Medical Residency Compliance Training: Where Art Thou?

I recently had the opportunity to present a compliance program during Grand Rounds at a internal medicine residency program. My one-hour program provided a compliance and regulatory overview and illustrative cases on the Stark law, Anti-Kickback Statute, False Claim Act, and other current topics. Judging by the questions and comments I got from both attending and resident physicians, my program was well received and more than overdue. That’s not surprising since mine was the first compliance program ever presented in the residency. Not surprising but disappointing.

I have been a doctor’s lawyer and compliance professional for most of my nearly quarter-century long career. On top of that, my spouse is a physician, and we have been together since she was an undergraduate dreaming of becoming a doctor. And although she attended an excellent medical school and received outstanding training in residency (she actually almost completed two), she got no compliance training in either. In my own professional journey throughout healthcare, including working with various medical schools and residencies, I have also seen little to no attention paid to formal compliance training.

When it comes to compliance and medical education, nothing has really changed over the last 25 years. Except everything. Fraud, waste and abuse, committed by and involving physicians, has been front page news for years. The government continues to trumpet its ever-increasing enforcement efforts and successes (specifically False Claim Act case recoveries) which, though return on investment peaked at over seven dollars per one invested just a couple of years ago, now still returns four dollars to one. We are in the midst of an opioid epidemic, declared a national emergency. The list goes on.

So, although the regulatory complexity and legal risk of medical practice has only steadily increased, and compliance training is a clear, proven method to manage or at least mitigate this evolution, there is still no serious formalized compliance training at the vast majority of residency programs (or medical schools, for that matter). And the numbers are not small. The latest ACGME numbers (the Accreditation Council for Graduate Medical Education, which oversees specialty residency programs) count 11,000 training programs with a total of 137,000 residents in 31 specialties and 114 sub-specialties.

The lack of meaningful compliance training programs in residencies is not only disturbing. I would characterize its absence as a major failing in a modern, responsive medical education process. In my own experience, physicians routinely wonder, worry and openly ask about compliance issues. The area clearly deserves serious attention.

At the outset of my recent program, I said “no patients would be cured because of what I was teaching.” “But,” I quickly added, “what you learn here today may save you and your practice or institution a lot of headaches down the road. In fact, the knowledge you gain could potentially save you, another doctor or even an entire organization, from ruin.” So I guess I was wrong. Patients will certainly be helped, at least indirectly, by carefully safeguarding their physicians’ ability to practice and the longterm stability of the healthcare organizations they rely on.

I know that we can do better. I challenge everyone involved, including those working at medical schools and residency programs, as well as my own compliance colleagues, to do more. More to ensure that all medical residents, and even medical students, receive at least basic compliance training during the course of their education. In whatever form that may take, whether a single overview session at the outset, and/or another one right before completion, or periodic sessions throughout a program. Any training is better than what most residents receive now.

Reid Pearlman is a lawyer, compliance educator, and Consultant/Principal of True Compliance Consulting, LLC. He welcomes inquiries about compliance training programs for medical students, residents, or any other healthcare professionals (whether still in training or already in practice). Reid may be reached at Pearlman.reid@gmail.com.