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Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons
Robert D. Sinyard, MD, MBA1, Anamika Veeramani2, Eva Rouanet, MD3, Roi Anteby, MD, MPH1, Emil Petrusa, PhD1, Roy Phitayakorn, MD, MHPE1, Denise Gee, MD1, Kyla Terhune, MD4
1Massachusetts General Hospital, Department of Surgery, Boston, MA; 2Harvard Medical School; Boston, MA; 3Brigham & Women's Hospital, Department of Surgery, Boston, MA; 4Vanderbilt University Medical Center; Nashville, TN
Background: Surgeons are particularly susceptible to changes to healthcare delivery, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula.
Methods: This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Purposive sampling was used to identify early career (<5 years following fellowship) surgeons. Semi-structured interviews were conducted and de-identified transcripts were analyzed via a constructivist grounded theory approach.
Results: Ten surgeons from six specialties and six institutions were interviewed along with three surgeon administrators. Three major domains of need were identified: (a) fundamentals of procedural coding, clinical billing, & compliance, (b) finding/building a practice, and (c) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire for a primer on evaluating job offers with simulated contract negotiation and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions.
Conclusion: There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program.
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