Business in Healthcare Module- a Missed Opportunity in our Trainees’ Development?

C. O’Connell1, M.K. O’Reilly2, G.J. Nason3

1. Department of Urology, Beaumont Hospital, Dublin 9, Ireland
2. Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
3. Division of Uro-Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

Dear Sir,

The Budget 2019 announced a health budget of €17billion. Healthcare spending accounted for 9.0% of gross domestic product across the Organization for Economic Co-operation and Development (OECD) countries in 2016.1  Ireland spends €4,706 per head of population- the 7th highest.

Despite this, doctors receive no training in business. Doctors study for between 4-6 years in medical school, with a subsequent one year internship followed by specialty training (4 years for General Practice to >10years for subspecialty training). No current training scheme in Ireland offers formal (or any in most cases) training in business. To obtain a Certificate of Completion of Specialist Training (CCST) some faculties require trainees to have attended a course in ‘Health Service Management’- this is not qualified further- indeed an online course or a weekend course is sufficient.

Currently there are several Medical Doctor/MBA (MD/MBA) programs in North America; however, a formal MBA for all doctors is unnecessary and impractical- the length of specialty training is already a contentious issue. The RCSI offer Masters Programs in Leadership, Management and Quality but none as part of the regular curriculum.  

A cross- sectional survey in Ireland demonstrated urology trainees underestimated the cost of disposable devices used during a common urology procedure (flexible ureteroscopy and laser lithotripsy) by over €300 per procedure.2  In order to maximise the cost-effectiveness of the operating theatre it is important to address knowledge deficiencies on healthcare economics among front line staff. A surgeon’s choice of device should not solely be influenced by cost but it does need to be a consideration.

The challenge remains when and to what detail does a clinician need to be educated in business? Every hospital in Ireland has stakeholders whose function and background is geared towards the economic viability of the enterprise. Doctors are trained to diagnose and treat patients- many chose this career based on a (mis)-understanding that this is what they were going to be employed to do. Is it fair to expect a clinician to develop and defend the business model for a new surgical system, a new radiological scanner or for a diagnostic suite?

Furthermore, with over 25% of consultants posts currently unfilled in Ireland- changes are required to attract and prepare the best homegrown trainees to take up practice in Ireland. Trainees finish specialist training programs with a significant lack of awareness of the functioning of a practice- private or public in regard to the costs of setting up a practice, scheduling, dealing with insurance companies, pensions, administrative costs, billing and planning to name but a few. There is a desire for an increased emphasis on non-clinical training among senior trainees.3

Healthcare is a massive national expenditure and efforts should be made to ensure this is used efficiently.  A sound argument could be made for the teaching of business principles in the later years of specialty training to better prepare trainees for the reality of clinical and economic practice. Can we really afford not to?

Corresponding Author:
Gregory Nason, FRCS Urol, FEBU
Clinical Fellow in Urologic Oncology,
Princess Margaret Cancer Center,
610 University Avenue,
Ontario M5G 2M9,
Email: [email protected]

1. Beiko D, Gonzalez CM, Mourtzinos AP, Rhee EY. Exploring the business of urology: Is it time for a “Business of Healthcare” curriculum in urology residency programs? Can Urol Assoc J. 2018 Oct;12(10):299-300.
2. MacCraith E, Davis NF, Browne C, Galvin DJ, Quinlan DM, Lennon GM, Mulvin DW. Identification and Cost of Disposable Endourological Devices for Nephrolithiasis: A Cross-Sectional Study Among Urological Trainees. J Clin Diagn Res. 2016 Oct;10(10):PC15-PC17
3. Schlumbrecht M, Siemon J, Morales G, Huang M, Slomovitz B. Preparation in the business and practice of medicine: perspectives from recent gynecologic oncology graduates and program directors. Gynecol Oncol Res Pract. 2017 Sep 22;4:14.