In a visionary statement, the deans of ten of this nation’s top medical schools, including four Ivy League schools announced today that they are replacing their schools’ entire 3rd-year curriculum with an intensive year-long course on diagnostic and evaluation and management coding.
“We are have come to the realization that coding is central to a physician’s work day, with estimates that it comprises up to 50% of their professional time, and thus it is incumbent upon us to train our top physicians in this very important task,” said a spokesperson for the group.
He continued: “Moreover, with the explosion of journal articles devoted to this topic and an entire industry of coding consultants developing around it, we realize that our students must master the body of knowledge necessary to become effective and skillful coders and thus deliver top notch care, if not innovators in the field. We hope that eventually we will also be able to offer fellowships in this discipline.”
When asked what the ramifications of deleting all the third-year clerkships might be regarding the training of these young physicians, a dean from one of the participating schools had this to say: “Medicine has simply changed. Doctors no longer need to talk to patients or examine them. Doctors can simply cut and paste from other physicians’ electronic notes and scan patients from head to toe. Why should we train them in these anachronistic skills when what they really need to know is how to code? We need to train doctors for the job they will be doing, not the job their grandfathers did. And the reality is that ICD and E&M coding are so complex that today’s physicians simply don’t understand it. We can no longer justify sending young doctors out into the world without this vital skill.”
Another dean, wishing to remain anonymous, had this to say: “I don’t wish to sound alarmist, but we can’t hide the reality that the entire future of patient care is at stake. If doctors don’t know coding, they can’t document, and according to CMS ‘if it’s not documented it’s not done.’ We simply cannot risk arteries re-thrombosing, cured cancers recurring, kidney stones re-obstructing or newborns re-entering the womb. What kind of medical care would that be?”
When asked if those events themselves would also require documentation, the dean said, “Clearly all health events require documentation. We have been meeting with CMS to determine where the responsibility for documenting lack of documented health events will lie. For now it is unclear if we have the resources to handle this important job, which is why we are advocating creating a fellowship in this field. We obviously need more dedicated research into this crucial area of patient care. We need to train researchers to perform metric analyses to identify correlations between patient outcomes and coding patterns amongst healthcare providers utilizing integrated versus non-integrated EHR’s in acute, sub-acute and non-acute settings both rural and urban. We are behind the curve on this.”
We interviewed students from the same school and the reaction was mixed. Most were glad to be free from the onerous burdens of call and scut work, but many were apprehensive. One aspiring orthopedic surgeon noted: “I just want to fix bones. Can’t the primary care doctors do the documenting? They do everything else?”
The surgery faculty, however, were even less sanguine. One surgery faculty screamed: “Yet another administrative move that shows how out of touch our leaders are with medical education. What the hell do they think 3rd-year students do all day long? Coding! That’s what. Now they get to sit in a classroom and sleep in their own beds every night just so that they can learn how to do something they have already been doing. Meaning I will have to do it myself. Administrative BS, that’s what this is! I may as well go into private practice.”
On a more positive note, a faculty member from the department of psychiatry had this observation: “Perhaps now we find the funding we need to perform the multi-variant analyses to identify correlations between patient outcomes and coding patterns amongst health care providers utilizing integrated versus nonintegrated EHRs in acute, sub-acute and non-acute settings both rural and urban so that we can identify physician and patient biases leading to optimal versus poor healthcare delivery perceptions.”
