Karen Nash

On Call wondered if dermatologists coming out of residencies are prepared for dealing with the challenges of running a practice. We asked dermatologists around the country if they think young physicians are prepared to make business decisions.

Moonlighting

"I don't know of any business being taught at medical schools, and even less so in dermatology residencies. They (medical schools) have really done a better job of getting physicians who are basically nerdy scientists, though not always, to learn social skills," he says.

Dr. Tokarek

"Some residencies don't allow moonlighting, but I did a stint in a doctor's office and learned more about business that way — things like how to deal with office staff. Not only do I think residency programs should allow moonlighting, they should encourage it," Dr. Tokarek says.

In Menlo Park, Calif., Jon C. Starr, M.D., went into private practice after eight years in academics.

"I don't think young dermatologists are prepared for the business side of medicine. There's no business education in our residency; that's not much of a mystery. That doesn't mean learning business is hard, but residents don't know they can make these decisions when you don't have any background," Dr. Starr says.

Larry Smith, M.D., has been in Longview, Texas, for 24 years. He says he had a business course during training, but he thinks today's residents are coming out more comfortable with the business end of a medical practice.

"We had, literally, a four-week course on practice management when I finished residency at Tulane. Part of that was because we requested it, and it was more of a packaged practice management program. We got out and knew almost nothing," Dr. Smith says.

Dr. Taylor

Higher priorities

Claudia P. Taylor, M.D., from Portland, Ore., was a lawyer who went to medical school. She doesn't remember any specific business training during the residency she completed two years ago, but she doesn't believe it belongs there, either.

"It would detract from the most important part of the program — the medical training in the science, how to do procedures, and how to read slides. To me, those are a huge priority. You have three years to be in the midst of these great medical minds; I wouldn't want to waste even a moment of that learning about business. The academy has courses; there are online courses and books," she says.

Starting out

On Call asked Dr. Tokarek whether he thinks more extensive business training could make young doctors more willing to take on the challenge of solo and small group practices.

"A lot of people come out of residency feeling like they're not prepared to run a practice. They don't even know what it entails — how to hire and fire people, or even how to buy supplies," he says.

"The question becomes who would teach the course, because in an academic institution not a lot of the faculty have experience dealing with that. It would probably fall to community dermatologists, like me, as volunteer faculty to provide some lectures or some hands-on training," he adds.

As for Dr. Smith, he recalls words of wisdom from one of his teachers.

"Dr. Henry Jolly said to me, 'I would hate to be starting practice at this point in time (24 years ago), because you're facing so many more difficulties than I was facing. But you have one great asset: You're totally ignorant about what you are about to face.'

"I look back on that and think how many more difficulties there are now, with the difference being that residents today are not ignorant," he says.

Karen Nash, a print and broadcast media medical reporter and former TV medical news reporter, has been writing On Call for more than 20 years. Contact her at welshman@sio.midco.net
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