Trim the fat
Fat is associated with excess. We
don't usually think twice about
counselling patients on the
benefits of an ideal body mass
index. Perhaps we should also
start thinking about trimming the fat in
the medical profession. Why? Because
our hospitals and medical schools are not
properly accountable for their budgets.
Money is spent, and things get done, but
how efficiently? Does anyone know?
On the first day of my second year at
medical school, I was surprised to see a
plasma screen flanking the administrative
offices. The screen faced passers by and
showed a PowerPoint slide displaying the
time and nothing else. Why? While working in the blood bank at a university affiliated hospital one summer, I learnt that it
had spent its annual budget for "office
supplies" in six months. Nine members of
staff had spent more than $C10 000
(£4800; €7000; $8800) on brightly
coloured pens and Post-it notes.
In Canada, health care is funded by
taxpayers and the government. Every
dollar that we waste is another dollar that
could have been spent on education, subsidised housing, or other social services.
Considering the limited budgets that are
allotted for health care, especially for public health, and the exorbitant tuition
fees that many medical schools charge,
we definitely have a problem. A study
found that 41% of urology residents did
not budget, and 12% of residents
maintained unpaid credit card balances
in excess of $10 000.w1
Looking at doctors' personal
finances, the problem becomes suspiciously systemic. The good news is that
the healthcare industry has started to
take notice. Some research papers are
starting to focus on "financial health."
One has argued that financial data are
like vital signs - meaningless, unless followed over time to assess trends. The
researcher says that financial health
needs to be monitored regularly and
that, by following predetermined guidelines, problems can be identified early.w2
Good financial common sense is
important to a general practitioner. They
are responsible for patients and the clinic.
But what about hospital doctors? Hospital managers' jobs include managing
resources, but doctors also have a part to
play in the efficient delivery of health care.
A paper in a psychiatry journal has
stated that clinical leaders need a variety
of business management skills. They
need to effectively handle overhead management (for example, buying a new
fax machine), to increase the appeal of
academic programmes (to lure highly
qualified primary investigators), and to
assess economic progress and identify
areas for improvement.w3
The underlying theme is essentially
"sink or swim." We can choose to hide
behind our ignorance and continue to justify our apathy by pointing fingers at managers, but if the boat sinks, we all go down,
patients included. The first step is to identify that an abundance of fat does exist
within the hospitals and medical schools.
Keep your eyes and ears open, and when
you spy something odd, think about ways
in which the situation could be improved
and look for opportunities to tackle the
problem. A small research project at medical school might make a very real
difference for a lot of patients some day.
Competing interests: None declared.
Teresa Pun, third year medical student, University
of Toronto, Toronto, Canada
Email: mephistopheles_03@yahoo.ca
studentBMJ 2006;14:309-352 September ISSN 0966-6494
- Teichman JM, Bernheim BD, Espinosa EA, Cecconi PP, Meyer J, Pearle MS, Preminger GM, Leveillee RJ. How do urology residents manage personal finances? Urology 2001;57:866-871.
- Deas TM Jr. Assessing the financial health of the endoscopy center. Gastrointestinal Endoscopy Clinics of North America 2002;12:229-244.
- Goldberg RJ. Financial management challenges for general hospital psychiatry 2001. General Hospital Psychiatry 2001;23:67-72.
