Business and medicine are two intrinsically interconnected subjects in the modern world; however, today’s medical students are grossly underprepared for the business side. The need for healthcare providers to obtain business acumen has become increasingly important in recent years because of the rising costs of healthcare, escalating pressure to increase profitability while maintaining proper resource allocation, and the desire to improve efficiency and quality of care.(1,2)
Without a clear understanding of business principles, medical students are ill-equipped to overcome these new challenges and may be more likely to experience stressors from all angles in the future.(3)
Avoiding future financial strain is an obvious benefit to medical students who seek business training; however, the advantages extend far beyond finances. Understanding business principles can alleviate medical student anxiety, prepare them for the challenges of running and maintaining a successful practice or career, foster healthcare innovation and initiative, offer opportunities for career advancement, and provide additional training in collaboration and interdisciplinary teamwork.(5,6)
Recent studies have demonstrated that medical students and resident physicians want to learn more about business and have often expressed dissatisfaction with their current education around the business of medicine.(4,7,8,9) Other studies show that medical students feel unprepared to enter the healthcare industry because they lack understanding of the healthcare system.(5,6) The ability to close this knowledge gap does not stem from an absence of interest within the medical student population but rather the shortage of appropriate educational offerings from medical schools.
The current educational offerings that integrate business and medicine primarily consist of dual degree programs (i.e., MD/MBA and DO/MBA). According to the AAMC, there were 97,836 MD candidates as of 2023, and of these students, only 533 (or 0.55%) were also enrolled in an MBA program.(10) The most updated statistics regarding osteopathic medical students come from 2021 data, which show enrollment of 35,177 DO candidates.(11) Of these students, only 213 (or 0.61%) are additionally enrolled in an MBA program.(12)
While the recent popularity and number of these programs at U.S. allopathic and osteopathic medical schools have shown considerable growth, they are not currently available at every medical school.(11,12) Moreover, these programs come with significant financial and time constraints that impose barriers, likely preventing enrollment for some individuals.
Some medical schools and their students have attempted to bridge this knowledge gap with student organizations focused on the teachings of business-related principles. It is currently unknown, however, how effective these organizations are at achieving this goal. In addition, some medical schools invite guests to speak on business topics, but little is known about the efficacy or consistency of these presentations.
Therefore, outside of these opportunities, students who are interested in learning about business are left to seek education opportunities on their own, possibly via social media or reading healthcare-related business resources such as those offered by The White Coat Investor.
The purpose of this study is to capture the attitudes of current medical students regarding their satisfaction with existing business learning opportunities and whether they desire additional opportunities. The data obtained from this study can guide medical school administrators in taking additional steps toward providing business education to their students. Basic healthcare-related business information should be readily available at every medical school across the country.
Methods
To better understand and address these barriers, a brief survey was administered to medical students in their first through fourth years of graduate education (see Table 1). This survey, expanded from an original project looking at before and after survey responses of medical students taking a pilot business and medicine course, was designed to assess their attitudes and perspectives regarding the integration of business and medicine within the educational framework as well as their knowledge of various business principles.(14)
The survey was emailed to a representative of every U.S. medical school, typically the student services coordinator or business organization liaison. Students then received an email from either their school administration or medical students at their respective schools asking them to fill out the survey. Because of a low response rate, a decision was made to post the survey link on various forums, such as Reddit, Student Doctor Network, and other popular medicine-related social media platforms.
The survey remained open for six months and was available on social media platforms for five of those months. Exclusion criteria included individuals who completed the survey without using their official school email containing “.edu,” who graduated from medical school, who previously completed the survey, and who listed themselves as undergraduate students.
The Redcap software was used for the survey questions. Question responses were based on a Likert scale, which is a rating scale used in questionnaires with two levels of agreement, two levels of disagreement, and a neutral choice. For example, when asked how comfortable they were with a certain topic, respondents were given the following choices: very uncomfortable, somewhat uncomfortable, neutral, somewhat comfortable, and very comfortable. Along with a Likert scale, there were also some yes, no, or maybe questions.
Response counts were obtained and then converted into percentages before the analysis of the data. These percentages were then used to compare and draw meaningful conclusions. This study was determined to be exempt from Institutional Review Board (IRB) oversight by New York Institute of Technology College of Osteopathic Medicine IRB under Exemption Category 2.
Results
Five-hundred-eleven medical students from 18 medical schools participated in this survey, providing valuable insights into their prior business education, current knowledge, comfort levels, and opinions regarding the importance of the business of medicine and incorporating this education into medical school curricula.
Of the 511 surveys received, only five failed to meet the exclusion criteria, leaving 506 survey respondents out of the available 133,013 enrolled MD and DO medical students (response rate = 0.38%).
The median age of participants was 26 years. The distribution of respondents across academic years included 146 responses from first-year medical students, 148 responses from second-year medical students, 96 responses from third-year medical students, and 115 responses from fourth-year medical students (see Figure 1).
Figure 1. The level of medical training and region of the United States demographics of study respondents.
A small majority of respondents (55.3%) reported not having taken any business-related courses, such as introduction to economics or finance, before or during medical school. Most responded they had not educated themselves on the business of medicine through books, podcasts, and other sources, with 60.3% of respondents indicated that they did not actively engage in such activities.
Self-Perceived Knowledge of Business Aspects of Medicine
Regarding their perceived knowledge of the business aspects of medicine, the majority of participants expressed minimal knowledge (42.5%). In comparison, when asked about the level of business management knowledge medical students should have prior to entering residency, 73.5% of respondents indicated that either basic knowledge or good knowledge is important. These two data samples in particular show the gap in actual versus desired knowledge. Figure 2 illustrates the recognized deficit medical students perceive in their education.
Figure 2. Actual vs. desired knowledge of medical students regarding the business of medicine.
Comfort Levels with Specific Business Topics
Comfort levels regarding knowledge of broad business topics were assessed among the medical students surveyed. In all the topics surveyed, the majority of medical students felt very uncomfortable.
Specifically, 38.9% of participants felt “very uncomfortable” with medical billing and coding, while 43.9% felt the same way about understanding insurance policies and claims. Furthermore, 50.8% of respondents reported feeling “very uncomfortable” when reviewing employment and insurance contracts, and 45.1% reported the same discomfort regarding life, disability, and malpractice insurance.
When assessing whether medical students perceived these topics on the business of medicine to be important for their general education despite their lack of comfort with them, 73.9% of participants considered them to be either very important or somewhat important. Figure 3 illustrates comfort levels across the various topics.
Figure 3. The percentage of medical students at each comfort level for each type of business topic asked.
Importance of Education on Each Topic
The next part of the study sought to assess the perceived importance of incorporating education on patient insurance types as well as physician insurance types into the curriculum of medical schools.
Regarding education on patient insurance types, 74.7% of participants considered it to be very important or somewhat important knowledge. Similarly, when evaluating education on physician insurance (such as malpractice, disability, and life), the study found that 79.6% of participants viewed it as very important or somewhat important.
Likelihood of Pursuing Business and Medicine Courses or an MBA
Another aspect of the study focused on the likelihood that medical students would pursue an MBA during medical school. A significant proportion expressed interest in taking a simple business and medicine course during medical school (51.4% somewhat likely or very likely), while 53.2% reported being somewhat unlikely or very unlikely to pursue an MBA during medical school.
To further delve into their preferences, we asked if a course or a student-run organization would be better. Would a student-run business and medicine organization on campus be sufficient to introduce medical students to core principles or would a school-sponsored course would be preferred? Participants provided diverse opinions, with 87.5% of medical students surveyed believing their medical schools should have at least one of these forms of representation of the business of medicine on their campus. Figure 4 illustrates the breakdown of the specific responses.
Figure 4. The opinions of medical students on the necessities of a business and medicine course, club, both, or neither.
Conclusion
While this survey had participants from 18 medical schools across multiple states as well as all class years, it is important to acknowledge several limitations of the study. First, the study relies on self-reported data, which can come along with certain biases such as recall bias and social desirability bias. Medical students may have provided certain responses based on expectations of how much they should know or want to know about the business of medicine.
Additionally, the study’s sample size from each medical school was not proportional, potentially leading to uneven representation across institutions. For example, 42.5% of respondents came from the New York Institute of Technology College of Osteopathic Medicine and 18.6% from the Touro College of Osteopathic Medicine, both in New York. This discrepancy may be because the origin of the study was in New York, making it easier to reach participants in that state. The findings may not fully capture the diversity of medical students and their opinions within each medical school as well as across all regions of the country. It is also important to recognize that these results may be influenced by the medical school’s curricular structure, location, mission of the institution, and even bias of professors.
Furthermore, the study primarily focused on medical students’ perceptions, comfort levels, and attitudes rather than objectively assessing their actual knowledge of business concepts. While self-assessment provides valuable insight into the opinions of medical students, it may not fully align with their actual competence and willingness to take courses on these topics if offered. Future research could try to incorporate objective assessments or follow-up evaluations to complement the self-reported data and provide a more comprehensive understanding of medical students’ proficiency.
Considering these limitations, the study still provides a valuable glimpse into the opinions of a diverse sample of medical students from multiple medical schools in multiple states. These findings are consistent with the opinions expressed in publications from attending physicians calling for business education at the pre-graduate level.
The study results emphasize the limited business education and knowledge among medical students. While a significant proportion of respondents have not taken any undergraduate business-related courses and do not actively educate themselves on the business of medicine, there is a recognized importance of business knowledge in the medical field.
Moreover, while there has been an increase in medical schools offering dual degrees to address this recognized importance, the results illustrate the idea that medical students understand their time constraints and are better suited for introductory courses of the business of medicine incorporated into their didactic years rather than full master’s in business administration degrees. Attaining an MBA along with a medical degree adds a great degree of financial and time constraints to a medical student in a field already well known to be extremely time-consuming.
Furthermore, medical students expressed low levels of comfort with specific business topics, indicating a need for further education in areas such as medical billing and coding, insurance policies and claims, employment and insurance contracts, loans and debt, as well as life, disability, and malpractice insurance.
Medical students across all years recognize the significance of having knowledge about physician insurance, including aspects such as malpractice and disability insurance, which are vital for protecting the financial and professional interests of healthcare providers. In concordance with this, a substantial number of respondents expressed interest in taking a business and medicine course during medical school, while the pursuit of an MBA appeared less likely. This strengthens our recommendation that medical schools should consider incorporating education on the business of medicine into their curricula to mitigate the deficiencies that persist.
Opinions regarding the necessity of a business and medicine organization versus a dedicated course exhibited a significant proportion favoring both options to effectively introduce medical students to core business principles. Integrating business education into the medical school curriculum is essential for equipping future physicians with the necessary knowledge and skills to successfully navigate the ever-evolving world of medicine.
It is important to recognize that the impact of business education may extend beyond the individual physician. Physicians who possess business knowledge can actively contribute to healthcare system improvements, participate in policy discussions, and collaborate with other stakeholders to enhance the overall efficiency and quality of healthcare delivery.
The results of this survey also have important implications for patient care. In today’s complex world of healthcare, understanding basic business aspects is crucial for delivering high-quality care and ensuring positive patient outcomes.
For example, a lack of proficiency in areas such as medical billing and coding, insurance policies, contract review, and financial management can negatively impact patient care in several ways.
First, inadequate knowledge of medical billing and coding can result in errors, reimbursement delays, and financial hardships for both the patient and the physician. This can lead to administrative burdens and increased healthcare costs and can turn into a vicious cycle.
Furthermore, a lack of understanding of insurance policies can prevent effective communication between healthcare providers and patients regarding coverage, resulting in confusion, delays in treatment, or even denial of necessary services. This can undermine patient satisfaction, trust, and rapport.
Additionally, a lack of knowledge of effectively reviewing employment contracts may leave medical students and future physicians vulnerable to unfavorable terms and conditions. This can have long-term effects on their career, work-life balance, and financial stability.
Along with employment contracts, managing loans and other forms of debt is a lifelong endeavor, especially with the increasing cost of medical school. Because of this, it is a critical aspect of a physician’s financial well-being. Inadequate knowledge in this area may lead to poor financial planning, accumulation of high levels of debt, and added stress, which can contribute to burnout. Lack of knowledge in each of these areas creates a financial burden on the physician and can then negatively impact patient care by diverting attention away from clinical practice.
To address this deficit, medical schools should prioritize integrating comprehensive business education into their core curriculum. This resolution will address the concerns of medical students while complementing their curriculum with the current landscape of medicine.
While incorporating business education into medical school education is vital, it faces certain barriers. It is well known that medical school is demanding and time-consuming, and there is limited time for additional coursework.
Many administrators may believe the medical curriculum should focus on medical sciences. The above results, however, illustrate that despite being entrenched in medical school, students continue to see the value of incorporating business topics into their education. Careful curriculum planning can create room for vital business topics without compromising any core medical education.
According to the study respondents, a business of medicine course would be helpful if it contained teachings related to medical billing and coding, insurance policies/claims, employment and insurance contracts, and managing loans and other forms of debt.
It is also important to acknowledge the opportunity costs (i.e., time, resource allocation, etc.) and financial costs that come from pioneering and integrating a course in the business of medicine. An instructor who is particularly skilled in business topics would be required, in addition to a platform for the classes, whether that be an online platform or a classroom.
Many medical programs are part of a larger institution that already houses several business degree programs. Perhaps utilizing these instructors and spaces on campus would be a credible solution that would require minimal cost to the university or medical programs.
Doing so may save the programs from having to hire an additional full-time employee, effectively saving thousands of dollars in full-time salary, employee benefits, and more without sacrificing quality in instruction by relying on medical professionals to teach the business course.
Future research could explore the long-term outcomes of medical students who have received business education, including their career trajectories, job satisfaction, financial well-being, and contributions to healthcare systems. Such studies can provide valuable insights into the lasting effects of business education on medical students and inform curriculum development efforts aimed at equipping future physicians with the necessary business skills for success in their careers.
As the world of medicine continues to evolve so should medical education.
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