Medical schools teach medical content well, but they miss the mark when it comes to teaching the practical side of medicine. Questions like How should I manage my income? What should I look for in a contract? or What happens when I’m sued? are left unanswered. Physicians generally learn these lessons on the job and make avoidable mistakes along the way.
Below are nine skills I wish I would have learned before leaving medical school.
Money management
Physicians are notoriously bad with money.
We go through college and medical school with no or low income, enter residency with modest income and then start our first “real job” making an average of $313,000 per year.
We take on about $250,000 in debt from medical school which we’ll pay back over the decades after residency. During the same time, we’re also likely to make financially significant decisions like getting married, starting a family or purchasing a home.
Medical schools generally do not train doctors to manage the money they make or how to strategically manage the debt they incur.
What can you do?
It’s never too late to learn.
The White Coat Investor’s blog and book have a ton of relevant information. Other medical blogs like KevinMD or Doximity also have physician-centric financial articles. Classic books like Rich Dad, Poor Dad or Think and Grow Rich are just two of many books available on personal finance.
More formally, personal finance courses or MBA programs are available to learn personal finance.
Negotiation
“…you don’t get what you deserve, you get what you negotiate.”
— Chester L. Karrass
Physician negotiations start with entering medical school and continues through to contracts for residency and jobs.
Patient encounters are negotiations; getting patients to understand the physician’s perspective and physicians understanding their perspective is a negotiation.
Outside of medicine, physicians find that everything seems to cost more when people learn they’re a doctor. Simple home repairs, getting your car worked on—it’s amazing how quickly inflation happens when one is wearing scrubs.
Learning to negotiate interpersonally and professionally is a critical skill for physicians – one we shouldn’t need to learn on the job.
What can you do?
Negotiation is a learned skill—the more you do it, the better you become. The good news is that there are ample opportunities to practice; the key is starting to look at everyday interactions as negotiations.
One negotiates with friends, with family, with every purchase, cell phone plans—there are countless ways to exercise the negotiation muscle.
There are also thousands of informal articles on how to become a better negotiator. Or, negotiations skills can be learned through books, trainings or conferences.
How to Read a Contract
Contracts set the terms of the job and how the payment will happen.
Contracts can describe the terms of hiring, firing, incentives, what a physician can do in their spare time, whether they can work anywhere else, who owns the ideas a physician has, how bonuses are paid, how the physician’s productivity will be measured and how consequences are managed.
Contracts are the paperwork that allow for any work a physician may undertake; medical schools are missing the mark by not explaining them.
What can you do?
It depends on how much of a contract expert you want to be. The easy answer is to read the contract and then hire an expert – an attorney with experience in physician contracts.
Several resources are available for self-study, however. Plenty of informal articles and guides exist on the topic, many of which conclude by recommending hiring an attorney. The AMA has several resources, including books and guides on contracts.
How to Run a Business
From basic, early questions like Should I form an LLC? to more complex questions like how to be an effective leader or how to manage your practice physicians can leave medical school underprepared for the career ahead of them.
Even though more physicians are employed than those in private practice, there is a pressing need for business literacy. Physicians who are in private practice need to know how those practices should be run; how to staff, billing and coding, credentialing with providers, negotiating reimbursements—often, physicians figure these things out as they go along.
Employed physicians would also benefit from business know-how. Understanding how hospitals are paid, how to budget, or how rates are negotiated may not be directly linked to clinical care but can put providers on the same page as administrators and help make the approach to medicine more complete.
What can you do?
There is no one way to start a business, and non-physicians in business also have to “figure it out.” The experience of on-the-job- training for business isn’t unique to physicians.
The goal isn’t that physicians leave medical school with business degrees; it’s to help them understand that they need to learn this.
There are plenty of books, blogs and conferences dedicated to practice management.
How lawsuits/investigations work:
According to the AMA, over a third of physicians have been sued at some point.
The good news is:
“Sixty-eight percent of closed claims were dropped, dismissed or withdrawn in 2015… …Of the 7 percent of medical liability claims decided by a trial verdict, the vast majority—88 percent—were won by the defendants (physicians).”
Regardless of the low odds of being successfully sued, legal proceedings can be harrowing. The threat of malpractice is only complicated by a total lack of familiarity with the legal proceedings themselves.
What happens when you receive a subpoena? How do you successfully undergo a deposition? Who can you talk to about the case? What are your rights?
These questions pale in comparison to how physicians feel about being involved in a case with a bad outcome, and the subsequent mental health impacts.
In the same vein are hospital investigations—not truly legal proceedings, but the provider’s care is being scrutinized. It’s a terrible experience to be the subject of a peer review case, a mortality review, a root cause analysis, or having your credentials threatened.
These are all events for which a physician’s first exposure is when they’re the defendant. Given the prevalence of these proceedings, medical schools have an obligation to prepare physicians for the experience.
What can you do?
Fortunately, the opportunity to learn the process doesn’t have to wait until you’re in it.
Within hospitals there are opportunities to serve on investigative committees. They go by different names: Peer Review Committee, a Quality Review, a Morbidity and Mortality, Performance Improvement Committee, Root Cause Analysis. Whatever your hospital calls it, get involved. This lets you see other people’s case reviews, familiarizes you with the process and, most importantly, will make a you a better doctor.
When you see care dissected, you see trends in the errors, you learn the terms and the triggers; you see the flaws in documentation and how things fell apart. When you have similar patients, you become keenly aware of how to avoid pitfalls. And when you become the subject of a review, it will not be unfamiliar waters.
Outside of hospitals, experience can be gained in the legal world through expert witnessing and serving on medical review panels. Not having your care reviewed but seeing how care is reviewed gives you an insider’s eye on the process – what works and what doesn’t – so if you’re among the third of physicians sued, you’ll already be educated on what to expect.
That Non-clinical Career Options Exist
Medical school makes the path seem easy; there’s one choice: Go see patients.
But in reality, there are many other options available. Physicians use some of these as side hustles, others become the main job with clinical work taking the supplemental role.
Non-clinical choices include consulting, writing, expert witnessing, research, private industry, medical science liaisons, file review, pharmaceutical, medical devices, the list continues.
What can you do?
Look and you will find options for non-clinical jobs.
SEAK leads the way for non-clinical conferences where physicians can learn about the options in general but also specific niche positions and how they work.
Look for Zebras, Kevin MD, PassiveIncomeMD, White Coat Investor, and Physician Side Gigs are all great places to start looking for non-clinical job options. The SEAK website has a pretty extensive list of options (if you join the email list), and jobs can be found on any popular job search engine.
There are even professional societies dedicated to non-clinical options such as the DropOutClub and The Society For Physicians With Non-Clinical Careers.
If you look, you can find them!
Managing Burnout
According to the Medscape survey, over 50% of physicians experience at least one sign of burn out.
This means that there’s a very good chance that you will also experience burn out. Burn out is defined as a constellation of symptoms of compassion fatigue, depersonalization, and cynicism.
The time to treat your burnout is before it happens.
By practicing mental hygiene, knowing signs, knowing what to look out for in a prospective job, how to ask questions about wellness, medical schools have an obligation to prepare their students for the lifestyle of medicine, not just he medical content.
What can you do?
It’s all about prevention and early identification. Physicians entering practice knowing about the likelihood of burn out would be more likely to be able to prevent burnout by maintaining a lifestyle outside of medicine: strong family connections, outside interests that help provide a more robust life than what is offered by the practice of medicine by itself.
Plenty of resources exist for addressing physician burnout.
Dr. Dike Drummond, MD, is a frequently cited leader in physician wellness and burn out. He holds annual conferences as well as having a plethora of resources available on his website, The Happy MD.
Professionalism
“Professionalism is not the job you do, it’s how you do the job”
—Shiv Khera
I’ve heard this story at a few conferences. It illustrates professionalism well….
A patient came into the emergency department in the middle of the night with a very small laceration on her chin.
The ER doctor who saw her wondered why she even came in—it was small enough to just need a bandaid or maybe some glue, but certainly didn’t require emergency medical attention.
The patient, however, refused to be touched by anyone except a plastic surgeon and began loudly refusing care and demanding to have a plastic surgeon called to fix what really didn’t require care in the first place.
The ER doctor’s hands were tied; he wakes up the plastic surgeon and, apologizing profusely, tells him the story.
The surgeon replies with “Thank you for this consult” and within fifteen minutes is in the ER, hair combed, looking fresh and wearing a suit.
He sits with the patient, listens to her concerns, puts on a full gown and applies glue and a bandage to the patient’s chin. He hands her his card and tells her he would like to see her in seven days time to ensure she is healing properly.
And then he thanks her for letting him take care of her.
The patient was ecstatic.
That is professionalism. On the phone, in person, with the patient. Like Shiv Khera said: It’s not the job he had, it’s how he did it.
What can you do?
Being professional is like having manners. It’s really hard to see where you’re lacking—you just see the consequences when you are in the situation.
Like any of the above skills not taught in medical school, a wealth of information is available online. But saying “Be more professional” is like telling a teenager to “have character”—it’s impossible for them to see where their character is lacking.
The good news is that it’s easy to see professionalism in others, the plastic surgeon, for example. If you find these people, work with them. Work around them. See if they can mentor you. Watch how they handle situations and learn from them. Or, find a career coach to help you become more professional.
Professionalism is like any of the above under-represented skills—it can be learned.
It’s never too late to improve your skills.
