(136) Knowledge Gaps in Business of Medicine Topics Among Obstetrics and Gynecology Fellows: Survey Study

Background: Physicians in training report high levels of interest in business of medicine topics including contract negotiation, practice management, basic economics, and personal finances. Despite this, many medical residency and fellowship programs lack formal business education. The purpose of this study was to identify knowledge gaps in business education among gynecology fellows.

Methods: An anonymous online 35-question survey was distributed to gynecology subspecialty fellows including pediatric and adolescent gynecology (PAG), minimally invasive gynecological surgery (MIGS), and reproductive endocrinology and infertility (REI) fellows from 2022- 2023. The IRB approved survey contained seven demographic questions, four questions assessing current debt burden and prior financial education, as well as Likert-scale questions measuring fellows’ comfort level with various business of medicine topics.

Results: Of the 483 fellows who received the questionnaire, 159 completed the survey, resulting in a 32.9% response rate. A total of 80 REI fellows (50.3%), 47 MIGS fellows (29.6%), and 32 PAG (20.1%) fellows completed the survey. Over half reported debt from undergraduate or medical school (52.2%). Over half (58.5%) reported zero hours of finance education in their residency and fellowship training. Almost all (99.4%) believed business aspects of medicine should be incorporated into medical education. In general, fellows reported relatively high levels of confidence in personal finance topics, including financial planning for the future (57.9%), purchasing a home (63.9%), and life and disability insurance (57.2%). Conversely, a large portion of fellows reported feeling “not at all confident” in business topics related to the field of medicine, including contract negotiation (24.7%), non-compete clauses (27.1%), relative value units (RVU)-system based pay (32.0%), general office practice management (58.2%), legal aspects of business (71.8%), accounting and billing (54.4%), and marketing (55.7%).

Conclusions: Our study demonstrates that gynecology fellows are interested in learning about the business of medicine but ultimately have poor self-reported familiarity with topics in this area. Fellows’ self-reported knowledge on contract negotiation, non-compete clauses, RVU-based systems, and coding and billing is particularly low, despite the importance of these skills in independent and academic practice. Formal education on loan management is also warranted, given the burden of educational debt in this population. We hope the framework provided in this study can inform future efforts for financial education among obstetrics and gynecology fellows.