Let me be completely upfront: I have an MD degree and an MBA degree. I earned my medical degree in 1980 and my business degree in 1996. I wrote the first definitive textbook about physicians with dual degrees (MD/MBA). Subsequently, I’ve written many papers on the topic, and I maintain articles and news clippings in several file folders, each 3 to 4 inches thick. I keep track of current trends. I encourage medical students and early career physicians to apply to business school if they have a genuine interest in the business and management aspects of medical practice.
However, the topic of dual-degree physicians easily unnerves me. I am sensitive to unkind remarks made about physicians with MD (or DO) and MBA degrees. How would you feel if you poured out your heart in an op-ed about “faking” your way through medical school and a physician responded, “I believe that the author who has by his name, MD and MBA, suggests he likely never was made for medicine.”
Physicians have been seeking MBA degrees for decades. Both the number of executive MBA programs and the number of MD/MBA programs offered by medical schools has steadily increased, as has the number of physicians receiving MBA degrees from these programs. The trend first became newsworthy in 1994, when the Wall Street Journal published an article with the title “A New Breed of M.D.s Add M.B.A. to Vitae,” written by George Anders.
Anders appeared to have penned the piece believing that, based on his interview sources, adding an MBA degree to one’s MD degree was a way to enhance physicians’ marketability and allow them to “pivot quickly…between the world of stethoscopes and the world of spreadsheets.” An MBA degree was viewed as a “ticket to open doors” and put doctors on a fast-track for hospital leadership positions. Physicians’ motivation for obtaining MBA degrees today remains basically the same as it did 30 years ago — to learn more about the business of healthcare and prepare them for taking on additional administrative responsibilities.
Several years after the Wall Street Journal article was published, the late distinguished physician Leonard Laster, MD, wrote the book Life After Medical School. In the book, Laster categorized and described five basic career pathways in medicine: primary care; surgery; psychiatry; disciplines removed from ongoing patient care (anesthesiology, pathology, radiology and nuclear medicine); and areas that bear little if any relationship to medical practice — for example, management and politics.
Further thoughts about the fifth career pathway — pursuits distanced from clinical medicine — led Laster to write a scathing article in 1998 in the now defunct American Medical News, which served as the official publication of the American Medical Association. The article was titled: “Physicians with MBAs? Not my doctor!” Laster opined that physicians cannot — and should not — serve two masters, concluding: “I will not allow my family members to be guinea pigs for testing whether these professional polarities [medicine and business] can be successfully used. I say let businessmen be businessmen and pursue profits, and let doctors be doctors and care for patients.”
Laster’s op-ed enraged readers and generated more letters to the editor than any article previously published in American Medical News. Obstetrician/gynecologist G.V. Raghu, MD, wrote a letter expressing the sentiments of many physicians who responded to Laster’s commentary. Raghu wrote: “It is amazing that Leonard Laster, MD…looks at MBA training as an antithesis of medical values. Does he prefer nonphysician MBAs to be making the management, cost-cutting and quality management decisions?” Raghu — and many physicians since 1998 — have thoughtfully made the case that dual-degree physicians would be a positive influence on how care is delivered.
The great debate about physicians with MBAs thus became entrenched in articles and letters, with definitive data lacking to answer the question of whether an MBA degree adds real value for physicians or forces them to live by two incompatible creeds. In the continued absence of such data and notwithstanding the perceived value of an MBA degree, including larger salaries for dual-degree physicians, the debate still rages.
Many academicians consider dual-degree physicians traitors to the medical profession despite research showing that business skills do not, in fact, lower practice competencies or draw students away from medicine. I’ve had to counsel several entrepreneurial medical school applicants and advise them to curb their enthusiasm about business school until after their interview lest the interviewer’s bias result in an outright rejection. I’m not convinced there is ever a good time for medical students and residents to declare their interest in business school. For various reasons, they may benefit by waiting until after residency to pursue an MBA degree.
Fortunately, a few level-headed and well-respected academicians have chimed in to even the debate. One, in particular, is my good friend and colleague David Nash, MD, MBA, founder and dean emeritus of the Jefferson College of Population Health in Philadelphia, Pennsylvania. In 1986, Nash and two colleagues anticipated the need for management-trained physicians to lead the “medical-industrial complex.” In their article published in the New England Journal of Medicine, they did not specify the importance of a business degree, but they argued that physicians needed additional training in management theory, educated perhaps through professional organizations.
In 1999, Thomas Bodenheimer, MD, and Lawrence Casalino, MD, PhD, wrote a two-part article also in the New England Journal of Medicine apparently legitimizing the role of “[physician] executives with white coats.” They described various roles and responsibilities of HMO medical directors. But in doing so, they continued the debate started by Laster. Bodenheimer and Casalino wrote: “The two opposing views reflect inherent conflicts in the role of medical directors — between the desires of patients and physicians, on the one hand, and the financial profit or survival of the organization, on the other, and between the unlimited demands of individual patients and the limited resources of society.” Simply put, business-minded physicians are — and always will be — stuck between medicine and management.
Diana Chapman Walsh, PhD, president emeritus of Wellesley College, published her PhD thesis as a book about corporate physicians. She offers a management lesson not taught in medical or business school, one that needs to be learned through experience and deep personal reflection: physicians must learn how to manage the tension that exists between their obligations as doctors and their role as part of management. This applies equally to physicians working for organizations and those who are self-employed. Unless this underlying conflict is resolved, physicians risk harm to their patients and reputations, and they may remain unpopular with their colleagues.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.