It is often said that healing is an art, medicine is a profession, and health care is a business. In the troubled health system in the US, the challenge has been to make the business as good as the art. This is so although the country has among the world’s best talent in both medicine and business management.
Strangely, the fact that health care is an economic activity that has to be professionally managed is a new realization, in the US and also in other countries. Mark V. Pauly, Professor at Wharton School, University of Pennsylvania, puts it nicely, “A light bulb went off and they realized that health care is a business.”
In response to the need for better health-care management, more and more doctors in the US started enrolling themselves in business schools. There were medical schools and there were business schools the medical students could attend after graduation. However, there were only very few dual-degree MD/MBA programs specifically meant for physicians. Around the late 1990s, doctors could choose from only a handful of joint MBA/MD degree programs in all of the US. But by 2000, the number had increased to 30. Now, medical school applicants can select one of about 65 joint MD/MBA degree programs.
Quite a few dual-degree holders opt for a career in health-care management. An NYT article gives the example of Dr. James S. Kuo, who joined a health-care venture capital fund after completing his medical degree and his MBA. He was later at the helm of affairs at health-care companies, including one in California headed by his wife, Dr. Geraldine P. Kuo, herself a specialist in muscular-skeletal medicine.
Though belatedly, concerns about the cost of health care have become part of the job profile of doctors. Young students and physicians feel that the best way to tackle this worry is to equip themselves with business basics by getting an MBA. A business degree enables them to see the hospital and treatment process from an efficiency perspective that would bring down costs without dragging down quality.
Here’s one example of how an MBA helps, from an article on the website Marketplace. Dan Blumenthal, a Harvard MBA and a doctor training at the Massachusetts General Hospital to become a cardiologist, found that doctors on daily rounds were taking too long to see all their patients, because of which their effectiveness was being compromised. The problem, Blumenthal discovered, was that the doctors were also teaching medical staff during their rounds. So he sat down with his boss to improve the quality of doctors’ rounds.
Doctors with dual degrees, such as Blumenthal, are the ray of hope for the US health-care system, where inefficiencies are causing a leakage of an estimated $1 trillion annually. Not just a few tweaks, a major surgery is required to save the health care system in the next five to ten years, according to Dr. Kevin Schulman, who ran the MD/MBA program at Duke University for over a decade.
Innovation is what Dr. Schulman feels MD/MBAs will bring to the system, as these dual-degree holders will be thinking like entrepreneurs. The system requires them, as the traditional health-care executives have obviously not been able to manage it very well so far. And managing the system well is an imperative if it is not to collapse.
Harvard Business School professor Rob Huckman says process management is now a key area for health-care professionals as much as it has always been for manufacturing executives. More doctors joining business management courses will make medical treatment not only more efficient, but also safer and cheaper.
Developments in the medical field have opened up a number of career options, Maria Chandler, president and founder of the Association of MD/MBA programs and a recipient of both degrees, is quoted as saying in an article in US News and World Report.
Advances in the sectors of biotech, medical devices, medical informatics, data analysis, and population management have increased the requirement of physicians with MD and MBA. Students with MD/MBA degrees can go also into pharmaceutical marketing, hospital administration, or wellness center or medical organization management. They may even be invited to participate in health-care policy-making or help implement a government health-care program. One extra advantage that a MD/MBA program brings to the student is the opportunity for a mid-career move.
For many young Indian doctors in America mulling dual-degree programs, perhaps the search for an idol may end with Vivek Murthy, Surgeon General of the United States. Murthy, an MD from the Yale School of Medicine and an MBA in Health Care Management from the Yale School of Management, is the son of immigrants from Karnataka, India.
Doctors with dual degrees are seen as ideal candidates for the job of hospital administrators, who earn higher salaries than clinical doctors—according to a New York Times analysis in 2014, hospital administrators earn an annual salary of $237,000 and clinical physicians $185,000. A study has found that hospitals managed by doctor-CEOs have done better than those without a physician at the top, reports The Atlantic. Chandler feels doctors cannot become administrators without business training. How will they handle a big hospital budget, for example?
However, Sanjeev Jain, former Merck CMIO and a Harvard MD/MBA, warns students against straying too far away from the medical path after completing the joint-degree program. He says not completing the sequential academic and legal steps in the medical profession could prove to be a big mistake for a student. For example, putting off residencies could rob MD/MBAs of opportunities to do clinical medicine, which is what helps doctors keep in touch with trends in treatment and problems in the health-care system.
In addition to career motivations, students who join MD/MBA degree programs are also motivated to make a difference to health care—from an altruistic perspective, feels Chandler. She says she has seen a rise in the number of students opting for the dual program. About 500 students are estimated to be enrolled in joint MD/MBA programs across the US.
At a time when health care has been beset by business problems, and as hospitals implement the Affordable Care Act (Obamacare), medical students find themselves increasingly wishing that they knew more about business management. They have realized that issues such as team building and budgeting are better handled by an MBA degree holder. Additionally, doctors with joint degrees seem to have more clout in hospital decision-making.
It appears that completing a dual-degree program also brings personality advantages to the graduate. Chandler says that business-minded people who earn their dual degrees become more compassionate, while, in business contexts, they become more ethical, as per the medical creed.
In the past, medical students doing joint MD/MBA programs faced criticism from their peers as they felt that the mission of health care clashed with business goals. They were labelled as “traitors” and seen as distracted from their primary calling. Not anymore, it would seem.
No surprise, but taking up the dual-degree program is not the easiest of academic pursuits. The program is a substantial time and money commitment. It takes five years—three years of medical school, one year of business school, and one year combining both—instead of four for just an MD, and after tuition and other payments for the MD program, the student has to find additional funds for an extra year for MBA, though the introduction of the five-year time frame has somewhat lowered the total cost of doing the MBA part. Moreover, some dual programs do not have the facility of a full internship, and students may well have to experience most of their business-management situations in the classroom.
Can an MBA be done after an MD? Yes, but Chandler says that doing an MBA during medical school gives the student a new perspective, “like you are wearing two sets of glasses all the way through.” Thanks to the MBA, joint-degree students are able to see how things can be done differently as early as when they go on their rounds in the last year of their program.
But despite the benefits that doctors with an MBA bring, there is something, after all, to be said about those who are focused only on giving treatment and care to their patients to the best they can, as they have been taught to do in medical school, leaving management to others. “The world still needs doctors who are very deep and thoughtful about specific clinical problems,” says Jain. “Even though I think the degree is valuable to anyone, I don’t think everyone should get an MBA.”
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