Adding more letters

I had a sinking feeling in my gut when I spied this headline in the New York Times the other day:

Adjusting, More M.D.’s Add M.B.A.

Somewhere back in the murky depths of the Internet, I know I’ve posted about the reality that medicine is a business.  The tension between the patient-care side of contemporary medicine (which is the reason we become doctors in the first place) and the balance sheet is an uncomfortable one, and I know I’m not alone in wishing there were a way of resolving that tension without either compromising the well-being of my patients or my own financial security.  It’s a very vexing question, and one that is consuming a tremendous amount of national energy and attention.

With this in mind, perhaps I could be forgiven for assuming that the article would be about physicians who had found the vagaries of small business ownership difficult enough to warrant heading to B school.  I found that prospect deeply disheartening.  If our current non-system requires that I “adjust” by adding another three letters to the already preposterous collection after my name, it’s hard to see how I can continue to keep patient care as my primary concern.

Thankfully, this was just a case of a misleading headline and a muddy thesis.

Under heavy pressure from government regulators and insurance companies, more and more physicians across the country are learning to think like entrepreneurs.

As recently as the late 1990s, there were only five or six joint M.D./M.B.A degree programs at the nation’s universities, said Dr. Maria Y. Chandler, a pediatrician with an M.B.A. who is an associate clinical professor in the medical and business schools at the University of California, Irvine. “Now there are 65,” she said.

Mark V. Pauly, a longtime leader of the health care management program at the Wharton School at the University of Pennsylvania, said, “A light bulb went off and they realize that health care is a business.”

Hmmmm.  I don’t know if I buy that last quote.  It seems to me that anyone who enters a joint MD/MBA program thinks of medicine as a business from the get-go.  I know a few people who have both an MD and a JD, but all of them got those degrees with an eye toward practice as med-mal attorneys, not because the legal pressures of medical practice demanded the second degree.  The research world abounds with MD/PhD combos, but they all obtained their degrees because they wanted a research-heavy career.  They didn’t go back to grad school because the journal articles got too complicated to understand without it.  People get the degrees they get because they’ll advance the careers they want.

If you look at the people interviewed for this article, it’s clear that it’s not about medicine.  It’s about business.

Dr. James S. Kuo, 47, said he was a third-year medical student at Penn when he decided to go to business school, too. After receiving his M.D. and master of business administration degrees, he jumped to a Wall Street job with a large health care venture capital firm.

Dr. Kuo went on to manage several heath care funds and later led several small health care companies.


Statistics about the joint programs are sparse, said Dr. Chandler, who is president of the Association of M.D./M.B.A. Programs. But she estimated there were as many as 500 students total in the programs.

Some, like Tufts and Texas Tech, offer the combined program in four years, she said, and many programs offer special aid packages.

“All physicians need some kind of business training,” she said. “For example, some physicians with large research grants don’t know how to manage the money.”

As for the nation’s troubled health system, “we are not running the business side very well,” Dr. Chandler said. “Part of the problem is we don’t have physicians sufficiently involved. They have a fuller insight about what is needed.”

“Cue the theme music from ‘Jaws,’ ” said Professor Pauly, of Wharton. “Entrepreneurs have to know how to navigate with the desire of payers to hold down prices and control uses in health care.”

He added: “They have to know how to please pointy-headed bureaucrats. This is going to be one of the survival skills in the future in health care.”

Again we have a quote that is not borne out by the article.  How is this going to become a survival skill?  Not one of the people interviewed for this article appear to be primarily engaged in clinical practice.  If the actual practice of medicine is going to require a greater degree of business acumen in the future, this article does not give us the details.   Those of us who simply want to have our own practices and function as small business owners usually have practice managers who handle the business side of things.  Is there any indication that the status quo will have to change?  The article doesn’t say.  Of course people who want to become entrepreneurs in the health care industry would be well-served to have an MBA.  But how is that any kind of adjustment?

This is a sloppy article that doesn’t know what it’s trying to say.  I’ll conclude by saying any article that includes this quote needed further edits before it went to press:

Her advice to entrepreneurs-in-waiting: “Take a risk, step into the unknown. Don’t be afraid to fail. I’ve made plenty of mistakes and had plenty of disappointments.”

And if life hands you lemons, make lemonade.  Think outside of the box, and let a smile be your umbrella.  Every cloud has a silver lining, and don’t let them rain on your parade.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.

One Comment

  1. Great post (the last paragraph made me laugh).

    I would like to think that the ambition of a lot of doctors, getting multiple degrees and such, might make people think twice about saying “if we had single-payer and cut reimbursements, the doctors would have no choice but to take it.”

    BTW, if you’re looking for postfodder, I found this interesting.

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