The MD, PhD and MD, MPH have long been fixtures in the world of medicine. More recently, however, a small but growing number of MD, MBAs have been joining the ranks. Driven by the convergence of science and business, as well as the current state of flux in the economics of medicine and health care, a growing number of physicians are returning to school to earn MBAs or taking advanced courses to boost their knowledge of a field they have long ignored.
Society is obviously troubled by the current state of medicine, explained Deborah C. German, MD, Senior Associate Dean of Medical Education at Vanderbilt University School of Medicine in Nashville, who helped launch the MD/MBA program there and at Vanderbilt 's Owen Graduate School of Management this year. We need more people who can bridge the gaps in understanding between business and medicine, who can understand the needs of physicians and patients and know what is necessary to make their interaction optimal, as well as how to provide the best care with limited resources.
Executive MBA and certified leadership track programs by the American College of Executive Physicians have become popular for physicians with established careers in academic and clinical practices. Leonard Zwelling, MD, was a medical oncologist and research scientist at MD Anderson Cancer Center when he was recruited into the Executive MBA program at the University of Houston. Subsequently, he was appointed Associate Vice President for Research at the Center, and assumed an expanded role in improving the infrastructure for research and information management systems.
Dr. Zwelling believes that his MBA training has given him the credibility to make systemic changes at his institution. The academic enterprise does not need to change its focus on creating new knowledge, he said in an interview, but the application of modern business principles can help improve the systems for achieving that goal.
For example, at MD Anderson, all systems are now computerized, so that the staff finds it easier to communicate with each other. Moreover, there are now uniform procedures for handling grants and technology transfer material contracts. Everything everyone needs is in one location, Dr. Zwelling noted. We aim to be affable, available, and able-in that order.
Steve Chan, MD, Assistant Professor of Radiology at Columbia University and New York-Presbyterian Hospital, hopes to achieve those goals in his specialty field. He is currently in the second year of an executive MBA program at Columbia. There are a lot of exciting new technologies and systems in the business world that improve operations and management, Dr. Chan noted, but academic radiology has not kept up with them. To integrate academic radiology into the 21st century health care enterprise, a greater focus on technology management and medical informatics is needed.
Better Options
For many physicians, both academicians and practitioners, the acquisition of additional business training has propelled them into new medical careers or enhanced their current ones.
For example, Richard J. Schuster, MD, completed a master's degree in medical management from Tulane University as part of a 30-month combination distance learning/onsite-training program sponsored by the American College of Physician Executives (ACPE). The training has empowered him in his position as an Associate Clinical Professor of Medicine and Boonshoft Chair in Health Systems Management at Wright State University School of Medicine in Dayton, OH.
Medicine is one of the few professions that makes leaders responsible for managing significant amounts of money without requiring them to have the requisite management skills, Dr. Schuster said. All physicians need to be educated managers, whether they pursue a separate degree or take a two-week leadership course. Health care administrators who aren't doctors can't understand medicine the same way physicians and other health care providers can.
Eager to educate others, Dr. Schuster is currently developing a training program in management and administration for physicians, house staff, and medical students at Wright State. Dr. Schuster credited the ACPE course with giving him the tools for negotiating effectively with the hospital leadership on budget and planning issues, as well as managing the multi-specialty teaching practice. It also helped him develop and promote new programs at his institution. I could do this because I knew how to create a business plan, analyze the budget and productivity data, and interpret physician and managed care contracts, he said.
The Language of Finance
In addition to degree programs in business management, some medical schools are offering certified programs in leadership and continuing medical education (CME) credits for management training. The Physician Executive Leadership program at Duke University Medical Center, for example, is an 80-hour CME course that covers everything from health care financing and accounting principles, to systems management and negotiating strategies. The program is modeled on other MBA programs that focus on the health care environment.
Physicians are so busy in practice that they often don't have time to see the bigger picture of how finances work at Duke and how it affects them, said Joseph Green, PhD, Associate Dean of CME, who directs the leadership program at Duke. Once our physicians understand the language of finance and business, they begin to understand why things are changing in their setting, and they become catalysts for helping other people to understand these changes.
Negotiating the changes that are necessary to lead and manage medical practices is also one of the focal points of the Yale Management Program for Physicians, a certificate program developed by the Yale Faculty Practice and launched three years ago. It is a cooperative effort by the Yale Schools of Medicine, Management, and Public Health.
The Program is targeted at physicians who oversee staffs of three to 20 and who are responsible for budgets for their clinic, hospital, or office practices. The aim of the course is to help them develop an idea into a workable program in an organization, explained Stephen Rimar, MD, Director of the Program. Dr. Rimar, who also has an MBA, said the biggest misconception about management training is that it will help physicians deal with money issues. The thing that drives our participants' interests initially are the financial topics, he noted. But as they get more involved in our program, they learn that management is a lot more than just manipulating finances; it's about people and organizations.
As part of their training, participants are asked to develop and present business plans for projects. The catch? They are given 10 minutes to sell their audience on their plan. Among the projects-some of which have been implemented-are business plans for a new surgical intensive care unit, a pre-term infant primary care program, and strategies for meeting staffing obligations with shrinking revenue.
Dr. Rimar sees the program as an antidote to a growing sense of ennui among physician faculty. Medicine is having problems because physicians are feeling hopeless, he said. In the business world, no one would stand for it. If we are to succeed, physicians have to get out of their slump and learn how to use available tools to deal with the changes.
Physicians also need to learn new ways of approaching problems, noted Steven Davidson, MD, who earned his MBA more than 10 years ago. Dr. Davidson, who is Chairman of Emergency Medicine at Maimonides Medical Center, is convinced that a generic business education can expose physicians to a new set of skills and ideas.
More training in medicine usually leads to subspecialization, whereas a generic business education encourages individuals to integrate new skills and perspectives that cut across all specialties, he said. I support a management model that considers the bigger picture-the importance of patient care, support and engagement with the larger community, and the development and support of employees that make the delivery of services possible within realistic financial restraints.
Better Quality of Life for Brain Cancer Patients
In what the researchers called the first study of its kind, a team at Duke Comprehensive Cancer Center used standardized methods to identify neurologic and psychiatric problems in adults recently diagnosed with brain tumors.
The prospective study, presented at the most recent annual meeting of the American Society for Therapeutic Radiology and Oncology, found that patients with left hemisphere tumors have more disease-related neuropsychological problems, such as memory loss, depression, and impaired learning and verbal abilities, compared with patients whose tumors are on the right. Glioblastoma multiforme was found to cause more overall neuropsychological deficits, including psychomotor and speed-of-processing problems, than any other type of tumor.
The study also indicated that quality-of-life problems can be quickly identified, an important factor for patients whose median survival is just one year.
These primary malignant brain tumors are themselves both life-threatening diseases and degenerative disorders of the brain that negatively affect cognitive function and quality of life, said Carol Hahn, MD, Associate Professor of Radiation Oncology. By identifying impairments such as depression and memory loss early on, we hope we can improve patients' quality of time even as we try to increase the quantity.
The researchers used a battery of tests including the Beck Depression Inventory; the Controlled Oral Word Association, which measures verbal fluency; and the Stroop Color Word Test to evaluate overall perception. Interestingly, they found that one very simple test, the single-item Linear Analogue Self-Assessment, measured quality of life just as accurately as the more time-consuming and complex tools.
We've begun to identify avenues where we can improve the quality of life for these patients, Dr. Hahn said. The direction now is to perhaps screen patients for depression, particularly those patients with left hemisphere tumors, and use pharmaceutical intervention to improve their lives when indicated.
Another member of the research team, Renee Dunn, PhD, Clinical Associate in Psychiatry and Behavioral Sciences, added: If we can identify early cognitive impairment, we could work on retraining techniques to reduce functional loss. There are methods to improve attention and concentration with speech and occupational therapy. Also, behavioral modification can help compensate for memory loss.
The researchers called for more widespread examination of depression in brain tumor patients, as well as clinical trials examining the effectiveness of antidepressants in helping improve their quality of life.
© 2001 Lippincott Williams & Wilkins, Inc.