Transcript of EP416: Why Should Med Schools Teach the Business of Medicine? With Adam Brown, MD, MBA

EP416: Why Should Med Schools Teach the Business of Medicine? With Adam Brown, MD, MBA

You can listen to the episode here.

[00:00:00] Stacey Richter: Episode 416. "Why Should Med Schools Teach the Business of Medicine?" Today, I am speaking with Adam Brown, MD, MBA, 

American Healthcare, Entrepreneurs, and Executives You Want to Know. Talking. 

Relentlessly Seeking Value. 

Now, I'm being pretty careful here because med schools are super sensitive about their curriculums, and I am sensitive to the fact there's much to teach in four years. So throw in no shade here. What do I know from the Krebs cycle?

Choices of what to teach are tough. With that disclaimer, today I am speaking with Adam Brown, MD, MBA, about an article he wrote entitled, "Dear Medical Schools, educate students on the business of medicine. Without it, you are doing your students a disservice."

Let me give you Dr. Brown's list for the why teach the business of medicine.

He says, number one, the role of physicians in medicine has changed. And we dig into this in the episode. Number two, there's an expectation mismatch. Docs are investing 10 years and on average 200 to 300k in real dollars to get that MD or DO. You don't want those new physicians quitting on the quick because the reality is so different from what they thought it would be.

Not being upfront about the business of medicine is like hiding the reality of the situation instead of preparing them. Number three that Dr. Brown talks about. If you don't understand the business of medicine, you do not know how to advocate for yourself, for the profession, or even patients in a way that is compelling to the current set of decision makers.

As maybe a corroboration here, may I just report that I probably have gotten conservatively 100, 150 emails and LinkedIn notes from physicians who say basically some version of the same thing. Thanks so much for Relentless Health Value. I wish I would have learned even the basics of what you cover in med school.

If I had, I would have been able to help myself and help myself help patients far better. Number four, that Dr. Brown talks about, docs are the ones with the prescription pads. Docs are just functionally the gang who are driving costs that patients and employers and taxpayers ultimately incur. Not knowing that how much, or just the whole story here, can inadvertently contribute.

Two, clinical morbidity because patients who fear they cannot afford care do not follow doctor's orders. We should get real about that. Or if they do follow doctor's orders and go into debt, I mean there's just study after study in oncology and otherwise that shows patients who cannot afford their care have worse outcomes.

We cannot hide from this any longer. Number five, the last reason that Dr. Brown gives is that there's lots of things that docs can do besides just be at the bedside. Not giving insight into these alternative paths seems Unfortunate for any doc who maybe wants to mix it up some because they're feeling burnt out or in a different season of their life looking for something more aligned with where they are as a person.

So now let's think about this whole question from the standpoint of the system itself, from the standpoint of doing better by patients. docs the business of medicine? Let's start here. When physicians do not understand the business of medicine, it's harder for docs to get into boardrooms and have their voices heard.

Not teaching the business of medicine in med school might be one reason why there is such a shockingly small percentage of doctors on the boards of directors at major non profit hospitals. Listen to the show with Dr. Sue Haskandy. And why there's so little dyad leadership in the ranks of both clinical and payer organizations, et cetera, and even fewer nurses are in organizational decision making roles, by the way, despite nurses actually being the most trusted profession, even more trusted than doctors.

By 14 percentage points, according to Gallup. One way to interpret this lack of docs and other clinicians in the boardroom is simple cause and effect. Doctors are losing control and ownership, and I mean this in literal terms, of the organizations that run the business of medicine, which controls the medicine of medicine.

Chad Erickson wrote a comment about this on LinkedIn that I thought was great. He wrote, Opportunities for physicians to really control or even impact the 86 percent of healthcare outside of their practice are being reduced every year. We expect doctors to make the decisions and be accountable for patients and outcomes, yet we are taking away their ability to do so.

And going one level deeper here on how not having enough docs and admin roles becomes a snowball rolling downhill kind of downward spiral, I'm going to quote Dr. Jeremy Granger. He wrote, When you are a physician administrator, it can be very strange. There's tremendous pressure from administration to think and act like one of them and give insight into how to best coerce physician behavior to align with administrator determined goals without necessarily involving the physician with setting those goals.

When you advocate instead with your physician hat, you can find yourself ostracized from that administrator clique. You realize they view physicians as knaves. And you as the Judas goat, you either pick a side, or if you're lucky, you land with a team that has physician leaders equipped with equal power as administrators.

So you see what happens. Doc gets an admin role and either chucks their stethoscope and their patient first mindset out the window to fit in, Or they quit, and then we never get to any sort of critical mass of clinicians and leadership roles that would reset the organizational ethos. So here we are, too few mission driven and business savvy docs in boardrooms mean patients get the kind of care they're currently getting.

And at the prices we're all currently paying. From the standpoint of doing better by patient, I hear story after story about some doc who was under the impression that, I don't know, working with a private equity firm to do a roll up of all the specialty practices in a local market was pretty cool and a totally victimless strategy.

Or the surprisingly high number of docs prescribing drugs on that most wasteful spending list, link in the show notes. There's one on that list, for example, that costs taxpayers or an employer two grand when that drug consists of basically two 15 over the counter meds mashed together. And yet there's the impression that the $2000 drug is a better financial choice because there's a copay card and the patient out of pocket might conceivably be less.

Until it isn't, of course because it's not like that additional $1970 in costs suddenly becomes free. Or what happens when a clinician is told to order largely unnecessary MRIs, because workers comp covers everything and no one cares. So this kind of thing continues to just happen, all this stuff. It takes a broader understanding to get the why and create the intrinsic motivation and necessary insight and right language and arguments to make things better.

But all of this is about patience. If I'm talking to margin driven peoples sitting around the conference room table with their calculators, are there any organizational consequences, meaning financial consequences, to not making sure doctors understand business and have a seat at the table? Here's two, there's probably more.

Number one, staff turnover. If that's a concern for any organization now, and if moral injury is cited as a reason for that turnover, which it often is, moral injury doesn't happen when organizational demands are aligned with clinician values. And here's a number two reason. Successful value based care isn't going to happen if docs don't understand the business of medicine. Listen to the show with Eric Gallagher or the one with Amy Scanlon, Larry Bauer. There's like 10 guests who essentially say the same thing. Docs who are in the dark about how the world actually works, IRL, can not be an aligned force helping move past the FFS fee for service status quo and the whole business model that underpins that Adam Brown, MD, MBA.

My guest today is a practicing emergency physician, board certified ER doc. He recently founded ABIG Health, working with healthcare companies on communication strategies and advising investment firms. He's also a professor of practice. At the University of North Carolina, Chapel Hill. Mentioned in this episode is a tweet by Brendan Keeler, also Dr. Denver Sally's very inspirational predictive scheduling work. All these links are in the show notes. My name is Stacey Richter. This podcast is sponsored by Aventria Health Group. Dr. Adam Brown, welcome to Relentless Health Value. Hey, thanks for having me today. Well, it is a pleasure to have you here today.

If we're talking about the teaching of the business of healthcare, let's just start at the very beginning and level set. What does teaching the business of healthcare, teaching the business of medicine mean? 

It's, it's a good question because when I've had conversations with people in the past about it, they'll oftentimes say, whoa, why do doctors need to know how to do accounting?

Or why do they need to know financing? or finance. Why do they need to know marketing? And they probably don't, depending on the type of role that they take in the care of patients after they leave medical school and residency. So it doesn't mean teaching finance and accounting. What it does mean is teaching about the broad industry.

So, key questions or key topics are how is medicine financed? What are the incentives for each of the stakeholders in this industry of medicine? How is medicine regulated? How does a patient encounter get billed? Who eventually pays for that bill? What are the drivers of decision making? What are some of the roles of consolidation in healthcare with payers or with hospital systems?

How do physicians play in this ecosystem? Are we a commodity? And how much do you, as a physician or a clinician, cost the system? How much do you functionally cost, meaning by your salary? But also, what are the things that you do that cost the system money or cost the patients money? These are the questions that I think become really important when I talk about the business of healthcare.

So if we were going to have a syllabus for a business of medicine class that a doc or other clinicians could take, as you just said, it would cover Roles of all of the various entities within the healthcare industry, as you just said, what are their financial incentives? What drives their decision making?

How much do doctors themselves cost? And what is the cost to the system of some of the stuff that they will do or choose? not to do, which all gravitates around probably a central point. What is the global top down view of the whole landscape? And then the doctors within that landscape. But it would be important to understand what the topography is.

Exactly, exactly. I look at it as the four Ps. So it's the patients. You need to understand the patients as a stakeholder. What are their incentives? We need to understand the providers, and I include in that physicians, nurses, uh, as well as hospitals. The third is the payers. So, the government payers, the non government payers.

And the last are the products in healthcare. So, the pharmaceutical products, the devices. And so those are the four key pieces, I think, because once you see that healthcare is not a business like any other business, then you realize, oh, this is why XYZ is happening or this is why I'm feeling this way or this level of frustration.

Most businesses run where you know what the product is. You know what the cost is of the product. You have a general sense of the quality of the product. And you either make a decision of whether or not you want to buy that product or not. But healthcare is very different. The people who are delivering you the product oftentimes have no idea or understanding of what the cost is.

The people who are ultimately buying the product, either directly or indirectly, have no idea of the true cost and whether or not they're going to pay one day one thing or another day the other thing. And what's also different about healthcare is that the product that you're buying, whether that's a drug or whether that's a device or whether that's a procedure or stay in a hospital, you don't have a full appreciation or understanding of the potential positives or negatives of that product.

And I probably should say the last thing is that Within healthcare itself, when you are taking a drug, when you are getting a device, whether that's like a defibrillator or a knee replacement, or you're being admitted to the hospital, good quality products can save your life, bad quality products could end your life.

And so that's where the business that we operate within here in medicine is very different from any other general business. 

Yeah, so in the grand scheme of things, when clinicians know about the business, then they understand why certain things are happening. This helps to bring the medicine back into medicine.

I think that is the point that you're making. And we've talked about this. Quite a bit on the podcast. There's just so much opacity in the healthcare industry, which is becoming financialized. So if we're thinking about the why teach the business of medicine, and if we're just kind of drilling in a more, crystallized kind of way if you were going to come up with a few reasons for just why exactly and specifically is it important for docs these days to understand everything that we just talked about relative to the landscape and the decision making factors that go on, etc. What would the rationales be?

[00:13:55] Adam Brown: I've alluded to some of them, but I think it's, if you look back at some of the things I've said, you can bucket the reasons into four main reasons, probably a fifth, but we'll hit four of them. First one is I think that the role of physicians in medicine has changed and the second is the expectations of physicians are often very different from the reality of what it's like to practice medicine and what you thought it would be like.

The third is being able to advocate for ourselves as a profession, but also more importantly for our patients. And then the fourth is understanding the cost drivers within healthcare because functionally we as physicians are those who are driving those costs. And so just diving into those and you start talking about this, there's been a shift that we've seen over the years with the role of consumerism.

Every night I turn on television and probably I'm making up this number, but 40 to 50 percent of the commercials are something to do with the pharmaceutical industry. Is that necessarily bad? Well, no, that's not necessarily bad. It just means that. Patients have a broader responsibility, but also a broader understanding of what type of potential drugs are out there.

But also that puts a pressure on to clinicians to prescribe certain types of medications. So there's a consumerism piece, that's just an example, but there's also a customer type of piece, which I think most physicians, if we think of our patients as customers, we bristle. But the fact is, is medicine is shifting more into a corporate based economy and market based structure.

And with that means that you have customers. That role of a physician within medicine has shifted and to be clear, I'm not saying that that's a good thing. That's just a reality. Physicians are being commoditized and are becoming more of a commodity within this market. There was just a, an article in the LA Times, which reinforces exactly what you're saying.

And also the, is this a good thing or not a good thing? They had done some survey and the majority of patients with medical debt, and by the way, that's a. Not a small percentage of patients did not believe their physicians had their best interests in mind when prescribing treatments. 

And that's a problem.

That's a big problem because if patients don't believe that a physician has the best interests of the patient in mind, and there's that doubt or that potential that, oh, if the physician writes this medication, they're going to get this kickback from a pharmaceutical company. But if that were the case then that reduces compliance or a patient wanting to take that medication. It causes a lot of doubt and concern with the doctor patient relationship. And those relationships are so vital to improving the health of patients and then, of course, public health in its entirety. So I think the first big reason is the role of physicians have changed.

But that leans in kind of to the second reason that I mentioned, and that there's an expectation mismatch. When I decided, it's kind of a funny story Stacey, when I decided to become an ER doc, and I'm kind of embarrassed to say this, but it was from watching the television show ER. I loved that show. Like, who doesn't want to do a heart transplant in the middle of emergency department?

Okay, that doesn't happen. But that did on the show. What I didn't appreciate was how much health care would change and the administrative burden and the administrative responsibilities that would start to shift over time. And I'm one of the fortunate ones actually in the emergency department that I don't have to do things like prior authorization.

Talk to some of my primary care colleagues and psychiatry colleagues and people from other other sectors of health care. And the administrative burdens that they face are just absolutely enormous. And for me, it's documentation, which is a problem in and of itself. But having that mismatch between what I thought things would be like and what things really are, that, I believe, drives, in some ways, burnout.

It drives... frustration. And then once you kind of get out of residency, you get into a practice, you realize, oh, this is significantly different than I expected. We're asking physicians to invest a significant amount of money a decade of their life to get into a business that yes, they understand the medicine part.

They really don't understand the business that they just invested so much of their lifetime, blood, sweat and tears into. They're investing 200, 000 to 300, 000 in debt. There's a lot of upfront loan money and then there's interest rates. There's a lot of opportunity cost and loss because they're in medical school and residency making less than market rate.

And then they're coming out and recognizing kind of what they were sold is not necessarily matching up. And so I think that's second reason that expectation mismatch is, is a big deal. And we need to be letting physicians know what life is going to be like. And what the world of healthcare is like, it's not like ER, the television show.

Ticking through your first two reasons here. The first one is that the role itself has changed over the years that there's no more George Clooney's doing heart transplants in the ER. It certainly was a different day where doctors had relationships with their patients. But as we move into the future with just the financialization of the healthcare industry, with the advent of patients who for good reasons or not are starting to just trust the industry and are now feeling like they need to be their own consumers because they can't trust physicians.

So you have this kind of confluence of factors, which all adds up to the role changing. And in that mix is the expectation of the clinicians and going into medical school there may have been assumptions of what the role would be. If any of us were asked to invest that amount of money in a business, but we're blinded to what the business really functionally did, then I think we would say that's kind of crazy.

Why would I do that? And that's kind of my point here is that we owe it to future doctors, future nurse practitioners and PAs to truly let them see what is the space that they are working in beyond just caring for the patients one on one because There are all these other type of things that are happening outside of that patient interaction that become impactful on their day to day work.

[00:20:29] Stacey Richter: So let's move on to your number three reason, which is advocate for selves and patients. 

[00:20:35] Adam Brown: So I think that the important part there is that unless you have understanding of the It's hard to drive change if you don't recognize the role that insurance or the role that government plays within the health care system.

How do you know as a clinician, how do you know how to advocate for the profession if you don't know the realities of the patient's insurance plans of their housing situation, the transportation situation, the socio political determinants of health, if you don't understand those and how those drive outcomes.

Then it makes it very hard for you to know what you should be advocating for, what you should be thinking about when you're interacting with those patients. And the fourth thing, I talked about this, uh, very briefly, but physicians are the drivers of costs, functionally. Meaning that everything that happens in medicine, for the most part, whether it's drugs that patients take, whether it's admissions to the hospital or admissions to nursing homes, those things only happen with a physician or a clinician order.

And so a physician understanding the ecosystem becomes important because we are driving costs. Now, I don't mean that again negatively. I just mean that. Things don't happen without a physician's signature. This weekend, I had patients had to transfer to another hospital. They didn't get into an ambulance to be transferred until I signed the bottom of the form.

Did they need to be transferred? Absolutely. But it helps me appreciate knowing all the different players involved in the process of patient care to understand what are the different incentives and what are the different drivers. And outside of those four things, there's really kind of a fifth thing.

And this is something that we don't always talk about in medicine. But going to graduate school, medical school is graduate school, can have another purpose than just providing bedside medical care. And giving physicians a bit of a view of where opportunities may be outside of healthcare becomes important for their own self development and recognizing that they don't just have to practice medicine.

Take my case, for example. I'm teaching, I'm... Doing marketing and communications, seeing those other opportunities of how I can put that medical care to use, I think becomes a really good thing as a preventative to burnout as well. 

Recapping the 4 plus 1 items in your list of reasons why it's so important for physicians to really understand the business of medicine.

We have the roles are changing. We have expectations are changing. We have a necessity if you're going to advocate for yourself or your patients to really understand what the incentives are of everybody up and down the line. Understanding also the cost drivers, which doctors play a huge role in, to your point.

And then lastly, understanding some of the business of medicine could give physicians additional insight into other opportunities beyond just the bedside, which could certainly come in handy as. One contemplates the rest of one's life. Exactly. So if we're thinking about this, though, in more philosophical terms, there was a number of things which certainly struck me as you were talking there.

And again, just speaking realistically about the place that we are, some of this stuff becomes very important. And one of them is, and I'll tee you up here and then ask what your, your thoughts are. But one thing that I have really been noticing, for example, I just was speaking at the Society of Actuaries.

So I was talking to a bunch of actuaries and there was certainly one, I'm certainly I'm not speaking for all actuaries here, but there's a kind of a theme that came out of my conversations with a bunch of actuaries. And it was kind of like, how can we be responsible for the outcome of any of the financial impact on patients of the math that we do?

Because we're just doing the math, but it's the chief medical officer or it's the doctors. We just hand over the equation and then somebody else makes the final decision about what to do. I've also had similar conversations with physicians who are kind of like, I am, insert overwhelm here. And I'm not unsympathetic.

Don't, don't get me wrong. But like, I am just trying to take care of my patients. And all of these other things that wind up happening, just the numbers of individuals with medical debt, 51%, I just saw a study over the weekend of patients say they have foregone or abandoned care due to cost. We have just care gaps.

We have all this stuff going on. And if you talk to any particular group who Inarguably has a huge impact on the overall system, but maybe this is kind of the tragedy of organizational decision making that everybody's feels like they're but a cog in the wheel, just doing their job to the best of their ability, but then nobody has ownership or accountability for what the total impact is of the entire industry on the patients that we serve.

I do believe that you brought up many great points and one of those is that. The way the system is set up is that if we all have our lane of traffic, we all have our silo and we never see anything else that happens in other silos, there's an ability to say, Well, that's not my lane or that's not my issue.

That's not my responsibility. And I think there's a lot of speakers out there that talk about team building and businesses and running good businesses. And I think that most would say that the term that's not my job is a culture killer. Thank you. But yet we are reinforcing that culture in the way that we teach healthcare and the way that we operate the system where we have business people doing one thing, finance people doing another thing, of course those can be together, and then clinicians in another lane completely separate, and when there's not cross talk, there's not cross talk.

So, yeah. Joint accountability, and there's not understanding across those different silos, then I think that's when you kind of revert back or actually have the system that we have today, where each individual stakeholder has very different incentives, and they're not aligned. And so I think that's where if we started teaching doctors about the business of medicine, and we started to Let them see what are the different pieces and parts of the wheel so that they're not just the cog.

We can start to then shape and change and also be a voice of reason at times when incentives get wonky. I think there is a moral and ethical piece to understanding the business of medicine. I written an article about compassion and capitalism. Are the two incompatible in healthcare. And, and I think they are compatible, but they're only compatible if there is a common incentive and a common goal.

So if enough docs or other clinicians see things going on that negatively impact patients or being done for what amounts to pure business reasons. 

If you start to have physicians that understand The business of health care and the business of medicine and the incentives and then you insert those physicians around the boardroom table and make sure that physicians are critical stakeholders where they can not only speak and understand the business practice, but also the clinical practice.

You start to broaden the view of what the outcome should be. You start to speak in such a way and influence in such a way so that that the business and decision makers are. are recognizing the implications of some of their financial decisions or their operational decisions and how the downstream effect is on patients.

And there is a way to start to shift focus so that while still in the stock market, it's not just about profit driving profits, it's more so about Also improving broad outcomes of patients. So teaching doctors the business of medicine gives them the ability to start shaping the system, sometimes from the inside but also from the outside too. And I think that's why for me, I've found it very important for me to be able to speak the language of business and also sit around the boardroom table and have conversations with executives who were not medically trained, but to help focus the way we do certain things so that we're impacting patients in a positive way.

And I hope that as more doctors start to learn the business of healthcare, that they can do the same.

If I was just going to sum up one of the main points that you're making there, it's this idea of making sure that physicians are in the boardroom. That's right. Because then you can have a dyad leadership, which is a new vocabulary word I learned recently where you have kind of this clinical and not clinical, more financially oriented leadership where both can work together to ensure that the business is sustainable while at the same time.

Patient outcomes are superior, that you create a virtuous cycle there, and we don't have that now. I interviewed. Dr. Suhas Gandhi. We spent a half an hour talking about how there is so few physicians on the boards of directors of the biggest nonprofit hospitals in this country. That's shocking to me. Yeah, it shocked me as well.

The most prominent profession on those boards is the finance profession. And here we are. I think another thing really important to mention is the number of doctors, nurses and others who I hear from so often who worked hard. and got into a management or administrative position. And if they advocate on behalf of patients with their fellow administrators, they are treated like a pariah.

A nurse was telling me the other day, she said, it takes two years for a doctor who gets an administrative job to lose their commitment to patients. And this feels like a system problem. You put on that suit and tie and get treated like an outcast when you advocate for patients by your administrative finance peers and by your board of directors with finance backgrounds.

And, you know, it would take someone with a backbone of steel and a trust fund or independent wealth of some kind with no worries about being fired to really stand up to all of that pressure. 

We're getting the system as it's been designed. Something that I want folks to understand is that we are getting what we designed.

The capitalism that we have is not truly capitalistic and it just happens to be right now that a lot of the dollars are flowing back to these vertically integrated large payer networks. Do I fault those organizations for, for that? Not necessarily. I kind of step back and say, Well, we've created this system, we've created a system that's allowing this to continue to happen and we're seeing the results of this not only in the cost of health care in the United States being significantly more than anywhere else in the world, we also are seeing our outcomes and our life expectancy a lot worse than you would expect and in many other places in the world.

As Brendan Keillor put it one time, he said, and I forget exactly what he was talking about, but he said, these companies are willing to perform mental gymnastics and delude themselves of the good they're doing and their lust to make money off of patients. 

I believe the lack of having someone who understands medicine, understands the implications of decision making, financial decision making and financial incentives and regulatory incentives.

I think that is one of the reasons why I'm advocating to put physicians back into understanding the industry in which they operate because not that all physicians are perfect beings and always are on the lookout for patients. Of course, we see bad news stories, but by and large, our reason for doing what we're doing our reason for taking the decade hiatus to educate ourselves so that we could take care of patients.

Like big driver of that is because we do want to help people. We do want to see our patients get better. We do want to see improved outcomes. And so that this completely goes back to what I was saying is that if you've got physicians having more awareness of why things are happening in the world that they operate in, and then you put those physicians back in the rooms with critical stakeholders.

You start to shift those conversations and it makes it a lot harder to make some of the decisions that are made to be purely financial and not without looking at what are the potential outcomes of those decisions. 

[00:33:05] Stacey Richter: Which is especially a powerful and potent statement when you consider that, as per Malcolm Gladwell anyway, it only takes 12 percent of individuals to create a tipping point.

So if we make sure that there's enough doctors in the room who have patient safety, quality, patient outcomes, patient experience, top of mind, then conversations can really start to, to tip in and shift. With that in mind, what's your very tactical advice? So let's just say I am a clinician in the boardroom.

What's some advice, like what do I do? Just keep raising my hand and saying like, hey gang, that's going to not end well for our patients that we serve, like what do you do? 

[00:33:52] Adam Brown: I think number one, taking a broad view is important. Looking at the entirety of the stakeholders that are potentially going to be in that boardroom, just stepping back and saying, okay, if you think of a profit and loss equation, what are the things that are increasing the revenues here at this practice or at this hospital or at this company?

Okay. And you can just go through the list, have conversations with key people around the table, the financial people at the table, the operations people. And you start to see, okay, well, this reimbursement is going up or this reimbursement is going down. This is what's driving the revenues at this location.

Then if you take a look at the expenses, this is the cost of X. This is the cost of nurses. This is the cost of physicians. This is the cost of the facility. And you start to see, then, how does that affect the profit at the end of the day, or the loss at the end of the day. It allows you to have more of an understanding of what are going to be the big points of concern for the operators, the finance people, the executives that are sitting around the table.

You become much more prepared. And having meaningful conversations with them because oftentimes when you are sitting around the table, there may be a singular issue at focus or a singular issue that needs to be discussed or a decision that needs to be made. But those decisions have to be made with an awareness and understanding of the financial environment or the qualitative environment around it.

And so I think that having that very simplistic view of what's driving the revenues, what's driving the expenses and what's the result. is one of the most tactical things that a physician can do. When they're looking at being a part of the conversation of the business at let's say a hospital or at a corporate entity.

And I think the reason that you're saying that is so that if a physician comes up with something that they see as an issue from a patient perspective, patients keep getting sepsis. Patients have 12 hours in the waiting room, like pick something that a physician may be very concerned about. If you just barge into the boardroom and you're like, we got to stop this, you may not necessarily get the reception and the support.

As if you because you're walking in with a problem, so if you can walk in with a problem as well as a solution, it's a lot easier to just say yes, we should do that because I see that you've thought this through as opposed to okay well now let's all sit around and try to figure out a solution to this.

And now you've got finance people doing medicine. Let me give you just a real example that's coming up a lot these days is do we invest in generative AI technology to be added into our electronic healthcare record, okay? Well, if you have a physician walk in and be like this is amazing, this could be great, this could improve documentation and reduce down the amount of time a physician has to Uh, spin documenting and put them back in front of the patient.

Okay, great. That all sounds good. But let's start stepping back and say, okay, what is the expense of that? And then what is the potential savings that could be had from that? Then you have to think about, oh, what are the increased security issues? What are the increased IT issues? What's the integrated costs?

Now, from a revenue perspective, could a physician potentially see more patients? Well, yes, a physician could if their workload is reduced. But physicians are already saying they're burned out. So do we want to add more burden of patient load to them, even though maybe their documentation load is going down?

And so once you start to look at those issues, you see what the potential financial implications could be, whether that's from a revenue perspective or an expense perspective, and better from both, then you're able to have a more, a conversation with the executives who are thinking more so from a financial lens.

And then you're able to overlay your clinical expertise on top of that. So I think that's where it's a real tangible thing that's happening, that's happening right now in many hospitals and are having conversations around this, but understanding the implications of those decisions, the financial implications of the decisions, both on the revenue and the expense side.

And then the downstream operational issues that can happen puts a physician in a better position to be able to address concerns that maybe even the hospital administration hadn't thought about. And so you're able to bring more to the table. So not only a potential solution, but also a different perspective to help change your shape or mold the physician, the decision in a different way.

A super inspirational case study of how this can work in a way that improves financials, patient care, and satisfaction and makes things better for clinicians. I'll link to the work that Dr. Denver Sally did using AI to do predictive scheduling. I'll link in the show notes. Dr. Adam Brown, is there anything I neglected to ask you that you want to mention here?

Well, I think we could have talked a long time about this, but when you are thinking about Should the business of health care or a broad view or a survey of the health care industry, should it take place and when should it take place? Should it take place in the hospitals and medical school or should it take place in residency programs?

We do have to think through that at times there may be some resistance to want to teaching this. There may be resistance because People want physicians to stay in their lane, or they may themselves, if they're administrators of a medical school, not see the need because they're not in the middle of some of these business conversations.

But I do believe that there clearly is a growing need. We just have to remember that even though there may be some reluctance on the part of a healthcare system or a medical school or a residency program to teach this information, we have to recognize that we owe it to our clinicians to give them. a better view of the business world that they are going to be operating in, and it's important for them to recognize as well that physicians can play a very critical role in helping shape the future of healthcare if they're given the tools and they're giving a broad understanding of the environment in which they're going to be working.

So I encourage administrators that may be listening to this, I encourage medical schools and residency programs that may be listening to this. to consider integrating this type of education into their curriculum. Because when I talk with physicians, and even some physicians that are taking my class at UNC, they say to me, Adam, why didn't I get this information before?

I could have used this information. I could have had more impact. I could have worked more closely with the hospital administration on more of these major issues. And so I encourage those who are listening or who have the ability to shape the curriculum of learning to consider strongly adding this type of education into their curriculum.

[00:40:24] Stacey Richter: Dr. Adam Brown, if someone is interested in learning more about your work, where would you direct them? 

[00:40:30] Adam Brown: They can come to my website at abighealth. com or they can check out my bimonthly Column on MedPage Today called "Prescriptions for a Broken System". 

Dr. Adam Brown, thank you so much for being on Relentless Health Value today.

Thanks so much for having me. 

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