MD/MBAs: Fixing Hearts & Healthcare

The clinical and business aspects of medicine traditionally have been seen as polar opposites, with MDs monitoring the health of the patient and MBAs taking the fiscal pulse of the institution. More and more, though, cardiologists have turned to additional education to become adept at both—a trend that broadens their opportunities and also may benefit peers and patients.

The second day on the job as chief of cardiology at the medical school at University of North Carolina at Chapel Hill (UNC), Cam Patterson, MD, sat down with an administrator to review the budget. As he recalled, it had a large number at the top, lots of numbers in the middle and glaring red number at the bottom. What he inherited in 2005 was a $2 million deficit. While he was a highly skilled physician—a cardiologist, distinguished professor and director of the Carolina Cardiovascular Biology Center—his medical bag of tricks did not include finesse with finances.

“I realized that I didn’t have the toolset that was necessary to sort out the complexities involved in why a cardiology division, which should be a big money maker, was losing money,” he says.

When he saw an advertisement for the executive MBA program at UNC’s Kenan-Flagler Business School, it spoke to him: Here was an opportunity to learn the business skills needed to steer the program back to solvency. For 28 months, two nights per week, he became a student again, earning an MBA by 2008. “It was one of the smartest things I ever did,” he said. “I would learn something in the evening and apply it the next day at work.”

An MD first

While multiple degrees are not unusual in medicine, they traditionally have involved completing an MD and then tagging on a PhD, or a master’s in public health, public administration or science, additional education that facilitates research in areas such as population studies or epidemiology. But cardiologists appear to be embracing the option of an MBA more often to hone their leadership skills, either by earning degrees sequentially or by enrolling in dual degree programs.

The number of medical and business schools offering dual MD/MBA degrees has burgeoned and is likely to continue on that track, according to Maria Young Chandler, an MD/MBA who heads up the Association of MD/MBA Programs. Based on a 2001 survey of 125 U.S. medical schools, she and her colleagues found that the number of programs had grown from six in 1993 to 33 in 2001 (Acad Med 2003;78[3]:335-340).

Today the count is about 65, “and that is half of all medical schools,” she says. “It is growing every year. I usually get contacted by schools interested in starting programs; there have been about four in the last year and two that have started.”

Chandler founded one of the earliest dual-degree programs at the University of California, Irvine. The program dates back to 1998. The University of Pennsylvania School of Medicine and Wharton Business School may own bragging rights to the oldest program, though, having established a joint MD/MBA in 1970.

Whether a traditional executive MBA or a dual degree, the core curriculum at most business schools likely encompasses similar fundamentals: finance and accounting; teamwork and leadership; management and human resources; economics; leadership development; and marketing. Programs often offer courses in negotiations, communications, innovation and entrepreneurship as well. 

“Business education is far more practical than medical education,” Patterson says. “In medical school, you get taught to pass the boards. That is the No. 1 objective.” The skills that he obtained in business school—such as a whole class devoted to how to run a meeting—were immediately applicable. “Those are really practical skills that anyone who is in an administrative or managerial position needs to know.”

He credits his business education for strategies used to turn the cardiology division around. He looked for opportunities to logically integrate and diversify programs, as well as to create efficiencies and growth. That included merging cardiology, adult cardiac surgery, vascular surgery and interventional radiology into a single unit, as well as launching an aggressive practice acquisition campaign to add private practices to their clinical group. The division is now in the black and profitable.

“We now have 60 new [employed] physicians who are part of UNC's heart and vascular clinical program who formerly were in private practice,” he says. “That whole process relied heavily on the skills that I learned at business school.”

Expanding horizons

In 1994, two decades after he received his MD, William J. Oetgen decided he needed to broaden his horizons beyond his cardiology practice and teaching responsibilities at Georgetown University in Washington, D.C. He considered public policy, public health and even a law degree but settled on the two-year executive MBA program at Georgetown, because it seemed to offer the most possibilities.

Unlike Patterson, he was not motivated by the need to fix an immediate problem. But when he walked away with his diploma, it became clear how he could use his business education. With the help of a colleague who had recently completed a master’s in medical management, he organized a group of physicians with whom he worked to found a large multispecialty group, Maryland HealthCare Associates. 

“I used something from every course in the MBA program,” Oetgen says.

In 2011, the American College of Cardiology (ACC) named him senior vice president for science and quality. The division serves as the ACC’s conduit for integrating cardiovascular research into practice to improve quality. That incorporates developing guidelines and programs, as well as responsibilities related to the National Cardiovascular Data Registry (NCDR).

While the MD side of his brain can evaluate the science in research proposals involving the NCDR and the private practice-based registry PINNACLE, the MBA side can assess the finances, resource requirements and return on investment. “It is not always a financial determination but finances play into it,” Oetgen says. “The MBA gives me a good analytic ability to assess various projects and make determinations based on the resources available and the possible benefits to patients and members downstream.”

Being an MD/MBA not only lets a physician apply business principles in a clinical setting, but it also allows him or her to safeguard the core mission of medicine—to care for patients—according to Chandler. As chief medical officer at The Children’s Clinic in Long Beach, Calif., she strives to reach as many patients as possible and provide them with the best care possible. With her business skills, she can evaluate what strategies offer good value to the eight-clinic nonprofit and make a convincing case to the CEO and CFO.

“No MBA can tell me what is best clinically for our clinics’ patients. They can tell me the business cases, but they don’t have the clinical perspective,” says Chandler, who also serves on The Children’s Clinic finance committee and still practices as a pediatrician. “If you have the clinical insight, then you may make very different business decisions than if you don’t.”

Like Patterson, Chandler sees an MBA offering valuable skills that aren’t taught in medical training. Besides the business basics, some MBA programs include courses on interpersonal skills that are designed to improve communication and collaboration. That knowledge may help in management and team building, for instance.

But does the MBA make an MD a better doctor?

A physician’s enhanced communication skills and self-awareness about his or her leadership style may improve rapport with not only staff but also patients, Chandler proposes; but she adds that many physicians have great rapport with patients without that formal training.

Oetgen and Patterson, on the other hand, take off their figurative business hats before entering the visiting room to consult with patients. They say that their MBA skills play no part in interactions with patients. “I was already a physician for 15 years when I went to business school, so those [patterns] were pretty well engrained,” Patterson says.

Saving time, money 

The next generation of MBAs may not have 15 years of practice under their belts when they enter their MBA program—or even 15 days. Dual degrees are designed to streamline a candidate’s education by integrating the two degrees, which typically shaves a full year off a student’s time commitment and saves him or her a commensurate chunk of change. 

“For the student, the advantage is that this can be done in one package and the saving of a year is quite useful,” says Thomas A. Pugel, PhD, vice dean for MBA and executive programs at the New York University (NYU) Stern School of Business in New York City. Once in school, it is easier to stay in school, he added. “They are not in transition; they are not trying to think about when is the right time, or do I have the time and energy to be able to get an MBA as a second degree.”

NYU, which unveiled its MD/MBA dual degree program in March 2012 and enrolls its first class this year, requires medical students to study full-time for the first three years in NYU’s medical school. The summer of their third year and spring of their fourth year they attend classes at the business school and then return to wrap up their medical education for the summer and fall of their fifth year. They complete the dual degree with a semester in the business school in the spring of their fifth year.

The savings may be substantial. Knocking a semester off medical school could save a student more than $24,000. Full-time MBA students at Stern will pay $28,277 in tuition and fees for one semester, so trimming off a semester will help their bank accounts. 

In 2012, 11 of the 160 students at NYU School of Medicine and several applicants expressed interest in applying for the MD/MBA, according to Steven B. Abramson, MD, senior vice president and vice dean for education. “It has become one of the most popular dual-degree offerings. We will have more students applying than we have capacity to train.” 

Oetgen, who has taught in Georgetown’s MBA program as well, cautions that students who go straight from medical school into business school may be handicapped because they lack practical experience. Pugel acknowledges that limited exposure may be a possible drawback but equates the three years of medical training students will have acquired to the work experience of a typical MBA student. “From our point of view, that makes a lot of sense.”

A brave new world

Some of these next generation of MD/MBAs also will encounter a new focus in business teaching, one that reflects the challenges of healthcare reform and changing payment structures through accountable care organizations and medical homes. “We want to create a generation of physicians who can not only be the MDs in these healthcare systems but also become leaders and understand modern healthcare delivery, which is no longer joining a practice or group practice but is much larger and institutional in nature,” Abramson says.

Recently minted MD/MBAs as well those in the early stages of their studies recognize they are entering a transitional period that may pit limited resources against expanding needs. They say they want to be involved in the designs and decisions that will impact how they practice medicine and the patients they serve for many more decades.

Darien Sutton-Ramsey, a third-year medical student at NYU who applied for the MD/MBA program, says his goal is to fix the system to make patient care better. “It’s not only medical issues,” he says. Patients also may have social and financial problems that need to be addressed to maximize their care. 

Aaron Horne Jr., a cardiology fellow at Johns Hopkins University School of Medicine in Baltimore, who completed his MD/MBA at the University of Chicago’s medical and business schools in 2006, describes this era in healthcare as a critical time. “For people such as myself, there is anxiety surrounding how we will be able to have practice models that are impactful and still financially feasible,” he says.

Horne’s research interests focus on health economics, systems improvement and how to incorporate technological advances into medicine to ensure that they become available to all patients. His business acumen gives him added perspective when choosing and framing research questions, he says, adding that his generation may offer a fresh perspective to the problems that continue to nag healthcare.

“There are a lot of smart people asking these types of questions, but it’s not inappropriate for those of us who are finishing our training to get involved early in our careers to figure out whether there are different models that we can employ that might improve the current systems,” he says.

In five years, Patterson predicts there will be many MD/MBAs who will be at the vanguard of healthcare reform—and who will be a valuable resource for colleagues as they navigate change. In the administrative or policy setting, they may serve as the voice of cardiologists and preserve their clinical priorities. In the clinical setting, they may help lead their peers through the transition and beyond.

“One of the things I have seen,” observes Patterson, “is the physicians who don’t have a business background are looking to people with this expertise to be the conduits to explain what the ramifications will be as healthcare reform rolls itself out.”

Dual degrees & dual careers

When Maria Young Chandler, MD, MBA, unveiled an MD/MBA dual degree program at the University of California, Irvine, in the late 1990s, the effort received criticism for training doctors in work outside the realm of patient care. The fear was that these much-needed physicians would leave the fold for business careers in established or emerging industries.

Her dean argued that physicians contributing to business as venture capitalists or entrepreneurs, if it happened, would be beneficial. In reality, Chandler recalls that they saw few MD/MBA graduates stray from their clinical path.

But that may be changing. "The younger physicians are thinking more that the sky is the limit," she says, as they ponder the possibility of running a business concurrent with practicing clinically.

In an online survey of graduates at 55 MD/MBA programs, the large majority reported completing residency training. Fifty-five percent of the respondents described their first job as being a practicing physician. Another 21 percent were professors or academic clinicians and 16 percent were medical directors or department chairs. The results were published online in 2010 by the Franklin Society, where co-author Joshua T. Goldman, MD, MBA, is president.

Cam Patterson, MD, MBA, straddles the line between cardiology and entrepreneurship as division chief at the University of North Carolina at Chapel Hill, and associate dean for healthcare entrepreneurship, as well as the founder of three start-up companies. He also is executive director of Carolina KickStart, which helps faculty turn research discoveries into biotechnology companies.

"Going to business school made me realize that an entrepreneur is part of what I am," Patterson says. His MBA experience not only helped him to take advancements from his lab—in fields as diverse as software and angiogenesis—into the commercial world, but also to become part of the entrepreneur community and engage in early-stage investments. "I never would have done that without getting over the fear factor that people who started companies had some special sauce that I didn't have."