As CEO of Health e Practices, Jill Arena brings over three decades of experience in medical practice finance and operations to the forefront of physician leadership development. In a recent Women in Healthcare podcast episode, Arena joins host Adrienne Lloyd, MHA, FACHE, to discuss why financial fluency is no longer optional for physicians—and how administrators can help close the knowledge gap.
Bridging the Financial Literacy Gap in Medicine
Arena’s career began in public accounting, a background she says uniquely prepared her for addressing the financial blind spots that many physicians face. “We don’t teach accounting and finance in medical school,” Arena explains. “And yet, we expect physicians to run practices, evaluate compensation packages, and make capital investment decisions.”
Through her work with the Physician Leadership Project, a year-long program for high-potential physician leaders, Arena dedicates two full sessions to finance. In her experience, even seasoned physicians are often unfamiliar with foundational terms like ROI, overhead, or budget variances.
One reason? A culture of “knowledge shame” in medical training. “Physicians are trained to always have the right answer,” Arena says. “Admitting they don’t understand financial concepts takes courage.”
Making Financial Data Accessible
Arena emphasizes starting at the basics—flipping over the P&L and looking at the bottom line—and building up from there. She recommends creating low-pressure opportunities for learning, such as:
- Brown bag sessions or open forums where physicians can ask anonymous questions
- Pre-board meeting Q&A time
- Sharing financials in advance to allow for thoughtful review
Even better: enlisting senior physicians to ask questions publicly, helping normalize curiosity and reinforce a culture of openness.
Transparency as a Leadership Tool
Arena advocates for full financial transparency among physician owners—and ideally, at a high level, for the entire practice. “When physicians see how thin margins are, especially in primary care, it shifts the conversation,” she says. Rather than having to say no to a purchase request, Arena presents the trade-offs: “You can have the $120,000 C-arm, but that’s a $12,000 cut per partner.”
This framing empowers decision-making and puts the focus on choice rather than denial.
Understanding Payer Mix and Practice Viability
A recurring theme in Arena’s consulting is the disparity between patient equality and payer variability. “All patients are created equal, but all payers are not,” she notes. Medicare and Medicaid reimburse significantly less per RVU than commercial payers, yet many practices aren’t structured to account for this difference.
Arena encourages practices to:
- Analyze cost per RVU
- Balance payer mix
- Equip front-desk staff to understand scheduling decisions through a financial lens
In one anecdote, she shares how an orthopedic group’s decade-long revenue decline was tied to a shift in local demographics—namely, a rise in Medicaid patients in their ZIP code. “They thought it was an 18-month issue,” Arena recollects. “It was a 10-year trend.”
Driving Performance Through Data
From staffing ratios to coding efficiency, Arena relies on benchmark data to fuel performance improvement. She’s seen success using blinded performance metrics at first, gradually moving toward full transparency. “Physicians are competitive by nature,” she highlights. “If you show the data, you don’t have to say much more.”
She also stressed the importance of practicing at the top of one's license—delegating appropriately and focusing time on what only a physician can do.
Building Trust Through Shared Goals
When asked for closing advice, Arena returns to the value of curiosity and humility. “Approach financial conversations like a physician handing you an EKG—you’re not trained to read it,” she says. “Why should we expect them to understand a P&L?”
Creating a culture where questions are welcomed—and where leadership aligns around practice sustainability—builds the foundation for trust, transparency and growth.
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