curriculum that would give trainees exposure and hands-on experience in business and interpersonal skills. “OR skills are as important as ever,” Dr. Mackey said, “but business management and leadership skills are becoming equally important.”