Respondents felt that improvement of leadership, management, and administrative skills was a direct result of their MBA experience (Table 4). Sixteen respondents (84.2%) agreed that their business program taught practical and deliverable leadership skills. In addition, 16 plastic surgeons (84.2%) felt they now had the skills necessary to lead an AMC as a result of their business education, in contrast to the 3 (15.9%) respondents who felt they would have the necessary skill set to lead an AMC without their business education.
Clinically, 9 (47.4%) agreed that their time spent with patients has changed as a result of their business education, whereas 8 (42.1%) disagreed. On the whole, 13 (68.4%) see their business experience as a way to better help their patients. When it comes to working with colleagues clinically, 15 (78.9%) responded that they feel their business experience gives them greater influence over their work counterparts when it comes to making business decisions, and 8 (42.1%) responded that they feel their business experience gives them greater influence over their colleagues when it comes to making clinical decisions.
Fifteen respondents (78.9%) felt that they had gained valuable business knowledge related to the medical field, and 15 (78.9%) felt that their attitude toward business in medicine had definitely changed as a result of their business education. However, over half (n = 10, 52.6%) found it challenging to use the skills they learned in business school in their current position.
In terms of the business education program, only 1 (5.3%) respondent felt that previous business experience was necessary to be successful, and the majority (n = 10, 52.6%) felt indifferent about having previous experience. Overall, the group of respondents was fairly equivocal on whether the MD and MBA experiences were well integrated, whether their medical knowledge was well integrated into the business curriculum, and whether there was adequate mentorship during the program. A large majority (n = 12, 63.2%) felt indifferent about their business program preparing them for a role in clinical medicine.
When it comes to the motivations for applying to their particular MBA program, the majority did so because of the school’s reputation (n = 10, 52.6%) and because it was their home institution (n = 10, 52.6%). The majority did not choose their program because of its track record for producing physician-businessmen (n = 11, 57.9%).
Looking at their overall experience, 18 (94.7%) surgeons felt their MBA program met their expectations, and 17 (89.5%) felt their business degree helped them reach their postgraduate goals. All respondents felt their MBA is valuable. Seven respondents (36.8%) foresee a change in their career path in the future, whereas 12 (63.2%) do not (Table 5). Some of the anticipated career changes include moving to a solely administrative role, becoming the CEO or COO of a health care system, becoming a clinical chairperson, and leaving medicine for entrepreneurial work. Additionally, all respondents recommend getting an MBA to fellow physicians. In terms of a timeline for when to get an MBA, the respondents were split—6 (31.6%) recommended doing an MD/MBA dual-degree program, 6 (31.6%) advocated for pursuit of the degree as an attending with less than 5 years of experience, and 7 (36.8%) indicated the degree should be completed as an attending with greater than 5 years of experience. No one recommended pursuing an MBA during residency or fellowship.
The practice of medicine and surgery is changing at an unparalleled pace. The new millennium brought with it not only groundbreaking new developments in biomedical science, but also an increasingly complex health care system. Besides patient care, challenges facing physicians include dizzying numbers of health care group mergers and acquisitions, rising health care costs, changes in medical insurance, high cost of professional liability insurance, diminished reimbursements, fear of litigation, and managed-care systems.5 Throughout history, physicians have started and have led hospitals and health care practices. However, as demands increased, their leadership roles started dwindling. Today, fewer than 3% of acute care hospitals are led by physician CEOs.6
The aforementioned are but a few of the challenges that have brought about an urgent demand for physician-leaders, who are proficient not only in patient care and communication, but are also fluent in business and management language. Although it is not the only method of obtaining business-related education, the MBA degree has long been recognized to be the pinnacle of business education. The 1980s saw the first physician pioneers with MBAs, and since then, MD/MBA programs have been gaining increasing popularity.7
Plastic surgeons continue to be at the forefront of medicine. The specialty dictates the utilization of creativity and extensive training to meet some of medicine’s most difficult challenges. Although the culture among plastic surgeons remains steadfast in its cultivation for success as an outcome of hard-work and extensive medical training, this paradigm does not hold true for the plastic surgeon involved in leadership and administration.3 This is perplexing especially since a large part of plastic surgical practice involves keen business acumen, be it PP, group practice, or in an AMC.
Similar studies on MDs with MBAs are scarce. In a survey of 87 MBA physician graduates of Boston University Questrom School of Business, Harvard Business School, and Wharton School of Business, Parekh and Singh5 found that they had obtained their MBA at a mean age of 41.4 years, 84% had completed a residency program, and on average they completed their MBA degrees 8.64 years after graduating from medical school.5 Lazarus8 found that while physicians who enter management are considered change agents for health care improvement, they receive no financial support and little encouragement from their teachers and colleagues.
Of our 19 respondents, an overwhelming majority was male (94.7%), which is perhaps reflective of the current sex bias within the surgical specialties. The largest groups of respondents either completed their MBA after at least 5 years of being in practice or before beginning practice at all. This coincides with the fact that the majority either completed an EMBA or an MD/MBA dual-degree program. From the data, it can be concluded that there are 2 overarching groups of plastic surgeons seeking additional business education. The first group is the established surgeon who is looking to add a new element to their established career. The second group is the medical student who commits to a dual-degree program looking to add business acumen to their portfolio with no professional clinical experience to draw upon. On another note, 78.9% of respondents indicated that they used some form of personal finances to pay for their business education, and less than half received any kind of outside funding, be it from their department or from a scholarship. With a reported $87,058 average cost of the degree, paying for an MBA is a hurdle that many do not get help with. Plastic surgeons are already regarded for their exceptional drive, but the data suggest even further evidence for academic and professional achievement when considering the work-life balance necessary to complete business school either during their medical education or during their established career, all the while taking on the burden of the high cost to obtain the MBA.
What then are the motivations behind the driven plastic surgeons that look to enroll in business school? In an early study before the explosion of the MD/MBA dual-degree programs, Gilmore7 stated the benefits of an MBA being immediate applicability, the ability to develop different career opportunities, and the opportunity to bridge the chasm that separated physicians and managers.7 A 2003 analysis of the state of MD/MBA programs in the United States found that prime motivations for the rise in this course of study were the drive to improve patient safety, health care quality, and organizational design and effectiveness.4 Parekh and Singh5 found that the top 3 motivations cited were learning about the business aspects of the health care system, obtaining a more interesting job, and surviving better in the new health care system.5 Enhancing personal finances was cited as 1 of the top 3 reasons by only 25% of respondents.
Our study uncovered 3 main motivations for plastic surgeons obtaining an MBA: adding a new dynamic to their existing careers, entrepreneurial drive, and credibility in management. Of note, none of the respondents chose to enroll in an MBA program with the goal of getting an increase in their salary. Taking all their motivations into consideration, it would then reflect that a plastic surgeon’s prime motivation for getting an MBA is to improve upon patient care rather than personal finances.
Having defined the motivations, it is important to examine the outcomes. When looking specifically at the utility of an MBA to physicians, Parekh and Singh5 compared the allocation of work time before and after the MBA and found a significant change in time spent for patient care, administrative tasks, and teaching.5 In our cohort, the majority (78.9%) remained in the same practice after completing their MBA; however, 73.7% of respondents noted a change in their daily responsibilities in their current career as a result of their business education, with most taking on business roles outside of their clinical work. In terms of patient care, 47.4% felt that their time with patients had changed after their MBA. Returning to the theme of remuneration, 63.2% of respondents did not note any increase in pay as a result of their business education. With the majority of plastic surgeons experiencing changes in their current career, especially in the areas of patient care and roles outside of clinical work, accompanied by no increase in salary, the utility of an MBA in plastic surgery is objectively aligned with the motivations for enrolling in the business program in the first place.
In addition to examining the objective outcomes of obtaining an MBA, it is important to draw upon the skills learned in business school and how those affect the plastic surgeon in the health care system. There are many expositions on the qualities required of a physician-leader. A physician-CEO must possess leadership, a sense of mission and vision, good business acumen, the ability to identify and manage pitfalls, and have good networking skills.6 In contrast, medical school deans are expected to be competent managers and visionary leaders balancing a complex environment of education, research, and clinical care.9 In PP, management and business skills can be even more important, including strong leadership, assembling a high-performance team, and appropriate marketing.3 Parekh and Singh5 identified the 3 most pertinent skill sets learned in an MBA curriculum as evaluating operations and implementing improvements, learning to be a more effective leader, and comprehending financial principles.5 Overall, 81% of the 87 physicians in that study thought that their business degree had been useful in the advancement of their career, and most believed that 20% of all physicians should acquire an MBA degree. Similarly, a survey of 568 physician members of the American College of Physician Executives showed that 90% reported that their investment in their business education was “worth it.”10
Our study shows that the most important skills plastic surgeons feel they glean from their MBA experience are in the areas of leadership, management, and administration. In total, 84.2% believed that their business program taught them practical and deliverable leadership skills. All but one responded indicating that their business education resulted in improved leadership skills. Applying leadership to a practical role, 84.2% of plastic surgeons felt they have the skills necessary to lead an AMC as a result of their business education. Pair this with the majority that did not believe they could lead an AMC before their business education, and the effects of an MBA on leadership ability become clear. In total, 89.5% felt their management skills improved, and all but one respondent reported they feel prepared to take on more administrative roles as a result of their business education. A large proportion (78.9%) felt that they had gained valuable business knowledge related to the medical field, with the same proportion having changed their attitude toward business in medicine after completing the MBA. The transferability of this is shown in the feeling of a larger influence over colleagues when it comes to making business decisions, with 42.1% even feeling that they have a larger influence over colleagues when it comes to making clinical decisions. Overwhelmingly, 94.7% felt that their MBA program met their expectations, and 100% feel that their MBA is valuable and would recommend it to fellow physicians. With regard to the timeline of completion, respondents were split rather evenly; however, all agreed that they would not recommend completing a business curriculum during residency or fellowship.
Although the outcomes of this study are valuable, there are some limitations. Our sample size is small, but when compared with the limited number of plastic surgeons with MBA degrees to start, our response rate was significant (61%). Additionally, the present study is not attempting to claim that obtaining an MBA leads to significantly different outcomes than not obtaining an MBA or earning a different graduate degree (MPH, JD, and so on). For example, a follow-up study to the current one could compare responses to our survey from both plastic surgeons with and without an MBA, or with different graduate degrees, and test for significant differences. A study of that kind would need a large enough sample size in both groups to claim significance. On that note, this study does not want to convey the message that the only way to improve one’s leadership, management, and administrative skills is to obtain an MBA. Our study is attempting to “set the stage” and is intended to serve as a report of motivations and outcomes for as many plastic surgeons earning an MBA as we could contact. Another drawback of this study is the relatively large diversity of MBA programs represented. Although it improves the generalizability of our study, it is possible that these programs will not represent the outcomes of all business school curricula. Also, a possible bias lies in the subjective responses of plastic surgeons with MBAs. This group of individuals is highly motivated to begin with, so it is possible that subjective ratings on attributes such as leadership could be a product of their already greater sense of achievement and/or ability. This was minimized by analyzing topics of interest both pre- and post-MBA to more effectively measure outcomes. Although our study represents the opinions of only 19 physicians, it is the only comprehensive survey to date on the motivations and outcomes of plastic surgeons with an MBA, and it can help to provide a guide to others in our specialty and beyond who are considering the degree.
Overall, plastic surgeons with MBAs are satisfied with their business education and would recommend the degree to their fellow physicians. In the face of little financial support, the motivations for plastic surgeons entering business school matched their objective outcomes. The majority enroll looking to add new dynamics to their career, to satisfy entrepreneurial drive, and to gain credibility in business, with few entering the program in hope of increased remuneration, perhaps reflective of a prime motivation being improved patient care and not so much financial gain. The most important skills they had improved as a result of their business education were in the areas of leadership, management, and administration. The practice of medicine is ever changing, and clinicians trained in the languages of both business and medicine will help bridge the gap in a health care system sorely in need of positive change.
The authors thank Brian J. Cole, MD, for helping with study validation. The authors also thank Evelyn Poczatek and Elizabeth Fraccaro for helping with study distribution.
3. Sufyan AS, Williams EF 3rd.. Key principles in running a successful business in facial plastics. Facial Plast Surg. 2014;30:172–174.
4. Larson DB, Chandler M, Forman HP. MD/MBA programs in the United States: evidence of a change in health care leadership. Acad Med. 2003;78:335–341.
5. Parekh SG, Singh B. An MBA: the utility and effect on physicians’ careers. J Bone Joint Surg Am. 2007;89:442–447.
6. Falcone RE, Satiani B. Physician as hospital chief executive officer. Vasc Endovascular Surg. 2008;42:88–94.
7. Gilmore A. Taking care of business: MDs in search of management skills turning to MBA courses. CMAJ. 1992;146:743–747.
8. Lazarus A. Physicians with MBA degrees: change agents for healthcare improvement. J Med Pract Manage. 2010;26:188–190.
9. Rich EC, Magrane D, Kirch DG. Qualities of the medical school dean: insights from the literature. Acad Med. 2008;83:483–487.
Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.
10. Weeks WB, Lazarus A, Wallace AE. Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives. J Med Pract Manage. 2008;23:232–237.