Teaching the Business Side of Radiology Could Have Long-Term Benefits

It’s no longer enough for radiology residents to master reading head CT scans or learn all the specifics of MRI imaging. Changing reimbursement structures and different healthcare setting models have made understanding practice management and healthcare policy a must.

In a recent study published in the March Journal of the American College of Radiology, researchers determined both residents and residency directors felt including these instructional topics would greatly benefit residents on the cusp of practice.

“It’s becoming more and more important to stay current on the business and policies of practice. If you’re not aware of what’s going on, then you can’t anticipate or make plans to navigate any changes,” said Jonathan Medverd, MD, lead study author and University of Washington radiologist. “If you don’t understand your place in the system and you don’t know who’s paying you, then you’re at a disadvantage.”

Medverd and colleagues surveyed members of the Association of Program Directors in Radiology and the American College of Radiology (ACR) Resident and Fellow Section (RFS) via email, and members of ACR RFS who attended the 2010 ACR annual meeting and leadership conference. Response rates were 21 percent, 12 percent, and 25 percent, respectively, and 560 individuals participated.

While residency programs do a good job at teaching residents about ethics, quality, and informatics, the curricula focus less on financial literacy, the basic understanding of practice governance, and performance metrics. It’s these areas, as well as strategic planning and accounting principles, where residents could gain from additional education, Medverd said.

In fact, the Association of American Medical Colleges’ 2011 Graduate Questionnaire revealed medical students were also interested in learning more about practice management. Less than 50 percent said they felt their knowledge in this area was adequate.

“Pushing general things, such as basic financial literacy or how Medicare billing works, into medical school could increase confidence among doctors in training,” Medverd said. “Then residency programs can pick up and focus more specifically on how these issues affect their particular fields.”

However, knowing residents should have more instruction in these areas doesn’t mean including it in the curriculum will be easy. According to Jennifer Kohr, MD, a diagnostic radiologist with New York Presbyterian Hospital who helped design and implement a radiology business course as a chief resident, two main challenges exist to beefing up this part of residency education: time and resident motivation.

The number of skills and modalities resident must master has increased in number and complexity, she said, making it harder to squeeze additional, non-clinical topics into the curricula. And even if a program does manage to fit them in, residents are often overwhelmed and lack the motivation to learn something that won’t help them with direct patient care. The benefits, however, are there.

“It is incredibly helpful for residents to understand how their actions in their practice may impact cost to the patient or to medicine, in general,” Kohr said. “The bottom line is that residents should know more about what they can do in their practice that is in the best interest of the patient.”

For example, she said, including residents in quality improvement projects and giving them hands-on experience can enhance their understanding of how these efforts work and why they are important.

Previous research published in Academic Radiology in 2004 supports Kohr’s assertion. In a study focused on introducing practice management skills during residency, Stephen Chan, MD, Columbia University’s radiology residency director, found that introducing this knowledge during residency could have long-term positive impacts.

“It is likely that radiology practices would benefit from the presence of one or more radiologists with managerial training and skills,” he wrote, adding that radiologists are best poised grasp these topics during the residency period.

But successfully augmenting the residency curriculum might not be easy, Medverd said. Programs must first acknowledge and promote the importance of meshing practice management and healthcare policy with their existing instruction. Secondly, they must identify their “champion,” the provider who will promote this type of education throughout the facility. Lastly, program directors cannot expect the residencies to change overnight – each champion will need time to fulfill their mission.

Ultimately, it’s most important for radiology residency program to simply start the journey toward enhancing their curricula. Doing so is imperative.

“Radiologists need to understand that we’re in a tumultuous period with healthcare in the national dialogue,” Medverd said. “There’s lots of change going on, and the calls for greater literacy among doctors toward business practice and healthcare policy have been long standing. The time is now to act.”