I found myself rushing again to the surgical floor at the Veterans Affairs hospital in San Diego. Upon entering the ambulatory surgery unit, I glanced at the monitor and saw my resident and attending surgeon’s name listed for two laparoscopic hernia repairs this morning. “Easy peasy,” I said to myself. Immediately, I logged onto the electronic medical record system. After reading up on the patients’ medical histories and other data, I had a good understanding of their health statuses. However, reading numbers and words is never enough to get a clear picture of a patient’s story, so I found the first patient’s bed and introduced myself. “Hello, my name is Olu, and I am the third-year medical student working with you today.” We spoke for a bit about what the patient did for a living and how the hernia was discovered. This suggested possible causes and gave me a good sense of the patient as a whole. Once I finished with the patient, I went to the workroom and cracked open Surgical Recall to prepare for the questions I was soon to be “tested” on in the operating room.
Once I entered the operating room, I saw the patient lying on the operating table completely covered in sterile blue cloth with only the lower left quadrant of the abdomen exposed with skin markings. The nurse said, “Timeout!” At this point, they listed the patient’s name, diagnosis, surgical site, chronic diseases and other things on the pre-surgery checklist. Minutes later, the attending surgeon exclaimed, “Scalpel!” He pierced the skin at an angle, creating a perfect opening to insert the surgical instrument. I stood there and watched attentively every move the surgeons made and I was ready to assist in any way I could.
In the middle of surgery, the surgeon said, “Well, they have another hernia on the right side.” Then the attending surgeon asked me, “Olu, what should we do? Operate on the two hernias now, or schedule a separate operation to repair the right hernia?” This is when putting on my management hat was necessary. I thought to myself, the obvious answer was to schedule a separate surgery, because we did not get the patient’s consent to operate on the right-sided hernia. That is exactly what I told the attending surgeon, and he said, “Yes, currently that is my only legal option.” However, is that option cost-effective? We must consider the cost of the surgical consultation, physician visit, surgical equipment, and surgical team labor. It doesn’t make financial sense to reintroduce these costs when we can save at least $7,750 if we operated on both hernias at that moment. In addition, we could also reduce the burden on the patient by avoiding scheduling additional doctor visits and a second operation. On the other hand, doing unplanned surgery can introduce a host of legal issues. For instance, there is always the risk of surgical error, which is more likely when additional sites are being operated on. Overall, it is crucial that, as physicians, we do what is best for our patient and, as businesspeople, we strive to sustain our health care system. At the end of the day, health care is about serving the patient, hence every business decision we make as health care professionals must be in the best interest of our consumers.
The Business of Health Care
The inner workings of the health care system are what medical schools don’t teach. When I applied to medical school, I knew I wanted to have a role in addition to a physician. Management caught my eye once I started my third-year rotations. My experience during the hernia repair expanded my mind on how critical the operations behind hospitals are in promoting effective and efficient care. Also, how that transcends into health care costs and how health care settings are eating up so much of the federal budget, partly because their methods of practice aren’t efficient. I then became curious about what I could do to provide efficient and effective care to communities that need it the most. In addition, how could I help combat these excessive health care expenditures so that the federal budget can be used more resourcefully?
Therefore, I applied to Johns Hopkins Carey School of Business to pursue a degree in health care management. I chose Carey because the curriculum focuses on business in medicine and the influences health care institutions have on the community. My experience so far has taught me that there is so much value when a physician is not only an expert on operating or creating a good differential diagnosis but also able to understand the mechanics of medicine. It is very necessary that physicians develop skills in business and leadership, especially with new payment models such as value-based payment schedules being introduced. Commonly, physicians are paid based on the services that they provide; however, this new payment schedule takes into account certain quality metrics. Are the physicians actually doing their jobs? Are they managing their chronic diabetes patients properly?
I took a particular interest in the physician payment schedules after learning about them in my health care management courses. Provider payment method is a part of the business in medicine that physicians should actively learn and advocate for. There are many other sectors in the business of medicine, such as operations, accounting, safety, and community outreach, that physicians should be engaged in.
Throughout the first semester of my program, I have taken in the knowledge that will be applicable upon my return to medicine. I can say that I am comfortable advocating for change in a hospital setting and creating alternate options to solve operational issues. I can use the knowledge I have acquired, such as human physiology, patient autonomy, health care laws, and health care services improvement strategies, to develop new strategies that allow care to be more efficient and effective so that we are using health care dollars wisely.
Looking back at the hernia repair, a business-minded physician would take initiative to propose a new approach in surgery consultation. What can we do as a health care facility to cut costs and save resources in case this were to happen again? What are some of the legal implications? How can we create a better experience for the patient? Asking questions like these is how physician leaders can stimulate change to push health care in the right direction.
This post originally appeared on January 30, 2019, on the Biomedical Odyssey blog from Johns Hopkins Medicine.