Knowledge of Business Practices in Healthcare: The Overlooked Non-Technical Skill in General Surgery Residency Training

General surgery training has undergone significant change over the past few decades. Technical innovation has prompted residency programs to accommodate with adjustments to curricula (e.g., laparoscopic and endovascular training). Similarly, the non-technical aspects of surgery practice have been increasing in complexity with stricter coding compliance, growing liability concerns, and decreased reimbursements (1). The lack of a formal training curriculum places general surgery graduates at a disadvantage for success in future practice, translating to difficulty in transitioning from residency to the attending role (2). Despite this, a majority of general surgery residents and attendings do not receive adequate training in these areas; however, there clearly is interest. A recent survey found that 87% of surveyed program directors believed that general surgery residents should be trained in business and practice management (3). Additionally, a survey of all general surgery graduates in the United States, from 2009-2013, indicated a desire for more training in all areas of practice management, particularly, medical coding, contract negotiations, practice management, and insurance billing (4).

In the past decade, there has been an increase in the incorporation of business and practice management curricula in general surgery residency. This is less the case for other aspects of the business of healthcare. There are, however, some examples of curricula in various general surgery residency programs across the country as well as other related specialties (e.g., plastic surgery, orthopedics, obstetrics and gynecology, and radiology). By conducting a literature review, we intend to identify and emulate best practices and incorporate novel experiences for general surgery residents at the University of Hawaiʻi (UH).

References:
1. Fakhry SM, Robinson L, Hendershot K, Reines HD. Surgical residents' knowledge of documentation and coding for professional services: an opportunity for a focused educational offering. Am J Surg. 2007;194:263–7.
2. Napolitano LM, Savarise M, Paramo JC, et al. Are general surgery residents ready to practice? A survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg. 2014;218:1063–72.
3. Lusco VC, Martinez SA, Polk HC Jr. Program directors in surgery agree that residents should be formally trained in business and practice management. Am J Surg. 2005;189:11–3.
4. Klingensmith ME, Cogbill TH, Samonte K, Jones A, Malangoni MA. Practice administration training needs of recent general surgery graduates. Surgery. 2015;158:773–6.