M.B.A. education for physicians: cross-training options

This article originally appeared in the American Journal of Roentgenology, written by Dr. Frank Lexa, guest editor of health policy for the American Roentgen Ray Society (ARRS).

2005 05 03 16 08 07 706Recent decades have seen an explosion of interest in executive education for medical professionals. The U.S. trend appears to be driven by an avalanche of changes in the organization of the healthcare system. This transformation has created the perception that there is a greater need for physicians to understand management and financial topics. In some cases, it is motivated by a desire for independence and entrepreneurship, particularly among younger physicians.

The phenomenon is also related to a truly global change in the relationship between technical and managerial disciplines. Worldwide, the traditional separation between managers and financial personnel on one side in opposition to scientific and technical experts on the other has been crumbling in many disciplines. This convergence is occurring in molecular biology, engineering, and telecommunications, as well as in U.S. medicine. There is a greater need than ever for us, as physicians, to have a broad appreciation of how management and medicine can be synergistic rather than antagonistic.

Take the example of opening a new center for your practice. There are many hurdles that you will face, and business training and experience can help you succeed in overcoming them. Knowing how to write a business plan will help you anticipate and solve many problems before they become serious. Training in business negotiations can make the difference in winning or losing most of the key components of the venture.

Marketing research will aid you in picking the right location and making sure that you will have enough referrals. Smart financial analysis will help you to ensure that the investment will meet your goals, and help you choose intelligently among competing choices such as another MR scanner versus a PET/CT. Other business disciplines such as operations research and management can help you with day-to-day functions, human resource problems, and so on. This article will focus on options for physicians who seek business education to enhance their medical careers.

M.B.A.s: timing, characteristics, and options

If you want to pursue a business degree, many options are open to you. The youngest readers of this article still have the simplest and usually cheapest choice of getting an MBA while pursuing their medical education. Currently in the U.S., there are almost 50 institutions that provide the option to pursue both an M.D. and M.B.A. degree in some type of concurrent fashion, according to the Association of American Medical Colleges (AAMC) Web site.

The programs continue to grow in popularity and new combined-degree offerings are launched regularly. When well executed, they can offer the best integration of education in both schools. Socially and financially, this is also an ideal time to accomplish these goals simultaneously while limiting the impact on your outside professional and personal interests.

However, there are potential downsides as well. In particular, many of our students struggle with the problem of what to do immediately after graduation with both degrees. They often feel drawn in two disparate directions. Graduate medical education is not very compatible with the kinds of jobs that freshly minted M.B.A.s are offered. Both early career paths usually require a high degree of commitment and long hours. The new graduate usually faces a stark either/or choice.

This dilemma is worsened by the perception (usually at least partially justified) that whichever path they choose, the new graduates risk becoming rusty in the arena they sideline themselves from. Although both worlds seem to be becoming more flexible, it is still more difficult to return to start a residency as a PGY 1 several years after graduating from medical school than to go straight through. This is compounded if that time is spent in an entirely different job track in a very dissimilar milieu.

It is also possible to go back for an M.B.A. after you have finished your training or been in practice. That feat can be accomplished in several ways, and the good news is that the demand has driven up the number of choices for those of us who are older and further along in our careers. Each route has its own advantages and disadvantages.

The most traditional way is to pursue a graduate M.B.A. These generally take just under two years going full time, and the average age of the students is usually mid- to late 20s. Many programs offer concentrations or majors, which can include healthcare or a closely related topic. Cost tends to be high, particularly at the top schools -- it is a shock to see that two years in an M.B.A. program may well cost you more than you spent for twice as much time in medical school years ago. Keep in mind that going full time tends to be quite intense -- particularly at the best-regarded schools. It is difficult or impossible to balance a full-time graduate M.B.A. program with a typical 40-50 hour a week job, let alone the more demanding, committed kind that most of us have in medicine.

A cohort structure is typical. This means that the vast majority of students start as a unit, take the basics together, and graduate on the same date. This design creates group cohesion, encourages peer education, and bonds students in an impressive fashion. The style of education is interactive and is very different from the classroom experience many of us had in the first two years of medical school.

At Wharton, we use a co-production model to teach. The professors don't show up for a lecture with an hour's worth of slides and just lecture for the entire time slot. Instead, it is an active conversation with the students. This is not just calling on them to ask questions like the experience many U.S. law students have in class. Instead, we are asking them to contribute to the class by bringing in their own work experiences to add to the prepared lecture material.

This is one of the primary reasons why it is extraordinarily unusual for people to be admitted directly to business school from undergraduate programs. This work experience is critical on two fronts -- first it brings the material alive for them, and second it allows them to contribute to the education of their classmates (and sometimes their professors).

Executive programs are another option. They also generally take around two years, but differ substantially in structure from graduate M.B.A. programs. Students generally attend classes on weekends with some occasional additional days or weeks thrown in. Many are residential to accommodate students traveling from a distance (we routinely have had students attend by commuting from Europe or Asia).

These students are older than the average graduate M.B.A., usually in their 30s, and they are usually still working at their pre-M.B.A. job. Often they are sponsored by their employers as part of an agreement to return after completing the degree. The cost is often the same or greater than that of a graduate M.B.A. at the same institution. Both executive and conventional programs often use a learning team approach. This means that you work within the same group of around five people for all or most of your basic classes. Your performance including your grade depends upon the team as well as you individually.

This last item can be enormously frustrating at times for highly motivated, independent-minded individuals such as specialist physicians. You can be dragged down if one or more of your team members turns out to be a slacker. However, that is one of the points of the design. If you are going to become a manager, you need to learn to manage people of all types -- sometimes under difficult circumstances. Those sorts of events and what I learned from them have stuck with me long after I've forgotten the arcane details of advanced accounting.

There are also a wide range of part-time programs that are less structured, but which still allow you to cover the material and receive the degree. Some can be completed in an à-la-carte fashion over a fixed period, and some offer additional scheduling options with classes during both day and evening. This flexibility is clearly attractive, particularly for busy professionals. The downside is that there is a loss of both the learning team and cohort experiences.

Less structured programs can be the best choices for people who don't have the time or resources to devote to an expensive two-year degree program. In addition, there are distance-learning programs that minimize or eliminate most of the physical classroom experiences. These are offered on the Web and have the advantage of being even more convenient in time and space. The downsides relate to the loss of face-to-face contact with the faculty and fellow students.

A final set of choices revolves around the personal question of whether you need the entire M.B.A. offering. You should ask whether you really require another expensive piece of paper. When you count the costs, don't forget the extraordinary time value your medical training represents. In addition to paying for the degree, you are also losing the time value of your skills and the financial power they represent during a period of reduced earning. If you completely drop out, you will also face the potential of your abilities and skills getting rusty and stale.

There are many ways to get started without making the commitment to a formal program, and it is beyond the scope of this article to explore all of them. However, many medical schools, business schools, and national organizations, such as the American College of Radiology have created shorter, more focused executive education programs that allow you to initiate cross-training by starting just in one area, such as finance or business planning. This will give you a taste for the material, gauge its relevance for you, and decide whether you are motivated enough to make a bigger commitment.

By Dr. Frank Lexa
AuntMinnie.com contributing writer
January 25, 2006

Dr. Lexa is a guest editor of health policy for the American Roentgen Ray Society (ARRS). This article originally appeared in the American Journal of Roentgenology (January 2006, Vol. 186:1). Reprinted by permission of the ARRS.

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Copyright © 2006 American Roentgen Ray Society

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