The editors, both otolaryngology professors, at Yale University and at the University of Toronto, respectively, attempt to fill a gap in graduate medical education curricula with this practical book. K. J. Lee, author of Essential Otolaryngology, also lectures on electronic medical records and health policy. Yvonne Chan recently coedited Health Care Reform through Practical Clinical Guidelines: Ear, Nose, and Throat with Lee. The editors' goal is to share advice that they received and valued on the topic and to provide recommendations that they wished that they had received. They want to augment graduate medical education for today's future physicians. Although a restructured health care system is noted in an introductory way, the writers also assert that much of that health care system remains unchanged. Thus, issues related to health care reform are not addressed substantively in this book. The contributors seek to provide tools for physicians, not politicians, to lead by understanding the business of medicine and the financial options available.
To lead, one must be educated. Medical education continues to focus on producing quality clinicians but neglects to train doctors in how to practice effective business techniques. Physicians move from an atmosphere where they ask the questions into one where they are expected to know the answers. Doctors graduate with an often unfulfilled need to know about marketing, finance, billing, fee collection, the health insurance industry, hospital administration, contracts, malpractice concerns, salaries, and private practice advantages. In the foreword, Gerald Healy states, “Hospitals will tell you that they understand how to deal with the morass called insurance and thus you should leave it to them and simply work for a salary…They are dead wrong…In this atmosphere, the patient-doctor relationship suddenly erodes” (p. x). The editors admonish readers to be leaders, not followers, and to dispel fear related to considering the possibilities of successful private practice due to lack of knowledge.
The thirty-nine chapters are written by forty-seven contributors, most of whom are otolaryngologists from a range of US and UK academic medical environments and private practice, and representing national professional associations. Also included are residents, fellows, audiologists, nurse, individuals with master's of business administration (MBAs), lawyers, medical and hospital administrators, bankers, and insurance and real estate professionals.
The book addresses the stated scope. In the beginning chapter titled, “From the Eyes of a Resident,” Alisha West emphasizes the essential role of reading for at least an hour per day. (It would have been especially laudable had she mentioned the library or the librarian.) She does not place any focus on learning about practice management. The second chapter jumps right into practice setup. Then the authors return to personal perspectives and practical, detailed advice on early career development from a ten-year practitioner. The next five chapters include similar perspectives from academic practice physicians from early, midcareer, chair, and emeritus contributors. Harold C. Pillsbury III addresses recruiting faculty and planning for succession. The next chapters cover solo practices, transitions to partnership, subspecialty groups, multispecialty groups, hospital-owned groups, and a comparative analysis. Military and Veterans' Administration careers have a chapter. Then the editors supply the key how-to guides on growing, sustaining, and winding down practices. The editors follow with chapters on the value of ancillary services and physician reimbursement. For an international perspective, there are chapters on Canadian and UK primary care and specialty practices. Lifelong learning and maintenance of certification are also discussed, including current options for continuing medical education. The chapter on dealing with health information technology software engineers could be of value to both sets of professionals. The real estate chapter is clearly written to educate on the basics. The chapters on inadequate insurance and long-term care insurance discuss coverage for the physician, the practice, and the staff. The writer on legal entities describes types of corporations and incorporation. Certainly, a chapter on personal income tax planning is essential, as is the chapter on money management. The last two chapters appear to veer away from the business focus, but “Ten Tools to Be a Successful Surgeon” describes time management and proper set-up. “The Art of Listening and Healing” communicates not only the value to the physician-patient relationship of the art of listening, but also touches on patient interaction. Jeralyn Fantarella notes that building rapport is a skill that can be learned.
Although filled with useful tips, this book could benefit from the assignment of topical sections and stronger consistency in editing. Use of tables and bulleted lists are effective when employed. Practically no chapters add references or additional readings, weakening the academic value of the text. Some chapters include checklists and helpful forms. Black-and-white illustrations complement the text. The index includes some cross references.
The two appendixes must be noted. Appendix A, “Common Sense Pearls: Excerpts from Dr. Lee's Lectures as Noted by Dr. Chan,” adds questionable value to the book. Citations have no references at all. Most are common phrases and surprising to read as serious quotations in a published work. Appendix B, “Common Sense Nuts and Bolts of a Usable Robust EHR: Pointers and Pitfalls Overview of ONC Planned Efforts,” also submitted by Chan, refers to “Excerpts from HIMSS (Healthcare Information and Management Systems Society) Presentation by Dr. K. J. Lee on May 1, 2012.” This appendix appears to be the slides that Lee used in the presentation. One source is cited. If the outline offered more detailed explanations, this section could prove of greater use. Appendix B was not related to the chapter on software engineers.
The book is designed as a practical resource and written in a conversational style. Authors include lessons learned from practice. The goal audience is students who are currently in residency and physicians who are interested in starting a practice. The material provides advice related to the authors' experiences but not in any scholarly fashion and not relevant to upcoming changes in health care law. The work is currently available only in print, in a softcover edition.
This title would complement established practice management works, such as the fifth edition of Healthcare Finance by Louis C. Gapenski (Healthcare Administration Press; 2011. ISBN: 978-1-56793-425-0), which does cover key legislation and the implications for physicians in a variety of practice settings, and the even more current American Medical Association Practice Management Center publications. This title is recommended as a non-core addition for health sciences libraries supporting graduate schools of medicine or teaching hospitals, in particular those with otolaryngology practices, rotations, or fellowships.