What they did (and didn't) teach you in medical school

On Call talked to dermatologists around the country to find out how they feel about their training. If you could go back today and redesign your medical curriculum, how would you change it? Are there courses you would add; or were there courses that made you wonder why you were wasting your time?

Mixed results

One doctor contends today's students are getting off easy, while another thinks the training should be shortened and perhaps more specialized.

But the most commonly desired course among dermatologists who spoke to On Call was, perhaps not surprisingly, the one named by Anthony M. Janiga, M.D., from Napierville, Ill.

"I know a lot of older surgeons and doctors, whose office managers basically swindled them because they just weren't able to understand what to look for. Obviously, I think I went into medicine for all those good, altruistic reasons, but the reality of it is that you also have to make a living and put food on your table. You need to know these things in order to have a successful practice."

In Tucson, Ariz., E. David Wright, M.D., is a dermatopathologist who decries the lack of any business-related courses during his training, too.

"I understand some business courses have been introduced into some of the residency programs, but I would think courses in contracting and dealing with insurers would be an absolute necessity," he says. "Unless you have a background in business, one is in for a rude awaking when one comes out and begins to negotiate with all of these companies and deal with all of the regulations."

Dr. Wright thinks business should be more important during training than a seminar offered sporadically.

Still in her residency, Jennifer Janiga, M.D., already wishes she had more business background during medical school.

"I'm already finding out that I needed more business training, absolutely," she says. "You're involved in coding and billing and reimbursement issues from the beginning of residency and you really get zero training on that in medical school."

Dr. Janiga says she's learning things now in her residency at Henry Ford Hospital in Detroit, but that it's really coming after the fact.

"My residency program has a lot of sessions to try to keep us updated, but I wish I had been prepared for the fact I would be dealing with this on the very first day of residency. Most people go into practice without any business experience whatsoever and find that they are not just seeing patients anymore; they're running a business at the same time, and they have to be able to do both."

Other problems

In Northbrook Ill., Peter S. Hallarman, M.D., agrees that the lack of business courses is a problem in medical school curricula, although not the only one.