Graham has been keeping up with recent rants in the medical blogosphere regarding the apparent unpreparedness of medical students for the “real medical world,” and in particular how the business side of medicine works. Dr. Wes was the first, expressing his surprise when multiple students he was interviewing for residency didn’t know the difference between ICD-9 and CPT billing codes, or the difference between the numbers 99233 and 99244. (Thankfully he later blames this on the medical schools rather than the students themselves, but still. When I go on my residency interviews, I’m pretty sure I’ll expect it to be more about medicine than about business school topics or how to start up a practice of my own 10+ years down the road. That’s fair, no?)

Kevin MD chipped in with some support of his own, making the rather ridiculous assertion that all medical students should be required to get MBAs before starting medical school. Dr. Pho, I hope you’re joking. After all, I’m sure every MBA program in the country has extensive coursework in medical billing codes, not to mention the fact that most MBA programs won’t let you in without at least a few years of experience working in the business field. I bet MBA programs would love to make exceptions for premedical students and dilute their carefully-crafted class statistics with a bunch of green folks going through the motions of yet another prerequisite just for the chance to apply to medical school. Here’s a better idea: If you people think it’s so important that medical undergraduates know every intricacy of medical billing and starting up one’s own practice, take it to the medical schools. We only know what we’re taught, and I guarantee there are a whole lot of people in medical school who couldn’t care less about what the difference between 99233 and 99244 is, especially when they’re trying to judge whether people interviewing them for residency would be good to work with and under.

Dr. Wes, here’s a tip: You might consider assessing your interviewees in a more direct way rather than giving them a pop quiz and showing off how much more you know than they do. You’ve been in the real world for longer than they have—heck, you’ve been in it, period. They’ll like your program a lot better too, I’ll bet. I don’t ask people I interview for medical school how much they know about how to conduct clinical research or how to intubate someone because they haven’t learned that yet. You shouldn’t necessarily fault them for it, nor should you fault their undergraduate institution or premedicial studies as a whole. That’s why it’s called premedical studies, and that’s why it’s called medical school. And if they have learned that stuff, then great. They’ll be more prepared than the next guy.

I can’t necessarily say whether learning this stuff prior to residency is useful or not. Neither Graham nor I have ever been residents or attendings, so perhaps we’ll come to our senses in a few years (or decades, in my case). Shadowfax jumps in with a more reasonable solution:

It’s not too hard to teach students some universal concepts about the business of medicine. A few lectures on contract law, some talks on professional negligence, maybe a bit on professional liability insurance, the difference between ICD-9 and CPT coding, a primer on various forms of reimbursement and how it is determined, the concept of Accounts Receivable, and some info on the RVRBS and how it relates to reimbursement. You hardly need an MBA.”

Hey, I’m fine with that. If you feel we need to know this stuff to be better at practicing medicine, then some coursework during medical school and/or residency wouldn’t hurt. I sure as hell have never heard of anything that Shadowfax mentions here, but I’m pretty sure I’ll need to have some understanding of it eventually regardless of what I do.