By 2010, nearly 40% of U.S. medical schools had established a medical doctorate (MD) and master of business administration (MBA) dual-degree program, a fivefold increase since the mid-1990s.1–3 Although many have speculated about the role of the MD and MBA degrees on physician career development or more broadly within society,4–6 to our knowledge there has been little examination of its use after training.
The Wharton School at the University of Pennsylvania established a full-time MBA program in health care management in 1971 and has since produced over 250 physician graduates. In addition to core MBA curriculum including accounting, finance, marketing, and strategy, students in the Health Care Management Program enroll in a diverse range of health-care-focused courses that cover health economics, management, and policy. By 2010, the program offered more than 15 health-care-focused courses including an immersive field application project where students are paired with health care companies to address real-world problems. The objective of this study was to evaluate graduates’ perceptions of the role of MD and MBA training on their professional development and career.
The Health Care Management Program at the Wharton School of the University of Pennsylvania provided e-mail contact information for all living physician or medical student graduates since its inception in 1971. We sent all graduates from 1972 to 2010 up to three e-mail correspondences using contact information from the Wharton alumni database. If possible, nonresponders were additionally contacted through online professional networks. Ultimately, we excluded graduates prior to 1981 from analysis because of a small sample size of only 16 respondents. Study coauthors (Mitesh S.P., D.A.A.) were also excluded from the sample.
We administered a two-part questionnaire electronically from September to December 2011. Part one requested sociodemographic characteristics, training history, and current professional activities. Part two requested free-text responses to the following open-ended questions on the role of MD and MBA training on respondents’ professional career and development:
- Please describe how (if at all) you use your MD and/or other medical training in your professional life;
- Please describe how (if at all) you use your MBA in your professional life;
- Please describe ways (if any) you use the combination of your MD/medical training and MBA in your professional life;
- Please describe ways (if any) the MD/medical training or MBA, or the combination, has hurt or limited your professional life; and
- Please reflect on the role of combined MD–MBA training. What role has it had on your career? What role does it have on society? Please state its advantages and disadvantages.
We divided survey responses into three groups based on the number of years since the respondent graduated from the MBA program (1–10, 11–20, and 21–30) to evaluate participants’ differences in primary work sector and perceptions based on their experience and the stage of their career.
We analyzed content from the free-text responses using grounded theory. First, three reviewers (Mitesh S.P., V.A., Mamta S.P.) read responses to each question to identify common themes. Second, to ensure that each reviewer coded comments appropriately, we selected 25% of the responses for each question at random and used them as the training set. Two reviewers (V.A., Mamta S.P.) worked together using the training set to assign themes to each of the responses. Responses could be assigned multiple themes or none at all. Through that process, we modified the original set of themes to a more consistent set to which all reviewers agreed. Third, the remaining responses made up the evaluation set, and the two reviewers worked independently to code these responses. Fourth, for comments with differences in coding between the two reviewers, a third reviewer (Mitesh S.P.) was used to adjudicate the disagreement to finalize the coding for the presence or absence of themes. We combined the coding of all responses into a single set for analysis. Interrater reliability between the two reviewers (V.A., Mamta S.P.) was assessed by using STATA statistical software, version 12 (StataCorp LP, College Station, Texas) to calculate kappa scores.
This study was reviewed by the institutional review board at the University of Pennsylvania and classified as exempt.
Among 247 graduates in the sample, 59.9% (148/247) completed the ques tionnaire, and among those respondents, approximately 89.9% (133/148) provided free-text responses. The majority of res pon dents were male (85.1%, 126/148), although this trend declined slightly over time. There were no significant differences in gender between respondents and nonrespondents. The majority of respondents entered residency training (79.7%, 118/148); however, this rate steadily declined from the 1980s (96.3%, 26/27) to the most recent decade of graduates (70.7%, 53/75) (Table 1). Among all respondents, 51.4% (76/148) obtained an MD before the MBA compared with 44.6% (66/148) that obtained the degrees simultaneously. The rate of having an MD before the MBA was higher among graduates from the 1980s (70.4%, 19/27) and then stayed consistent for the subsequent two decades of graduates (46%–47%; 21/46 and 35/75). Very few respondents reported obtaining their MD after the MBA (2.0%, 3/148), typically representing those that took time off early in medical school and who were not in a dual-degree program.
Among the 148 respondents, 145 reported a primary work sector. One hundred sixteen respondents reported entering residency, and the more time that had elapsed since graduation, the less likely they were to identify clinical practice as their primary work sector (Figure 1). Among respondents within their first decade after graduation from the MBA program, 46.2% (24/52) reported clinical practice as their primary work sector compared with 39.5% (15/38) among respondents 11 to 20 years after graduation and 19.2% (5/26) of respondents 21 to 30 years after graduation. Two primary work sectors with the largest absolute increase between less experienced and more experienced respondents were entrepreneurship, startup, or venture capital (5.8%; 7/52 to 5/26) and hospital administration or provider organization (5.8%; 7/52 to 5/26) (Figure 1). The three sectors with the largest relative increases were consulting or marketing (100%; 2/52 to 2/26), insurance or managed care (100%; 1/52 to 1/26), and nonprofit or philanthropy (100%; 1/52 to 1/26).
There were 29 respondents in the sample who did not enter residency. Only 1 respondent had 21 to 30 years of experience post graduation and reported consulting or marketing as the primary work sector. Among the 21 respondents with 1 to 10 years post graduation who did not enter residency, 33.3% (7/21) reported biotechnology, pharmaceuticals, or medical device as their primary work sector; 23.8% (5/21) reported consulting or marketing; 19.0% (4/21) reported investment banking, hedge fund, or equity management; and 14.3% (3/21) reported entrepreneurship, startup, or venture capital.
Aside from clinical practice, the roles of the MD on professional life were most commonly reported as informing business perspective and analysis, and medical expertise (Table 2). However, later in their careers, significantly fewer reported the MD as providing medical expertise (3.7% [1/27] with 21–30 years post graduation versus 22.7% [17/75] with 1–10 years after). The MD was more often reported as providing professional credibility, whereas the MBA was commonly reported as conveying leadership, management, and business skills. The combination of degrees helped to inform business perspective, provide multidisciplinary experience, and improve communication between disciplines. Compared with older graduates, recent graduates reported that the degrees provided career acceleration at higher rates (21.6% [16/75] with 1–10 years post graduation versus 3.7% [1/27] with 21–30 years after). The majority of respondents did not report any negative impact from the degrees; however, some reported that the MD “pigeonholed” or limited their business career options, and the MBA was sometimes seen as a “distraction” from their medical career.
Over the past two decades, the number of training programs that provide graduates with an MD and MBA degree has increased fivefold.1–3 Although many reports have weighed the costs and benefits to pursing this type of training,7–10 there is a paucity of published research on this topic. To our knowledge, this study is the first evaluation of graduates’ perceptions of how their training affected their career development and professional lives. Overall, MD and MBA graduates reported mostly positive attitudes towards their training and often noted the benefits of career acceleration, professional flexibility, and credibility in multidisciplinary domains. Although there were very few negative attitudes towards the training, they were focused on the opportunity costs of obtaining the degrees (e.g., time, tuition fees) and how peers in one discipline may negatively perceive the role of the other degree (e.g., MBA seen as a distraction by physician peers). More recently, physicians graduating from the Wharton School have entered residency at slightly lower rates. Those graduates who do practice clinically have tended to shift more effort towards positions in leadership and business later in their careers.
Policy makers and medical educators have speculated on the leadership role that MD and MBA graduates might play among the physician workforce.1,5,6,11,12 A 2010 survey asked radiology department chairpersons if they had earned another degree in addition to their MD.13 Among 53 respondents, only 4 (7.5%) reported having an MBA. In comparison, 5 reported having a PhD, and 3 had earned an MPH. More generally, the proportion of hospitals led by physicians has decreased significantly from upwards of 35% in the past to less than 4% by 2008.11 In our study, we found that 40% to 50% of respondents reported leadership as a key skill gained from the MBA training. Furthermore, graduates with more experience reported less time practicing clinically and more time in leadership roles within other sectors. However, less than 20% of respondents reported that hospital administration or provider organization was their primary work sector, indicating that although these physicians pursue leadership roles, many may not be directly related to managing health systems or medical practices. Yet, given the changing dynamics of hospitals that require better balance between clinical care, leadership, and business initiatives, graduates with MD and MBA training could potentially fill a growing need within the workforce. Future research and policy efforts might be focused on how to better align the interests of these graduates with training and development pathways that result in leadership positions within health systems or in roles that affect population health.
Our study has several limitations. First, as with any survey evaluation, our analysis is limited because of nonreporter bias. Second, our study was a single-center evaluation, and the findings may not be generalizable to graduates from other programs. Furthermore, changes in leadership or focus within the MBA program can affect career trends over time among graduates, and we were not able to adjust for this in our analysis. However, because this is the oldest program in the country, it provides the longest interval for evaluation. Third, although we compare differences between graduates across three decades, we cannot assume that these trends are temporal, and some findings may be due to the wwenvironment at the time of graduation as opposed to an evolution since graduation.
Graduates with MD and MBA training report mostly positive attitudes towards their training’s impact on their career and professional lives. Many of these physicians are pursuing leadership and primarily nonclinical roles, particularly later in their careers. Given the significant increase in medical schools that offer this training, our findings reveal new insights and may have significant implications for policies affecting physician workforce, such as the potential for hospital leadership tracks or administrative pathways. Further study is necessary to evaluate whether similar trends exist more broadly.
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