Taking the Healing Arts from Bedside to BoardroomThe New Physician
Define the following terms: Decarboxylase. Macrophagic myofascitis. Radiculopathy. Arteriole.
Good. Now try these: Amortization. Floating rate. Uncertainty analysis. Vertical market. Impaired capital.
Not medical terms? Don’t be so sure. You already know English, and are pretty fluent in medical nomenclature, but it may be useful to learn one other language before you graduate: business-speak.
If your image of a physician is someone in a white coat moving resolutely from exam room to exam room, listening to patients, ordering tests and making clinical decisions, you have only part of the picture. In today’s health-care world, many physicians wear power suits (without stethoscopes), attend lots of meetings and rarely, if ever, see patients.
At the root of most students’ reasons for choosing medicine is the desire to help people—to cure disease, to relieve pain, to prolong healthy lives. At first pass, it may seem that a “desk job” might not fill that need. But there is more than one way to ease suffering and promote wellness: “The chief appeal [of an executive career] is one of scope,” says Brian Hurley, a 2008 M.D./M.B.A. candidate at the University of Southern California’s Keck School of Medicine and Marshall School of Business. “As a physician in an exam room, you see one patient at a time. As a physician executive, you can influence hundreds to thousands of patients with a single project.”
The role of physician executive now goes well beyond managing a practice or overseeing housestaff, having become a specialty of sorts in itself. Once, doctors took care of the clinical work and “suits” saw to management—an arrangement that made sense in simpler times. But as health care has grown more complex, the line has blurred. Physicians who think they can practice without concerning themselves with administration are quickly disabused of that notion when they find that a patient’s insurance won’t pay for the medicine that’s best for his or her condition, or when a new diagnostic technology that would save lives is too expensive, or when the amount of time they spend with each patient is regulated by nonphysicians for reasons completely unrelated to the interests of the patient.
Things aren’t any more straightforward in health care’s corporate and public-sector offices, where insurance executives try to learn the nuances of medical procedures in order to decide which to cover, pharmaceutical administrators struggle to evaluate the merits of a clinical trial protocol and policy-makers mull over conflicting evidence about mandatory vaccines.
Clearly, there are many jobs in today’s health-care industry for which the ideal candidate has both medical and management expertise. “A physician’s primary concern is, and should be, getting needed medical services for their patients, says Dr. Maria Chandler, faculty adviser for the M.D./M.B.A. program at the University of California, Irvine. “But physicians have been accused of not understanding the financial necessities of health care.”
For example, Chandler says, in a hospital budget meeting, a physician might be quick to insist that “we can’t cut that program; it saves lives,” but be unable to suggest ways to pay for the program. A better understanding of the financial realities of medicine would help in situations like this.
And on the other side of the boardroom table are administrative officers who have to tell M.D.s that they must do without a valuable diagnostic tool or preventive medicine program because it is too costly or will divert resources from other programs—the kind of broad corporate thinking not usually found in day-to-day patient care.
Physicians are more willing to listen if the hard news comes from their medical peers, believes Dr. Barbara Linney, director of career development at the American College of Physician Executives (ACPE). “Executives have to influence physicians and sometimes change how they practice,” she asserts. “We need M.D.s in [these] positions.” Having a physician at both ends of the equation makes sense, since “a physician won’t be able to say to another physician, ‘You don’t know what it is like on the ground.’”
The idea of mixing business with medicine appeals to many physicians-in-training, but envisioning how such a career would look can be difficult, especially when your experience has been limited to the clinic. Heading an HMO or running a group practice may spring to mind, but these jobs are just the tip of the iceberg. Like clinical practice, executive career options vary enormously, running the gamut from procurement to policy-making.
“The challenges of an executive career involve asking strategic as well as medical questions,” says Dr. Amrit Ray, who has made his career in the pharmaceutical industry and also holds an M.B.A. “People are often surprised to find out that there are several hundred thousand physicians [in executive positions], and they do many different things.”
Ray is vice president of medical safety assessment for Bristol-Myers Squibb—just one direction a physician can go in that industry, where other options include working in clinical trials, research, marketing, education and strategic planning.
Not all physician executive positions require the skill set of an M.B.A. though. “In some careers, medical skills are more pertinent; in others an M.D./Ph.D. might be better suited to the job at hand,” Ray notes. “The set of opportunities has evolved very much in the past 10 to 20 years.”
Both Linney and Chandler agree that the field is booming right now. But, Linney warns, “the competition is fierce.”
In the nonmedical world, graduates choosing business careers are about as normal as it gets. Your parents will be proud, and no one will ask awkward questions about why you are doing this. But a medical student deciding to take this route still raises a few eyebrows. Why would anyone want to spend eight or more years learning medicine just to don a suit and tie and shuffle papers? And how can you know if it’s really right for you?
“In my experience,” says Hurley, “some students enter medical school already set on the notion of becoming a physician executive, but most tend to gravitate toward it as they progress in their medical education. During my first and second years, I took a hard look at the injustices I was fighting as a local student group leader, and recognized that the solution required change driven by executive leaders, not simply by rank-and-file physicians.”
Katherine Chiu, a 2009 M.D./ M.B.A. candidate at the University of California, Irvine, School of Medicine (UCI) and the Paul Merage School of Business, knew this was the path for her in the fall of her first year of medical school. “As an undergraduate, I had been exposed to lots of business education, and I have always been interested in the politics of medicine,” she recalls. As she began her medical training, Chiu witnessed medical directors and chiefs of staff “trying to be advocates for
their patients and having to fight with insurance companies.” She saw her role clearly.
Hurley’s and Chiu’s approach—exploring the business path during their educational years—is the way to go, believes Linney. “Often, people get into medical practice and find that it’s not what they expected. They look around and think, ‘Maybe I’ll try management.’” This is not the way to step into a physician-executive career, she says. “You can’t do this because you’re running from clinical practice. You have to have a passion for this kind of work.” Chandler agrees: The right person will be someone who “has the urge to fix the health-care system,” she believes.
In addition, you have to be a problem-solver, a team player and a good communicator. The ideal candidate will “behave well and work well with others,” says Linney, in her best imitation of a kindergarten teacher. “Screamers and throwers don’t make it here,” she says.
Earning Your Pinstripes
So once you’ve decided that this is for you, what’s next? Looking over the course listings for medical school, you’ll probably notice that there aren’t very many (if any) courses on the business of medicine. The obvious solution, of course, is to take the road Chiu, Hurley and others are on: getting a dual M.D./M.B.A. degree. It is becoming more common for medical and business schools to align programs for students to pursue these dual degrees. In 1993, fewer than 10 universities in the United States and Canada offered M.D./M.B.A. degrees; now more than 50 have such programs. Each school has its own method of including all the course work, but typically the dual degree takes an extra year (and costs roughly the equivalent of an extra year’s tuition), making for five years before residency training. The M.B.A. work can be done between the third and fourth years or in segments during the last two years of medical school—the course work cannot be done simultaneously.
That’s not all there is to it, though. “Education is not the ticket in, as it is with clinical practice,” says Linney. “Most recruiters [for management positions] are looking for someone who is board certified, has practiced clinically for at least five years, and has some management experience.”
But you don’t have to wait until you complete your residency and start practicing to begin building a résumé that will ultimately land you a good management position. “There is a lot you can do at the medical school level to get you started,” says Linney. She recommends taking on a variety of leadership roles, particularly those having to do with finance. If potential employers see that you’ve had management experience, particularly supervising people and handling money, you’ll be ahead of the game, she says.
Bill Rietkerk, a 2008 M.D./M.B.A. candidate at UCI, is taking this approach: “I’ve been using my M.B.A. training to advance a personal project developed here at UCI. It’s called the Joel Myers Melanoma Awareness Project. We teach junior-high and high-school students about sun health and melanoma. I have been able to use my training to secure an endowment that has allowed us to continue the project far into the future, and I have used training about process organization to streamline and reorganize how we recruit volunteers and schools so we can increase the amount of children we reach.”
Of course, as Ray at Bristol-Myers Squibb has pointed out, an M.B.A. is not always necessary in order to become a physician executive. The ACPE was formed as a response to the growing need for physicians in health-care management positions. Rather than promote M.D./M.B.A. programs, however, the ACPE designed its own certification program using a mix of live training, online training and distance education. The association also provides networking and assistance with job searches. But while there are many routes one can take to prepare for a career as a physician executive, everyone agrees that the first step is taking on leadership roles as early and as often as you can.
In some respects, careers in the business of medicine and in the practice of it are not vastly different. Physician executives can make more money than family practitioners or pediatricians, but rarely approach the incomes of cardiologists or orthopedists. The hours can be long, but there is rarely evening and weekend call.
A “day in the life” will be different, though. A physician executive will spend little time with patients (sometimes none), and lots of time in meetings. He or she will work closely with other physicians, executives and sometimes government officials. Paperwork will overtake lab work, and negotiation will often trump independent decision-making. The goals and satisfactions are much the same, however. Whether you are in the clinic or the business office, you are working to impact the health of individuals.
In the end, the important questions are not “Am I suited for this?” or “How do I pull it off?” but, “Is this the life for me? Is this what I want from medicine? Is this what I want to contribute to medicine?”
For Ray, the answer is a resounding yes. “As a resident, I was very engaged with patient care. I…would sometimes see 20 to 30 people a day. You can miss that sometimes,” he says. “But there were many limitations as well. Therapies were not available or not accessible, or economic constraints kept the patient from getting what was needed. It was troublesome. I looked at the Hippocratic oath and wondered if we were doing all we could. I began to look at where these problems are solved…and that brought me to the pharmaceutical industry.”
For similar reasons, Chiu hopes to work in a nonprofit or at a health policy institute, helping to design a better system for future patients. Rietkerk hopes to run a group private practice and eventually become a department head in an academic setting. Hurley is already using his administrative skills as national vice president of the American Medical Student Association. And all are figuring out unique and challenging ways to put their medical training to use helping patients on a large scale, changing the outcome not only for a select group of people but for all of society. “It [will] be an incredibly rewarding career,” assures Ray.
Avery Hurt is a freelance writer in Birmingham, Alabama. Direct comments about this article to firstname.lastname@example.org.