It's a long-standing truism that many physicians are poor businesspeople. An early lesson of the TransforMed national demonstration project has been that even among the carefully selected participants, many offices had serious deficits in business management.

On the other hand, many family physicians are doing well financially.

What makes the difference? Family physicians are not often well prepared to be good business managers; they make errors both in failing to get paid for all the work they do and in failing to manage their expenses as carefully as they should. Their practices are just not businesslike businesses. Why does this occur, even though business management has been a required part of the family medicine residency curriculum for a long time? It is because this curriculum doesn't do the job we need.

The present curriculum isn't useless. Instead, its problem is a matter of timing. Family medicine residents are focused on learning how to be good doctors, not savvy business managers. Why? Because to succeed in residency, they need to know medicine, not business management. Most do not yet know what the setting of their first job will be. They do not want to clutter their minds with business tools they can't use and can't even appreciate the uses of. Like all adult learners, they do not learn well when they do not see good reason to learn.

When do new family physicians become motivated to learn at least the basics of business management? Most often it's when their noses bump into hard reality: when they seek to keep an office afloat, when they are trying to puzzle out their employment contract, and when they have to start paying back their medical school loans.

Why not teach business management then – when the need becomes acute? What if our specialty, led by the AAFP, offered a business-management curriculum designed not for the resident but for the new physician?

Making it work

The Academy could develop a structured, hands-on, practical, business management curriculum designed as an after-residency activity. Participation would be expected but not required.

The curriculum could include some in-person classes, enduring materials, reading lists, facilitated webinars or teleconferences, and several small independent-study projects related specifically to the individual physician's practice circumstances. The AAFP has already developed a lot of pertinent materials that could be excellent starting points and resources for the curriculum: the “From Residency to Reality” curriculum, the “Practice Management for the 21st Century” course, the book On Your Own: Starting a Medical Practice From the Ground Up, the “Practice Enhancement Forum,” a wealth of articles from FPM and probably more.

The in-person portions could be delivered through residency programs. Teaching is an obvious strength of residencies; for this business-education program, the students would be new physicians who live near a given program, irrespective of where their original training occurred. This would help to develop relationships between recent graduates and nearby programs, and it might even encourage more new physicians to participate in precepting or community teaching.

A “train the trainer” process would be required to equip residency faculty to do the teaching and mentoring. Training some successful family physicians to teach within the planned curriculum could enable them to transmit the business management skills they have acquired to new physicians – a win-win enhancement. A fee structure could be developed to cover faculty compensation and other costs of making this a self-sustaining business model.

What goals would be accomplished?

• The new physician would far more easily see the relevance of the content to his or her situation and be better able to make immediate use of the material.

• The program would strengthen the expectation that learning continues after residency.

• The value of residency programs would be broadened beyond their traditional scope.

• The AAFP would have another coup in providing a needed and valued member service.

I freely acknowledge that this is the barest outline of an idea. It needs refinement and careful feasibility assessment. I set it forth to get your input. What do you think?