Why Understanding the Business of Cardiology Is More Critical Than Ever

Illustration: Lee Sauer

For selfish reasons, I've advocated for fellows' business education for years. As a former cardiovascular medicine administrator, I've had many challenging conversations with frustrated physicians over their profit and loss (P&L) statements. Their P&L statements never reflected how hard they were working. Or they did not understand why we couldn't pay them what they had collected.

However, in the current climate, it's even more vital that training directors and mentors arm their cardiovascular fellows and early careerists with basic business principles so that they can advocate for their patients and themselves in an often harsh, competitive and shifting clinical world.

Resources

• MedAxiom and Wharton Online Program: Business Essentials for Cardiovascular Fellows
• MedAxiom and Wharton Online Program: Cardiovascular Business and Management Essentials Program

One in four cardiologists is over 61 years old, and there are not enough fellows-in-training to cover the delta of cardiologists who are slowing down professionally and inevitably retiring. Patients are living longer and are sicker than ever, and patient volumes are increasing in cardiovascular settings. Hospital administrators and providers need to make decisions quicker, faster and more efficiently. Cardiologists should be at the table to help expedite decision-making, especially since the decisions often affect their clinical practice.

I married an interventional cardiologist. It was NOT love at first RVU – quite the opposite. His lack of understanding of the business side of cardiology made me feel like I had job security as an administrator whose focus was business. However, that was not the case, and I learned that lesson the hard way. I now appreciate that the more physicians know about the business of cardiology, the more productive their practices, divisions and departments are.

My husband has also learned that mastering the business principles of hospital and physician practice operations is fundamental to career development for all physicians. “For me, this began with understanding how much the things that we do cost the healthcare system. I began to understand that costs went beyond the acquisition price of devices, drugs and testing and rather encompassed the costs associated with complications and avoiding diminished quality of life among our patients,” said Duane Pinto, MD, MPH, chief medical officer of JenaValve Technology, Inc. “Later, understanding exactly how money flows through physician practices and hospitals allowed me to understand how I would be compensated and to appropriately advocate for myself and others.”

Duane has walked in my shoes as he took on administrative roles in his career, and a better understanding of business allowed him to assess the needs of clinical programs and formulate cogent proposals that went beyond “clinical arguments.” This allowed him to engage in open dialogue that usually resulted in investment in staff and new technology and always led to a greater understanding of the factors in play when these proposals were not accepted. 

While Duane developed this knowledge through time and experience, it’s critical to arm physicians with this knowledge as early as possible in their careers, making tools like the MedAxiom and Wharton Online Business Essentials for Cardiovascular Fellows program crucial to filling the knowledge gap. Programs like this are especially important given the number of early careerists who may have to step into the shoes of retiring physicians sooner rather than later. This knowledge allows physicians in clinical and administrative roles to:

• Build new programs more efficiently.
• Introduce technology into procedural areas more quickly.
• Create meaningful and improved compensation models.
• Be more agile as a team.
• Have meaningful conversations about how to shape the future of cardiology.
• Advocate for patients.
• Advocate for themselves and other healthcare providers.

When the business proposition is not clear, it leads to endless meetings that translate into wasted time. Time is money, and the worst part of it all is that these inefficiencies fuel an unnecessary (and unproductive) animosity between administrators and physicians who should be collaborating. Administrators do not want to be the rate-limiting step to progress, but we are also held accountable for our side of the process. Administrators need to produce business plans, articulate strategy and justify our budgets.

Despite the inherent competition in the field of cardiology, cardiovascular providers and administrators tend to be passionate about their work. My husband and I have learned to appreciate the different perspectives we bring to the conversation and recognize that we are stronger together than we are in opposition. MedAxiom advocates the importance of Dyad leadership for a reason.

It's hard to be an administrator. It's hard to be a physician. It’s even harder and more counterproductive if we don’t work together. Let’s learn from our mistakes and teach newly practicing cardiologists how to advocate for themselves and give them the know-how to leverage their clinical expertise and get involved.