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For physicians in search of an edge, MBAs are an answer

While some want to avoid mistakes that colleagues have made, others are looking for a new perspective

From the March ACP-ASIM Observer, copyright © 2003 by the American College of Physicians-American Society of Internal Medicine.

By Gina Rollins

Michael A. Patmas, FACP, first thought of enrolling in business school shortly after he sold his group practice to a health system. As his new employer "destroyed" his practice over a four-year period, Dr. Patmas vowed he would never find himself in such a bad situation again.

The Portland, Ore., internist said the health system made a series of blunders. It refused to accept cash payments from patients at the time of service. It advertised for new patients, even though the practice was so overbooked that new patients were waiting three months for an appointment.

By the time Dr. Patmas earned his degree—a master of medical management—it was too late to save the practice. "It wasn't worth buying back when they were through with it," he recalled. Even so, he said the skills he learned have changed how he views the practice of medicine—and have opened up new opportunities.

Management training for physicians, he said, is the cure for what ails the business of medicine. "The task of doctors today is to figure out how to deliver care within the constraints of the marketplace," Dr. Patmas explained. "Management training allows us to respond with an entrepreneurial mindset."

While that kind of talk might have been anathema to physicians 10 years ago, medicine and MBAs are no longer strangers. A survey conducted by the St. Louis-based recruiting firm Cejka & Company for the American College of Physician Executives found that between 1999 and 2001, the number of physicians who have an MBA or other business degree increased 23%. The number of physicians who have a master of medical management degree doubled during that same period.

Even as the number of physicians getting business degrees is rising, the age of many of these students is going down. Experts say that more young physicians are seeking business training, and they're not necessarily getting a new degree as a way out of clinical practice. Instead, experts say young physicians want to play a bigger role in the business of medicine.

Putting a degree to work

Physician executives may view a business degree as a feather in their cap, but some doctors say that those who remain in the trenches of patient care can use their business training on a daily basis.

"A decade ago, just about any inefficient practice could still have relatively good income," says Scott W. Yates, FACP, president of North Texas Medical Group, a six-physician internal medicine practice in The Colony, Texas. "Now, a relatively efficient practice can have stagnant income. Doctors can work harder and still see others with less training make more while working less."

Dr. Yates said he initially viewed a business degree as one way to avoid making the same mistakes he had seen during training. "I did my residency in a private practice and I saw how the doctors dealt with day-to-day business issues," he explained. "They weren't too good at handling them, and I knew I wouldn't be either. I realized I needed a different set of skills that aren't intuitive and weren't part of my medical training."

Dr. Yates said that his business training has helped him critically look at accounts receivable and other financial statements, for example. "I don't think anyone could embezzle funds" from my practice, he explained. While he doesn't do his practice's books, he knows enough to work with his accountants—and make sure that everything is above board.

Andre Chen, MD, a family physician at Austin Diagnostic Clinic in Austin, Texas, said his MBA training has helped him take a more active role with high-level tasks like budgeting. But just as importantly, he said, his training has helped him in more subtle ways. By incorporating tips from classmates who worked as engineers to streamline manufacturing processes, for example, Dr. Chen said he has a better handle on his day-to-day workflow. He even keeps his in-box empty.

New perspective

While business school provides tangible skills, many physicians say their training has given them a much-needed change in perspective.

Orly Avitzur, MD, a solo-practice neurologist in Tarrytown, N.Y., learned a hard lesson about physicians' approach to problem-solving early in her MBA coursework. During a group exercise, she and her teammates were asked to replicate a model of a human being built out of Lego blocks. Soon after her group got down to business, however, her teammates booted her from the room.

"The team began to analyze strategies and assign various tasks," Dr. Avitzur recalled, "and I kept thinking it was a ridiculous waste of time. I thought the only way to do it was to go out in the hallway, look at the model and build directly from that."

When she stepped out into the hallway, she was surprised to find that other physician-students had also been exiled from their teams. "We had this cut-and-fix mentality, a sense of urgency that doesn't allow time to contemplate strategy," she explained. "The lesson I learned was that the thinking process involved in seeing patients is quite different from what you need in business."

Richard Boss, MD, a cardiologist in Concord, N.H., compared his business school education to leadership training. Management training, he said, "helps you learn about yourself and what you'd like to do." In his case, earning a master of medical management degree helped him realize that he'd rather serve as a mentor to other physicians than actively pursue a career in management himself.

Intensivist Michael Apkon, MD, said that his MBA training gave him a different take on medicine that allows him to see many sides of a problem. "I think an MBA helps physicians understand and find solutions to pressures in their environment," said Dr. Apkon, who is associate professor and vice chair of pediatrics at Yale Medical School and co-director of the pediatric intensive care unit.

Although Dr. Apkon earned an MBA primarily to better manage the pediatric intensive care unit, he said his new degree may one day help him move out of patient care. While he said he doesn't relish the idea of leaving clinical practice, he considers it inevitable because intensive care work is so physically demanding.

In some cases, a business degree can lead to totally unexpected new pathways. While Dr. Chen was working on his MBA shortly after residency, he took a course that involved writing optimization algorithms for the airline industry. That work and other courses inspired him to develop a coding and clinical software company, StatCoder.com.

"I never would have done it without business school," he said. "You never know what you'll learn there that may have nothing to do with your practice."

The best degree?

Which type of degree or program is best for you? Besides the traditional MBA, there are also programs to earn a master of medical management, a master of health administration and a master of public health with a concentration in management.

Physicians say the choice ultimately comes down to personal preference. Drs. Chen and Yates both pursued traditional master of business administration degrees because there were good programs near their homes. Dr. Yates said he was also looking for a business-heavy environment.

"I didn't want to know what doctors think about business," he explained. "I wanted to know what business people thought."

Dr. Boss, on the other hand, figured that because he had spent his entire career in medicine, it made more sense to look at business through the prism of medicine, so he earned a master of medical management degree. "It made more sense for the training to focus on medicine rather than being part of a general business school," he explained.

Drs. Boss and Patmas said they liked the master of medical management program because they needed flexibility to juggle their professional and personal lives. The programs they found used distance learning to limit on-site class time. Traditional MBA and executive MBA programs, on the other hand, often require students to attend classes during evenings and on weekends.

T. Allen Gore, MD, director of the inpatient psychiatric service at Howard University Hospital in Washington, chose an executive MBA program catering to physicians for two reasons: It fit with his work habits and its faculty included senior leaders from the worlds of business, health care and academia.

Regardless of the type of program you choose, the cost of earning a business degree—both economically and personally—can be high. Dr. Gore estimated that he spent about $65,000 on books and tuition, and another $30,000 on travel, room and board.

The personal cost, however, was even steeper. At one point, Dr. Gore asked his wife and children to decamp to the family's second home in South Carolina. "If they'd stayed with me, I probably would have flunked out," he said. "It's way more demanding than you think going in."

Dr. Chen said that in-state tuition at a local program kept his out-of-pocket expenses down to about $24,000 over 21 months. Between his practice and coursework, however, he said that he "didn't do much but study and work for two years."

The payoff

Business training provides many intangible benefits, but the hard work and expense can have more immediate payoffs.

Maher A. Roman, FACP, assistant professor of medicine at Loma Linda University School of Medicine, found that he was able to put his degree to work right away. After earning an MBA at the University of Redlands in Redlands, Calif., he helped design and implement an open access primary care practice model at the Loma Linda VA Medical Center.

That project alone, he said, justified the time and money he spent on his business education. "From day one, patients see a primary care physician" and stay with that physician, he said of the new system. "It's very fulfilling to me."

And while Dr. Patmas' business degree didn't help him save his practice, it did help him in his new job as medical director of the Providence Ambulatory Care and Education Center in Providence, Ore. He was able to help bring the struggling center, which has a large number of indigent patients, into the black.

"We completely corrected the financial situation of a wonderful clinic that was in distress," he explained. "We have been able to continue to provide care to poor, vulnerable patients who otherwise wouldn't have access."

What about colleagues who think that physicians with a business degree have gone to the "dark side" or put personal gain above patient care? According to Dr. Roman, those sentiments are misplaced, particularly in today's health care climate.

"There's no disagreement that health care is a mess at the micro and macro levels," he said. "The more we adopt business concepts, the better off we'll be."

Gina Rollins is a freelance writer in Silver Spring, Md.

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