M.D.–M.B.A.s
A NextGen Pathways in Medicine Article
For many doctors, dealing with the business side of medicine can be confusing. They must deal with rising expenses and competition, as they attempt to set budgets, manage loads of paperwork, fight with insurance companies for reimbursements, hire staff, develop marketing strategies, and negotiate contracts. The success of one's practice may have as much to do with one's business acumen as with one's skill as a physician. Dr. Kevin Schulman, Director of the MD/MBA program at Duke says, "Today's healthcare issues are management issues for which most physicians are woefully unprepared. Quality, safety, patient satisfaction, resource allocation, and process improvement are all management concepts where we have tools available to address these issues that are not being utilized to their full extent. Broader questions about structure and financing of healthcare services and technologies are all business issues as well. Even not-for-profit organizations need management skills and capabilities."
As a result, some doctors choose to take a break from clinical practice and hit the books again, enrolling in MBA programs. Increasingly, however, universities are offering joint five-year programs from which students emerge holding both Doctor of Medicine and Master of Business Administration degrees. These programs are rigorous, but they help students save a year of time and tuition. Before 2000, eight universities offered the dual degree programs. Today, the Association of American Medical Colleges lists 48 schools that do so.
A 2004 survey of MD/MBA students in six universities by Dr. Windsor Westbrook Sherrill found career opportunities, opportunities for innovation, consistency with career interests, and opportunities to make a difference in medicine to be the most influential factors in the decision to enter the joint degree program. Many see it as an opportunity for physicians to take back control, to shape where medicine is going.
Most joint MD/MBA programs require that the student be admitted to each school independently and do not give joint degree candidates preferential treatment over other candidates. This means that as an undergraduate one has to complete the prerequisite courses for both business school and medical schools, and one must take the GMAT as well as the MCAT. In some cases, one can apply to the program when one is already enrolled in medical school. However, business school usually requires extensive work experience that many medical students lack. However, summer internships or the clinical rotations during the third year can count towards that experience.
At some schools students spend the first three years in medical school, the fourth year in business school, and the fifth taking electives in both, though other universities may divide up the time differently. In addition to fulfilling the core requirements for both schools, students may take courses that specifically address health care policy and management. The programs allow them to gain clinical skills along with managerial and administrative expertise.
Schulman says, "All physicians need exposure to health policy and management as core competencies." Whether or not one needs to go as far as obtaining the additional degree depends on the young physician's goals. Jason Brinton, a student at Harvard Medical School, explains, "MBA degrees open up a lot of opportunities for medical students looking to eventually work at the intersection of business and healthcare, whether in HMO or hospital administration; consulting or finance; private equity or venture capital; or at a pharmaceutical or medical device concern. Though it's arguable whether an MD is necessary in the first place for these pursuits (many hospital CEOs do not have MD degrees), an MBA is not necessary either. Three of my classmates are entering venture capital, consulting, and banking without MBA degrees. An MBA will open up doors — the question the interested student must ask is whether it is worth the extra year, and that depends on what he or she hopes to do in the long run."
MD/MBAs may become administrators in hospitals or managing partners of private practices; they may also end up working in companies that provide various health services or health-related products (e.g. pharmaceutical and biotech companies). Some pursue the purely clinical track and have varying experiences as to how useful their MBA degrees turn out. Schulman says, "Most of our MD/MBA students return to medical residencies and develop applications of their new skills later in their careers." Some may choose to focus exclusively on business, but ideally the programs will produce students that will "apply their skills back to medicine — in research, patient care, or management." Brinton says, "My father did an executive MBA program 10 years ago and felt that it has helped him both as a practicing physician and as a manager of his group practice."
The MD/MBA programs are hoping to produce physician leaders, individuals with a deep
understanding of medicine whose business training will put them in a unique position to address some
of the problems confronting the healthcare system. Health care costs are rising much faster than
the rate of inflation. Over 45 million people in the United States are uninsured; those with
insurance are required to pay more and more in co-payments. Many hospitals are becoming strained to
the point of bankruptcy. Brinton says, "I'm hopeful that physicians who educate themselves about
these issues will be better prepared to speak up from corner offices to capitol buildings on behalf
of practical solutions that address these challenges." Dr. Schulman writes, "Health care is now 16%
of [our] GDP and people are wondering whether the healthcare system is contributing to national
productivity or is a drain on the broader economy... There will be an increasing focus on managing
our resources efficiently. There will also be calls for innovation — in information
technology, in medical technology, and in service delivery. It will be an exciting time, calling
for leadership from within the medical profession." The MD/MBAs are getting ready to answer this
call. 
Marta Gorczyca is a writer for the Next Generation and a member of the Harvard College Class of 2007.