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Dr. Matt Deneke

By the time the average physician hits 35, he or she will have spent three decades or more getting an education. And with a head crammed full of medical knowledge, most doctors aren't surprised to realize that other more practical things get scant attention. Things like practice management.

Dr. Matt Deneke, an assistant professor at UAMS, heads up the "10-Block," a program he describes as a "hodge-podge … everything that the accrediting national bodies require but were missed along the way."

Deneke reasons that medical school may not be the place for practice management, anyway.

"Residency is probably a better forum for that than medical school," he said. "You have such a wide range of options in medical school, you don't really know what you're going to do, but I think (practice management should) be offered as an option in residency training (to) second and third year residents who have a better idea of what they're going to do, and also for the fellows."

Even if it was an option for residents, a practice management course would be difficult to manage.

"You have time restrictions now," Deneke said. "Practice management would be time spent in class and time is in short supply for residents."

So, for now, what training that is made available is offered the last year of medical school?

"The class meets for four weeks, the last week of March and the first three weeks in April," he explained. "It's the last rotation that students take before they graduate … before they start the residency program."

The class is taken by all graduating seniors and features topics as diverse as how to buy a house to bioterrorism.

"We're trying to gear the course more towards internship preparedness," Deneke said. "But we have no formal explanation on how to set up your practice."

Deneke, a Pine Bluff native who was educated at UAMS and trained in Birmingham, Ala., didn't get the training in practice management.

"We had some complaints that we weren't given any training," Deneke said of his time in Birmingham. "If I were to open a solo practice, I would have no clue."

Most of what medical residents or students hear is largely anecdotal.

"The usual response was to get a good office manager," he said. "The mentality is 'I'll hire somebody' or 'I have a friend who'll take care of it for me,' but right now it is learning it on the job."

Truthfully, "There's no way we have time to teach you how to run a business in this short period of time," said Deneke.

That isn't the case for the different subspecialties, though.

"Different programs did it differently; family practice, they seemed to have more, they seemed to do a better job of exposing their residents to different options, particularly practice management," Deneke said of his one-month rotation. "They seemed to have it built into their residency program."

The reality is also that "it's already bursting at the seams, they don't have enough time to teach all the topics relating to medicine. And it's hard to find an area to push in the other information."

When asked what he would change if he could, Deneke said, "I'd like to see optional after-hours kind of courses put in place, something like that, where it would be an option for residents and fellows."



The Flip Side

The contrast between how the medical school and the pharmacy school trains its students couldn't be any sharper.

"Our students take one required course in pharmacy management," said Donna West, RPh, PhD, associate professor at the UAMS College of Pharmacy. "It's required, but you can take hospital management or community pharmacy in the third year of pharmacy school."

West teaches community management, a three-hour, semester-long class often paired with an elective in personal financial management. "I'd say over half of our students take that three-hour class, as well," she said. More students would sign up but, according to West, "not everyone can get in."

Cultural differences play a key role comparing physicians to pharmacists.

In pharmacy, young graduates are more apt to become entrepreneurs soon after graduation, while young doctors rarely nowadays hang up a shingle by themselves.

"Out of last year's class, about 10 of them went to work for an independent pharmacy," West said. "But some of them went to work for a chain and learned the management of a chain and then went on as an independent." Other options include management rotations in the fourth-year of pharmacy school. West added that the practice management is a topic covered in regular lectures and by the various outside speakers.

Even with all of that, West said it doesn't always sink in.

"There's much more concentration on the drugs, drug therapy and patient care," West said of the students studying to pass the accreditation tests. "What we usually hear (from those working) is that they wish they had paid more attention. I get a lot of phone calls every year that start out, 'Dr. West, I remember we did a lecture on … ' or 'Dr. West, I remember you referring us to ... ' So I think they become aware of the resources out there, but it doesn't sink in until (they're) out there." Pharmacy students can also pursue a combination PharmD and MBA degree, and, West pointed out that some students pursue a law degree.

West said the management training "is very practical and very feasible for pharmacists. Regardless of where they go to work, they will have some management responsibilities."



ie.
November 2006

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