Administration & Operations

The Dual Degree Debate - What to Consider Before Getting an MBA as a Physician

The business of health care is changing. Does that mean you need a business degree?

When people find out I have a dual MD/MBA degree, their first question is usually about what I intend to do with an MBA. When pinched for time, I usually say something glib, like "have my own parking spot." In reality, the utility of the MD/MBA dual degree is difficult to explain quickly. Moreover, the factors that go into the decision to get a second degree can be numerous, complex, and individual. I started my MBA at the end of my first year of medical school and finished it during interview season. Fortunately, I was able to pursue both degrees concurrently and finish both in 4 years. However, not all programs nor all students are the same. My path and my perspective on the dual program may not be identical to another MD/MBA, but I hope that this article can help those thinking about pursuing a concurrent business degree.  

An MBA will:

Expand your knowledge base
Having a background in business or economics is not mandatory for pursuing an MBA. However, you will inevitably learn a lot more about these and related topics while pursuing the degree. As physician learners, pursuing an MBA also helped me experience a break from the science-heavy subjects and was a refreshing way to gain some knowledge about the business world. You will work with classmates who have no idea what a Kreb even is, but have a wealth of non-health care industry knowledge that is both illuminating and interesting. You will also study topics that cover a broad range that encompasses economics, design, and marketing. Your intellect will truly grow and help you understand the world outside of the hospital and textbooks. 

Provide experience in the non-medical world
You won't necessarily be "interning" on Wall Street, but some aspect of your MBA training will have you working on a consulting project or similar. You will experience some semblance of what day-to-day life looks like for people who, for instance, don't live in hospital call-rooms. 

Help you become a better leader AND team player 
Many of the MBA classes are a combination of small-group and individual work. While basic prerequisite classes like statistics are heavily skewed toward the individual side, the vast majority have some group project or team deliverable. In the medical field, we tend to be the kids who still have traumatic memories of having to do all the work in school projects, as we are inclined toward perfectionism. The same holds true for the kinds of individuals who decide to pursue MBAs. Having so much group work, you really learn how to step up when things are a bit disorganized, or when your particular strengths and expertise are needed. At the same time, there are occasions when you have to fall back and allow others to lead and contribute. This is very true for teams in both medicine and business. However, whereas in medicine you almost expect a similar background and a well-established hierarchy, in business school, the teams are so varied and diverse, that you really have to hone both your team-building and team-leading skills. 

Broaden your network 
Someone once told me an MBA is all about learning how to shake hands. That's true, to an extent. For instance, during my MBA training, I had the opportunity to be in groups with and get to know attendings from my own medical school, administrators from nationally recognized companies, and even a producer from a well-known TV studio in NYC. You learn how to present yourself professionally and with confidence. You can no longer hide behind the short white coat saying, “I’m just a medical student, I don’t know yet.” You learn how to mingle and foster a sense of familiarity with new acquaintances. All of these are really great skills to have as a physician, particularly in a field where you have such a short period of time to build a connection with a patient. So, while part of it is the simple action of shaking hands and trying not to focus so hard on the shaking that you forget the person's name, the most important aspect is learning the skill of relationship and network building. 

Teach you a new vocabulary 
"Enterprise solutions," "momentum," "synergy," "risk management," "strategy," "growth," "leverage." Pepper a few of these puppies into regular conversation and you're basically a CEO. Realistically, you have to know the language to establish some baseline from which the team, unit, or company operates. We have our own medical lingo. "Pt. was NPO at MN 2/2 N/V/D s/p KUB and labs. W/u WNL. IVF d/c'd. WBAT." (Try saying that at a sales meeting and not being carted away in an ambulance for a stroke evaluation.) Memorizing MBA lexicon won't teach you all there is to know about business or leadership, just like knowing medical jargon can be accomplished by TV script writers without any actual medical knowledge. However, it WILL teach you the vocabulary to contextualize your formal and real-world learning. 

Give you street cred
OK, maybe not street cred per se. However, having an MBA really shows that you mean business (sorry, I had to use that pun somewhere). It shows not only a recreational interest in administration or business, but a true dedication to the field. When I went to my hospital system's CMO as a 4th year med student and asked to follow her around for 4 weeks, she knew I wasn't looking for a vacation block. As a result, she created a 4-week, comprehensive crash course for me to learn many different aspects of hospital administration. It was a once-in-a-lifetime opportunity that would not have been granted to me had I just shown "interest" in administration without the 3 letters to back it up. A few attending-level physicians have told me that having those extra letters has helped them advance the nonclinical parts of their career as well. Many doctors are reluctant to go into administration. The concept of medicine as a business is offensive to many clinicians, but it's also our reality. If you look at the administrators at your hospital, I bet there are just a few MDs (with the majority in middle management) and mostly RNs, MHAs, CPAs, etc., in the highest positions.  So, when doctors go that extra step to obtain a business degree, it shows their commitment to and interest in nonclinical aspects of the health care system, contrary to the common assumption that doctors have no desire to step into that world. It effectively puts them in the game as well.

Provide you with a plan "B" 
No one goes to medical school thinking they will go through the rigors of medical training and residency only to burn out 5-10 years later and never wanting to see a stethoscope ever again. However, physician burnout is an undeniable problem. Emergency medicine is notorious for burnout, even before you finish residency. While it's healthy to be optimistic and positive about our futures, we also need to be aware of this reality. We can't expect to want to switch days and nights every few shifts and be on our feet for 12 hours for the rest of our careers. We also cannot predict what will happen to our bodies, emotions, and life situations later in our careers. That's why you need a backup plan to protect that huge investment in time, money, and youth you made by going into medicine.  

An MBA will NOT:

Make you a financial guru, venture capitalist, stockbroker, etc. 
For some reason, the minute you graduate from medical school, everyone wants your medical advice. As if, suddenly, having a diploma in your possession is what gives you all that knowledge you've spent years acquiring. The same thing happens when people learn you have an MBA. I honestly still have just rudimentary knowledge of how stocks work and have a negative net worth to invest into startups. If that's your thing and you put time and interest into those skills, by all means, go for it. However, don't expect an MBA to make you into a "finance" person. Sure, basic finance is part of the training, but people go to years of business school specially dedicated to finance or investing or have decades of experience before they can even be a viable player in the financial world.  

Give you a parking spot and C-suite… yet 
You don't earn the 2 letters after your name without blood, sweat, tears, or other bodily fluids which may or may not belong to you. Similarly, no one will make you a CMO/CEO/CIO/C-whatever-O the second you get your MBA. You still have to work hard to advance that part of your career. You have to climb the ladder, establish yourself, and prove your skills just like you do in medicine. The same way you cannot walk into a hospital with your med school diploma and expect to be an attending, you can't get a C-suite office as an MBA graduation gift either. It is, however, a nice conundrum to have when you have to figure out for the first time how to arrange MD, MBA with all the period and comma glory at the end of your signature. 

Eliminate the need for doing a residency 
The most uniform, consistent piece of advice most physician leaders, MD/MBA or otherwise, have given me is: "You have to be a good clinician first." This is the difference between being called "doctor" vs. being called "Mr./Mrs.," or worse, a "suit." Inherent to being a physician leader is being a physician. Inherent to being a leader is that you, usually, have to be good at what you do, or at least be respected for what you do. You have to do a residency and spend that time being the best doctor you can be. Unless you're over the whole doctor thing and want to be a "consultant" forever, you cannot forego residency training. Even IF you want to be a consultant, and you are not residency trained, you might regret it when no one takes your medical training seriously. Residency does not only train you in your specialty, it trains you to understand both the healthcare system at large and microsystems unique to the institution. It helps you understand what the flow is really like, and what problems clinicians actually (vs. theoretically) face. It also gives you a huge set of colleagues and friends who can contribute to your knowledge, career, and influence.  Moreover, finishing residency isn't just a checkbox to complete so you can move on to bigger and better things. Residency is where you hone your doctoring, leadership, and management skills. You have to be a good doctor to earn respect as a physician and as a leader. 

Teach you all there is to know about business 
Did medical school teach you all there is to medicine? Probably not. The same applies for business school. You still have to research and read up on topics when you lack full understanding, and you have to go through some on the job training as well. There will be MANY such topics because both fields are very broad and are impossible to condense into a finite amount of education. 

Guarantee you a high-paying job after school or residency 
This one goes with the parking spot statement, with a little qualification. It can be tempting to look at the salaries of the CMOs and other MD/MBA big shots. Not only are the salaries enough to make you want to Scrooge McDuck into a fantasy pool of money, but the benefit packages induce immediate salivation. But in reality, everything is a bell curve; we just don't often hear about those on the lower end of the curve. While on average, an MD/MBA degree can lead to a higher salary, that higher salary is not because you happen to be the doctor with an extra degree and more student loan debt, but because the degree, along with a lot of hard work and experience, allowed you to attain a position that pays a higher salary. Therefore, some of the statistics might make you think that you will earn more than average just because you have more education. In reality, you still have to get a job, perhaps one that uses your MBA, in order to get that higher salary. 

Factors to consider before making a decision:

Burden
Getting a second degree requires sacrifice in terms of money, time, energy, family, etc. Whether you are getting it during, before, or after medical school, these demands are often concurrent and, therefore, double. During my MBA training, I had online classes every Thursday evening, meaning my entire family had to coordinate and take turns entertaining and keeping my very loud toddler - who had the sole life mission of breaking into the bedroom and ripping out my headphones - quiet. Their Thursday (and many other) evenings were captive to my MBA work, online team meetings, and powerpoint recordings in addition to the rigors and demands of having a wife, mother, and daughter in medical school. While I could sometimes work out scheduling issues between med school and my MBA program, I had multiple really tough moments that required an energy level and insomnia that bordered on mania. I still get tachycardic and sweaty remembering how I had to do a week-long, on-campus boot camp for the MBA while studying for Step 2 (which was 1.5 weeks away), with my usual childcare provider being out with a broken hip. Additionally, it is difficult to make assumptions about how flexible individual residency directors can be with even online classes, let alone the in-person activities some MBA programs demand. You also have to consider whether you can truly sacrifice all of your post-shift or personal time and intellectual real estate to crack open yet more textbooks and participate in class. In residency, some portion of that time should be spent studying medicine and preparing for your boards, which can be difficult if you have a whole other degree for which to study. In terms of the financial sacrifice, as a person who avoids looking at their loan statements to ward off nervous breakdowns, I can tell you it's not small. My medical school offered an alumni discount (very tiny but not negligible) as well as forgiveness of 25% of the required MBA credits because of the dual program, which helped a little. However, my debt is still the size of a small private island that keeps magically growing while I sleep. Some universities offer discounts for staff and faculty as well. You have to do the math to figure out what is more fiscally realistic for you and what kind of discounts and offers you can take advantage of. This might make a difference in your loan repayment or deferment, as well as the timing for when you would enroll in classes to maximize your tuition savings. 

Timing
I knew that after medical school, I would probably never want to go to any kind of school ever again. That's why I decided to suffer once and get the degrees done together. As a resident, I cannot imagine factoring in an MBA degree right now, but it may not be impossible, depending on your program and schedule. Waiting to be done with residency to do the MBA is another option, one that depends on your post-residency plans and life stage. For some, this may be the optimal timing, since your schedule may finally have some flexibility. As mentioned previously, be aware that timing may also impact what kind of financial incentives you have for doing the MBA. For instance, some jobs may offer to pay for a portion of your classwork, while your alma mater may provide tuition discounts. You may potentially get better loans and scholarships before you start making that sweet attending money. Depending on the program, there may also be limits on how much time you have to complete the degree. If you pursue both concurrently, you may have additional time to space out your learning, given that you might have conflicting schedules and demands from both degrees. If your program sets a cap of 18 months for example, and you still have to pass your Boards and move across the country, and you're also about to become a parent, those 18 months creep up very fast. 

Post-training career aspirations
If you never want to do anything outside of the department, especially anything that requires attire other than scrubs, why put yourself through an MBA? An MBA, or any degree other than a medical one, makes sense only if you are interested in that field of study and/or that field of study will advance your career. If you're getting a business degree just for the knowledge, there's plenty of sources that are several tens of thousands of dollars and years of your life cheaper. Conversely, if you're getting an MBA just for bragging rights, there are better ways to spend 1/3 of your mortgage and 1/2 of your free time. Additionally, with the rise of the Administrative Fellowships, there is a built-in degree that you complete while you do the fellowship. Whether that degree is an MBA or MHA or MPH varies by institution. However, if you are planning on looking for a fellowship opportunity to pursue business, policy, or administrative training, this is a viable option to consider. 

Personality/interest
For some people, the thought of meetings, Excel spreadsheets, and talking to a bunch of suits is one of Dante’s rings of hell. For others, it's a necessary evil to exact change and make important decisions. It all boils down to what is interesting, natural, and stimulating for you. We have all seen that person in med school who dropped out in the first few years, or even the one who trudged through the preclinical stuff until they got to OB and bailed. They were miserable from the onset, and everyone saw it coming from a mile away because they were neither interested nor built for medicine. The same is true for business administration. Either you're the type who digs this stuff and has the right disposition for it, or you're not. It may be hard to tell if you've only thought about it theoretically and have no real-world experience. My suggestion is to do what wannabe doctors do to figure it out - shadow in some capacity before you take the plunge. I got my taste for business administration while inadvertently falling into that role in my job before med school, which made me realize that I was both cut out for and into this whole business thing. Some residencies and even med schools offer rotations or electives for you to get a taste of the admin world for yourself. Alternately, you can seek out a practicing MD/MBA or administrator who happens to also be a physician and ask them about their experience or see if you can tag along and observe what they actually do.  

Other types of degrees
I don't have much experience with MHAs, PhDs, or MPHs to be able to offer any sensible advice on why you should or shouldn't pursue those instead of an MBA. Undoubtedly, there are specific differences in what the various degrees focus on from a learning perspective and what kind of opportunities they present later in your career. An MBA is usually the most general "administrative" degree and can be applicable outside of health care. With that, however, you sacrifice a health-care-focused curriculum during your studies. If you think another type of degree is better suited to your needs and aspirations, do some research to see what the other degree can offer you that the MBA cannot (and vice versa). It always helps to talk to someone who has pursued that degree and get a sense of their experience. Getting real insight from someone who has both talked the talk and walked the walk is crucial. 

Hopefully, this information will help you decide whether a dual MD/MBA degree is right for you. You may wonder why I would (as the business-savvy doctor that I am) encourage more doctors to become my competitors in the power struggle to be the biggest fish in the health care admin pond. The reality is that there are many, MANY ponds and they are struggling. To overuse the common parlance, the health care landscape is changing, and unfortunately not for the better in most cases. Our systems, our specialties, our patients, and our colleagues need us. They need us to innovate, cut costs, protect our coffers while saving lives, provide a non-whitecoat perspective, and be the bosses that we know we are. And, if you're the right kind of fish for this kind of work, there's plenty of pond to share. 

Suggested Reading

  1. This article in the Harvard Business Review from Lisa S. Rotenstein, MD (a fellow MD/MBA and resident), Raffaella Sadun, and Anupam B. Jena about why we need better leadership training during our pre- and postgraduate medical education: "Why Doctors Need Leadership Training."
  2. A really comprehensive piece by Vidya Viswanathan in The Atlantic that holds true to a lot of my personal experience and that of my MD/MBA colleagues: "The Rise of the M.D./M.B.A. Degree."
  3. The Association of MD/MBA programs: www.mdmbaprograms.org. This website has a fairly up-to-date list of current MD/MBA programs. Most of the programs listed have a link where you have to dig a little deeper for program specifics but this is a good place to start.  

References

  1. Bernhard K. Why an MBA is a good choice for an M.D. Boston Business Journal. https://www.bizjournals.com/boston/news/2018/02/13/why-an-mba-is-a-good-choice-for-an-m-d.html Published February 13, 2018. Accessed March 26, 2019. 
  2. Gorenstein D. Doctors are arming themselves with MBAs to navigate a tricky health care landscape. Marketplace. https://www.marketplace.org/2017/02/15/health-care/why-doctors-are-arming-themselves-mbas-navigate-tricky-health-care-landscape Published February 15, 2017. Accessed March 26, 2019.
  3. Rotenstein LS, Sadun R, Jena AB. (2018, October 17). Why Doctors Need Leadership Training. Harvard Business Review. https://hbr.org/2018/10/why-doctors-need-leadership-training Published October 17, 2018. Accessed March 26, 2019.
  4. Smith-Barrow D. Become a Business-Savvy Doctor With a Joint M.D.-MBA Program. U.S. News and World Report. https://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2013/10/01/become-a-business-savvy-doctor-with-a-joint-md-mba-program Published October 1, 2013. Accessed March 26, 2019.   
  5. Viswanathan V. The Rise of the M.D./M.B.A. Degree. The Atlantic. https://www.theatlantic.com/education/archive/2014/09/the-rise-of-the-mdmba-degree/380683/ Published September 29, 2014. Accessed March 26, 2019.  

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