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Now, I\u2019m being pretty careful here because med schools are super sensitive about their curriculums. And I am sensitive to the fact there\u2019s much to teach in four years. So, throwing no shade here, what do I know from the Krebs cycle? Choices of what to teach are tough. With that disclaimer, in this healthcare podcast I am speaking with Adam Brown MD, MBA, about an article he wrote entitled \u201cDear Medical Schools, Educate Students on the Business of Medicine\u2014Without it, you are doing your students a disservice.\u201d

Let me give you Dr. Brown\u2019s list for the \u201cwhy teach the business of medicine.\u201d He says:

1. The role of physicians in medicine has changed, and we dig into this in the episode.

2. There\u2019s an expectation mismatch. Docs are investing 10 years and, on average, $200K to $300K in real dollars to get that MD or DO. You don\u2019t want those new physicians quitting on the quick because the reality is so different from what they thought it would be. Not being up front about the business of medicine is like hiding the reality of the situation instead of preparing them.

3. If you don\u2019t understand the business of medicine, you do not know how to advocate for yourself or the profession or even patients in a way that is compelling to the current set of decision-makers.

As maybe a corroboration here, may I just report that I probably have gotten (conservatively) 100, 150 emails and LinkedIn notes from physicians who say basically some version of the same thing: Thanks so much for Relentless Health Value. I wish I would have learned even the basics of what you cover in med school. If I had, I would have been able to help myself and help myself help patients far better.

4. Docs are the ones with the prescription pads. Docs are just functionally the gang who are driving costs that patients and employers and taxpayers ultimately incur. Not knowing the how much or just the whole story here can inadvertently contribute to clinical morbidity, because patients who fear they cannot afford care do not follow doctors\u2019 orders. We should get real about that. Or if they do follow doctors\u2019 orders and go into debt \u2026 I mean, there\u2019s just study after study in oncology and otherwise that shows patients who cannot afford their care have worse outcomes. We cannot hide from this any longer.

5. The last reason is that there\u2019s lots of things that docs can do besides just be at the bedside. Not giving insight into these alternative paths seems unfortunate for any doc who maybe wants to mix it up some because they\u2019re feeling burned out or in a different season of their life looking for something more aligned with where they are as a person.

So, now let\u2019s think about this whole question from the standpoint of the system itself\u2014from the standpoint of doing better by patients. Why is it important to teach docs the business of medicine? Let\u2019s start here.

When physicians do not understand the business of medicine, it\u2019s harder for docs to get into boardrooms and have their voices heard. Not teaching the business of medicine in med school might be one reason why there is such a shockingly small percentage of doctors on the boards of directors at major nonprofit hospitals (listen to the show with Suhas Gondi, MD, MBA [EP404]) and why there\u2019s so little \u201cdyad leadership\u201d in the ranks of both clinical and payer organizations, etc. And even fewer nurses are in organizational decision-making roles, by the way, despite nurses actually being the most trusted profession\u2014even more trusted than doctors by 14 percentage points, according to Gallup.

One way to interpret this lack of docs and other clinicians in the boardroom is simple cause and effect. Doctors are losing control and ownership\u2014and I mean this in literal terms\u2014of the organizations that run the business of medicine, which controls the medicine of medicine.

Chad Erickson wrote a comment about this on LinkedIn that I thought was great. He wrote, \u201cOpportunities for physicians to really control or even impact the 86% of healthcare outside of their practice are being reduced every year. We expect doctors to make the decisions and be accountable for patients and outcomes, yet we are taking away their ability to do so.\u201d

And going one level deeper here on how not having enough docs in admin roles becomes a snowball rolling downhill kind of downward spiral, I\u2019m gonna quote Jeremy Granger, MD, FAAP. He wrote, \u201cWhen you are a physician administrator, it can be very strange. There is tremendous pressure from administrators to think and act like one of them and give insight into how to best coerce physician behavior to align with administrator-determined goals without necessarily involving the physician with setting those goals. When you advocate instead with your physician hat, you can find yourself ostracized from that administrator clique. You realize that they view physicians as knaves and you as the Judas goat. You either pick a side or, if you\u2019re lucky, you land with a team that has physician leaders equipped with equal power as administrators.\u201d

So, you see what happens. Doc gets an admin role and either chucks their stethoscope and their patient-first mindset out the window to fit in, or they quit. And then we never get to any sort of critical mass of clinicians in leadership roles that would reset the organizational ethos.

So, here we are. Too few mission-driven and business-savvy docs in boardrooms mean patients get the kind of care they\u2019re currently getting and at the prices we\u2019re all currently paying. From the standpoint of doing better by patients, I hear story after story about some doc who was under the impression that, I don\u2019t know, working with a private equity firm to do a roll-up of all the specialty practices in a local market was pretty cool and a totally victimless strategy. Or the surprisingly high number of docs prescribing drugs on that most wasteful spending list. There\u2019s one on that list, for example, that costs taxpayers or an employer $2000 when that drug consists of basically two $15 over-the-counter meds mashed together\u2014and yet there\u2019s the impression that the $2000 drug is a better financial choice because there\u2019s a co-pay card and the patient out of pocket might conceivably be less \u2026 until it isn\u2019t, of course, because it\u2019s not like that additional $1970 in cost suddenly becomes free.

Or what happens when a clinician is told to order largely unnecessary MRIs because workers\u2019 comp covers everything and no one cares\u2014so this kind of thing continues to just happen \u2026 all this stuff. It takes a broader understanding to get the why and create the intrinsic motivation and necessary insight and right language and arguments to make things better.

But all of this is about patients. If I\u2019m talking to margin-driven people sitting around the conference room table with their calculators, are there any organizational consequences, meaning financial consequences, to not making sure doctors understand business and have a seat at the table? Here\u2019s two (there\u2019s probably more):

1. Staff turnover. If that\u2019s a concern for any organization now, and if moral injury is cited as a reason for that turnover (which it often is), moral injury doesn\u2019t happen when organizational demands are aligned with clinician values.

2. Successful value-based care isn\u2019t gonna happen if docs don\u2019t understand the business of medicine. Listen to the show with Eric Gallagher (EP405) or the one with Amy Scanlan, MD (EP402) or Larry Bauer (EP409). There\u2019s like 10 guests who essentially say the same thing. Docs who are in the dark about how the world actually works IRL cannot be an aligned force helping move past the FFS (fee-for-service) status quo and the whole business model that underpins that.

Adam Brown, MD, MBA, my guest today, is a practicing emergency physician, board-certified ER doc. He recently founded ABIG Health, working with healthcare companies on communication strategies and advising investment firms. He\u2019s also a professor of practice at the University of North Carolina, Chapel Hill.

Mentioned in this episode is a Tweet by Brendan Keeler. Also, Dr. Denver Sallee\u2019s very inspirational predictive scheduling work.

I\u2019ll leave the last word on this to Michael R. O\u2019Brien, MD: \u201cYou don\u2019t overcome the corrupting influence of money in medicine by ignoring its existence. \u2026 To slay the dollar-eyed dragon, we must be able to see like the dollar-eyed dragon.\u201d

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You can learn more at ABIG Health and by reading Dr. Brown\u2019s bimonthly column.

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Adam Brown, MD, MBA, is a board-certified emergency physician, entrepreneur, and accomplished healthcare executive whose professional journey traverses clinical practice to strategic leadership.

Having risen through the ranks at Envision Healthcare, Dr. Brown\u2019s tenure there culminated in his role as president of emergency medicine, where he spearheaded the COVID-19 response and clinical communications. His impactful leadership led to his appointment as chief impact officer in 2021.

In 2022, Dr. Brown left Envision and established ABIG Health, a healthcare strategic advisory firm. Additionally, he took on the mantle of professor at the University of North Carolina, Chapel Hill, Kenan-Flagler School of Business (his alma mater), teaching healthcare operations and strategy to MBA students. He is the advisory board co-chair at the Center for the Business of Health and on the business school Board of Advisors.

A frequent media presence, Dr. Brown has been featured on CBS, Yahoo Finance, BBC, and local Washington, DC, outlets, speaking on various healthcare issues. His column, \u201cPrescriptions for a Broken System\u201d in MedPage Today, showcases his commitment to meaningful change in healthcare.

His passion for empowering informed health decisions shines through his roles as a communicator, leader, and strategist. A recognized thought leader, his ability to connect, envision, and lead underscores his impact on shaping healthcare.

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08:49 What does it mean to teach the business of medicine?

11:04 The four Ps that are key within the business of medicine.

13:27 Why is it important for doctors to understand the business of medicine?

21:46 \u201cThings don\u2019t happen without a physician\u2019s signature.\u201d

27:27 Why physicians who understand the business side of medicine can broaden the view of outcomes for the business decision-makers.

28:30 Why is it important to make sure physicians are in the boardroom?

29:36 EP404 with Suhas Gondi, MD, MBA.

30:52 \u201cWe are getting what we designed.\u201d

33:37 Dr. Brown\u2019s advice for clinicians in the boardroom.

38:21 The work of Denver Sallee, MD, MMM, using artificial intelligence to do predictive scheduling.

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You can learn more at ABIG Health and by reading Dr. Brown\u2019s bimonthly column.

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@ERDocBrown discusses teaching the business of #medicine on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare #healthcare

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Recent past interviews:

Click a guest\u2019s name for their latest RHV episode!

Rob Andrews, Justina Lehman, Dr Will Shrank, Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5)

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