The Physician MBA: Improving Business Savvy in Medicine

One of the largest challenges faced by leaders in healthcare during the Covid-19 pandemic was making difficult decisions in the face of ambiguity. This parallels what is taught in business school where future leaders are taught how to make management and financial decisions with limited information. While many physician leaders within hospitals and clinics have no formal business or leadership training1, we believe that intensivists are in a unique position to become physician executives. Studies have shown that physician led hospitals, on average have 25% higher quality scores when compared to non-physician led hospitals2. In order to sustain this model, we need more physicians with formal training in not only business, finance and management, but more importantly leadership. Training physicians to develop core leadership capabilities has the potential to improve patient care delivery and outcomes3.

A recurring theme in many business school courses is how to create a strong value proposition4. In essence, a value proposition identifies a target demographic or audience with a particular problem and communicates how a company’s product solves that problem better than their competitors. While some would argue that intensivists lead teams on a daily basis, the value proposition for obtaining a Master in Business Administration (MBA), is that it provides the skills and knowledge necessary to lead across specialties and disciplines by training physicians to acquire a more global perspective in order to develop innovative solutions. While more healthcare specific degrees such as a Master in Healthcare Administration (MHA) or a Master in Healthcare Leadership (MHL) do exist, whether to pursue one of these degrees rather than an MBA depends on the long-term goals of the physician. The benefits of an MBA over these other degrees, is that an MBA provides a broader scope of knowledge and the skillset to remain relevant and compete within the dynamic healthcare market, which has recently attracted new entrants from Amazon, JP Morgan, and Berkshire Hathaway.

As a group, physicians maintain many attributes that make them ideal candidates for leadership positions5. First, physicians are already viewed as experts. Their years of training confer not only a sense of credibility6, but more importantly a shared understanding of the practice of medicine. This knowledge and expertise positions physicians to become transformational change agents. As frontline leaders, physicians are in a better position to understand how board room policies and decisions will impact care delivery. Second, physicians, by nature of our training, are natural bottom-up leaders. Progressing from medical student to attending physician has taught us the importance of seeking feedback and ideas from all members of the team6. The team approach to the practice of medicine leverages the diverse perspectives and ideas of all team members, regardless of hierarchy, to develop a treatment plan.  Finally, and perhaps most importantly, physicians practice patient-centered care. The foundation for all our decisions stems from our core belief that the patient comes first. Bringing this patient-centered strategy and focus to the board room may, in part, explain why physician-led hospitals continue to achieve high quality metrics.

Anesthesiologists trained in Critical Care Medicine are uniquely positioned to leverage the knowledge gained in an MBA program. As physicians who care for some of the sickest patients in the hospital, there is a natural credibility and level of respect paid by our colleagues in healthcare. Often intensivists are already considered leaders within the hospital setting. Additionally, Anesthesiology training covers the full age range of patients from neonates to geriatrics. Patients come to the operating room with all medical conditions, and Anesthesiology services are used throughout the hospital. From airway management and code blue teams to sedation services, anesthesiologists interact with nearly every generalist and subspecialist within a hospital system7. These daily interactions provide a holistic knowledge of the complex interplay of all the moving parts within a hospital, a perspective sure to be valuable in the executive suite of any healthcare system.

Moreover, the Intensive Care Unit (ICU) is a high cost and high resource utilization setting. As such, a savvy leader with formal business training could help a hospital system reduce costs and run more efficiently in this high yield area. With its multi-disciplinary staffing including environmental services, physical therapy, respiratory therapy, registered nurses, advanced practice providers, and physicians, the ICU itself is a hospital within a hospital.

Importantly, physicians who have pursued advanced management degrees have overwhelmingly felt it was worth the investment. In a survey of 568 physicians who have a dual degree conducted by the American College of Physician Executives, around 90% of those surveyed felt it was worth the investment8. While there were limitations to this study, innovative MBA programs have moved the entire coursework online, which has made it easier for busy working professionals to attend. Moreover, it has substantially decreased the cost of getting a degree from a respected institution.

In business school, students learn that instead of selling a product, a business should focus on selling a solution to their client’s needs. More than ever before, healthcare needs brilliant, dedicated physician leaders to come up with innovative solutions to the complex issues of healthcare access, equity, and affordability. If physicians are not the ones leading the fight for providing equitable healthcare for all, the future may be decided by those without the intricate insight required to make the inevitable difficult choices.

Interview with Laureen Hill, MD, MBA
Group Senior Vice President & Chief Operating Officer
New York Presbyterian/Columbia Division
New York, New York

Question: Did you consider alternative degrees: a Master's in Healthcare Administration, a Master's in Healthcare Leadership?

Answer: I did not consider other degrees and I did not choose a “healthcare” MBA program because I wanted the full breadth of business training and perspective to prepare me for the physician executive level work I wanted to do.

Question: Do you think having an MBA helped you secure your current position as SVP/COO at CUMC?

Answer: I do not believe the degree itself was necessary to secure my role but I do believe it was helpful in the sense that the business knowledge, vocabulary, skills and approaches I learned in business school were instrumental in how I solved problems and how I led people and programs; I believe my subsequent achievements and experiences were instrumental in my recruitment for my current role.

Question: Do you think intensivists/anesthesiologists are in a unique position that makes them well suited to leverage a business degree to pursue a leadership role?

Answer: I do believe the inherent nature of being hospital-based physicians in the OR and ICU provides anesthesiology/intensivists a very good perspective on the hospital care delivery platform; while not the only specialty practice that affords that opportunity, I do agree that understanding the OR/ICU environments and the team-based nature of OR/ICU practice are good preparation for someone wanting to pursue additional business training for hospital leadership roles.

Question: Do you think having an MBA helps in your role as SVP and COO of CUMC?

Answer: Undoubtedly “yes,” but having said that, I know of many successful healthcare executives that do not have MBA credentials and conversely, I know many individuals that do have an advanced degree but are not performing at that level.

Question: What advice would you give to intensivists whose long-term goals are to become physician leaders/executives?

Answer: I advise individuals aspiring to leadership roles to first consider the problems they care about and want to work to solve, i.e. is it how we educate and train the workforce, how we measure and drive quality outcomes, how we define and deliver better value in healthcare, how we measure and improve operational efficiencies, how we improve workforce engagement and culture, etc.?  This self-discovery exercise will help individuals identify the right kinds of roles they may want to pursue based on actual duties/responsibilities/spheres of influence and not just based on titles. The responsibilities and daily work of a CMO are very different than that of a CQO or COO for example. The second question to consider is if one is equipped with the right skills, knowledge, experiences, and attributes to be successful in a particular role or if it is important to acquire any of those through additional education, experience, projects, coaching, mentorship, etc. Lastly, I encourage individuals to consider—when they are successful in a particular role they are thinking of pursuing, will it have mattered and if so, why? Reflecting in this way is a good approach for anyone aspiring to do something more because there are many ways to lead, make important contributions and have significant impact; choosing the right path for the right reasons is a critical first step.

References:

  1. Why Doctors Need Leadership Training. Available at: https://hbr.org/2018/10/why-doctors-need-leadership-training. Accessed January 26, 2022.
  2. Gupta A. Physician versus non-physician CEOs: The effect of a leader’s professional background on the quality of hospital management and health care. J Hosp Administration 2019;8:47.
  3. Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance? Health Care Manage R 2017;Publish Ahead of Print:NA;
  4. How to Create an Effective Value Proposition | HBS Online. Available at: https://online.hbs.edu/blog/post/creating-a-value-proposition. Accessed January 26, 2022.
  5. Loh E. Doctors as health managers: an oxymoron, or a good idea? J Work Management 2015;7:52–60.
  6. Why The Best Hospitals Are Managed by Doctors. Available at: https://hbr.org/2016/12/why-the-best-hospitals-are-managed-by-doctors?autocomplete=true. Accessed January 26, 2022.
  7. Desai AM, Trillo RAJ, Macario A. Should I get a Master of Business Administration? The anesthesiologist with education training: training options and professional opportunities. Curr Opin Anesthesio 2009;22:191.
  8. 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 Medical Pract Management Mpm 2008;23:232–7.

Authors

Christopher Webb, MD
Associate Professor
Director of Graduate Medical Education
Kaiser Permanente South San Francisco Medical Center
Kaiser Permanente Bernard J. Tyson School of Medicine
San Francisco, California
Paul Weyker, MD
Associate Professor
Director of Perioperative Medicine
Kaiser Permanente South San Francisco Medical Center
Kaiser Permanente Bernard J. Tyson School of Medicine
San Francisco, California