Understanding the Business of Medicine Should be an ACGME Competency

AUGUST 07, 2016
Arlen Meyers, MD, MBA

The Accreditation Council for Graduate Medical Education (ACGME) 
accredits Sponsoring Institutions and residency and fellowship programs, confers recognition on additional program formats or components, and dedicates resources to initiatives addressing areas of import in graduate medical education.

In 2002, the ACGME launched a competency initiative called the Outcome Project. As a result of this project, ACGME identified six ACGME Core Competencies to be used by GME programs to evaluate their residents in training. The six ACGME Core Competencies are: patient care; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; professionalism; and systems-based practice. Each competency is made up of different milestones residents are required to master at key stages of their medical training.

Patient Care 
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Medical Knowledge 
Residents must be able to demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Practice-Based Learning and Improvement 
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Interpersonal and Communication Skills 
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, and professional associates.

Professionalism 
Residents must be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems-Based Practice 
Residents must be able to demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Noticeably absent are demonstrating competencies in the business of medical practice, medical practice entrepreneurship and the process of medical innovation and quality improvement. As a former program director, my observation was that these learning gaps contribute to poor patient outcomes, persistent systemic dysfunction, and patient experience problems due to ignorance about best practices, many of which derive from non-sick care industries.

It is time to add competencies in the business of medicine to graduate resident education for the following reasons:

1. Shifting trend to value-based care assumes doctors know about value and how to create and measure it. Here are 10 things doctors should know about value.

2. Fixing the ills that beset the US sick care system will require increasing participation by physician entrepreneurs, beginning in their residency training.

3. The impact of socioeconomic determinants of health disparities and business model trends will, arguably, have more impact on the future of care than scientific and clinical advances.

4. Graduating residents are perplexed about following an independent or employed career track.

5. The future of private practice is in jeopardy, in part, because residents are afraid and lack the knowledge, skills and attitudes to be independent practitioners following graduation.

6. Medical schools have little or no interest in providing their students with medical practice entrepreneurship education.

7. Residents lack a fundamental understanding of basic business concepts and practices.

8. The ability to deliver state of the art care depends on having a VAST business model.

9. Residents cannot always depend on having an employer to shield them from having to engage and be knowledgeable about the business of medicine.

10. Employed physicians are required to have the business skills necessary to satisfy the clinical, business and marketing objectives of their organizations to achieve their missions.

For too long, despite loud objections, the ACGME has kept their head in the sand when it comes to requiring fundamental business practice competencies from graduating residents and their training programs. The goal of resident education is to create independent medical practitioners that patients can trust. As such, being able to practice the business of medicine is as important as being able to practice the art of medicine. Teaching and learning the business of medicine to residents will require some changes. One of them is to stop calling it practice management and restructure the learning objectives and curriculum.

It's time for the 7th competency: 

Medical Practice Entrepreneurship: Residents must be able to demonstrate they can deliver state of the art care using a valid business model.

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