A Curriculum in Medical Economics for Residents

Objectives: In today's changing marketplace, it is increasingly difficult for physicians to be both effective clinicians and practice managers. The plethora of insurance and reimbursement plans, with their confusing language of acronyms and abbreviations, intimidates most practicing physicians. However, understanding the various plans is critical in enabling resident physicians to successfully navigate the medical marketplace and make informed career decisions. To develop residents' understanding of the current American health care system, we created a curriculum to introduce the principles of medical economics. Description: At the University of California, San Francisco, the UCSF-VA PRIME program instituted a series of seminars in health economics, taught by local experts in the field. Residents were given a syllabus of articles before each class, and they were expected to participate actively in each of the seven 90-minute seminars. The topics covered were (1) an introductory history of American medical economics and the development of work-based health insurance; (2) how government-sponsored health care systems (Medicare, Medicaid, and the VA) developed, who qualifies for care, and what problems may arise with funding these programs; (3) the creation of Blue Cross and Blue Shield, and their prominence in the current health care system; (4) medical reimbursement programs (including health maintenance organizations, preferred provider organizations, and independent provider organizations) and variations on these systems; (5) single-payer plans, using the Canadian health care system as a paradigm and assessing how its implementation in the United States would affect American medicine; (6) health care quality; and (7) the role of legislation and government in medical policy, using the failed Clinton health care plan as an example. There were three types of interactive seminars. Most commonly, questions based on assigned readings acted as starting points for discussion. Some seminars were case-based. One particularly effective session on the topic of health care quality used role-play exercises where different seminar members depicted practitioners, clinic managers, and health plan representatives to illustrate different perspectives of the same problems. Discussion: Our residents reported a high degree of interest in and enthusiasm for our pilot curriculum. Dynamic seminars with leaders who promoted discussion by direct participation, such as during the role-play exercises, were the most successful. Interestingly, however, the reading assignments were less effective, since residents were unlikely to read long, dense articles. The most highly rated readings were the medical economics features from The New England Journal of Medicine, as they seemed the most concise and accessible. We feel that, with continued revisions and by creatively increasing interactivity in each session, this innovative curriculum meets important educational needs of our residents, and that it is easily exportable. Long-term outcome assessments include rating residents' abilities to become successful patient advocates, participation in research or fellowship programs in health care quality, and future career development into leaders in health economics and policy.

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