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At the turn of the 20th century, Abraham Flexner, a research scholar at the Carnegie Foundation, visited the 155 medical schools then in operation in the US and Canada, on a fact-finding mission about the quality and standards of modern medical education.
His findings, documented in the Flexner Report, were often scathing; he characterised some as “indescribably foul”, and one in particular as “the plague spot of the nation”. About half the schools closed as a result of his report, and the curriculum he proposed – two years of basic science classes, followed by two years of clinical rotations – quickly became the norm.
Today, this curriculum is standard, and it leaves little room for anything else. Many medical students graduate with no idea how insurance works or how to set up a practice.
But at a time when issues such as the rising cost of health insurance and an ageing population dominate the political agenda, many students are coming to the realisation that this traditional approach is no longer sufficient. An increasing number are augmenting their medical education with a joint MD/MBA.
“To have the impact I want to have, I need to understand business,” says Fallon Ukpe, a student in the MD/MBA programme at the Duke University School of Medicine and the Fuqua School of Business in North Carolina.
Ukpe, president of the school’s student body, aims to work at a hospital in a strategy and leadership role after graduation. “With just an MD, I could see patients and that is very noble, but I want to change the way we practise medicine,” she says.
Joint MD/MBA programmes, which combine medical training with the study of business and health industry management, have multiplied in recent years. In 1993, there were ﬁve programmes in the US; today there are 65, according to figures from the Association of MD/MBA Programs (AMMP). Among the top schools that offer the dual degree are Columbia, the University of Pennsylvania, Harvard, Dartmouth, and Cornell.
Sweden’s Karolinska Institutet recently became the first school in Europe to offer a joint medical and business degree.
“Healthcare is not done in a vacuum,” says Don Melville, director of MBA and masters programmes at the Desautels Faculty of Management at McGill. “A physician who knows his or her speciality, but who also knows the administrative side of things is able to make the best decisions, and maximise the efficiency and value of the system.”
Maria Chandler, AMMP president, says the trend toward such programmes is student driven. “Students are recognising the complexity of healthcare,” she says. “They realise change is needed, and the more skills they have, the more they can help.”
Schools view these programmes as “a good recruiting mechanism”, adds Dr Chandler, a paediatrician with an MBA, who is also an associate clinical professor in the medical and business schools at the University of California, Irvine. “If you don’t have a dual degree programme, that limits the kinds of students who are interested in your school.”
Most MD/MBA programmes are five years in length and structured in a similar way. Students spend three years completing the required medical curriculum, followed by a year at the business school doing a set of management courses, such as finance, strategy and marketing. Generally, the final year is spent on electives at both schools. Most encourage students to complete a medical residency or other clinical training upon graduation.
The goal is to create doctors who understand core business concepts and who are adept at teamwork, according to Stefanos Zenios, professor of healthcare management at Stanford Graduate School of Business.
“We’re not just teaching the business of medicine; we’re teaching business in general,” says Prof Zenios. “It’s the hard skills of management, such as budgeting and accounting, but also the soft skills of how you work in a complex organisation with different cultures and constituencies, how you make change, and how you influence.”
Many students say that business school provides welcome relief from medical school, which requires a vast amount of reading, memorisation and lonely academic work. Business school tends to involve more group-based assignments and activities.
“It’s not a break,” says Prof Zenios. “They use a different part of their brain. They students love the social, experiential, teamwork-based aspect of the MBA curriculum. But they find courses such as finance very challenging.”
The programmes are still relatively new, so there is not a well-trodden career path. School officials say that the majority of MD/MBA graduates pursue careers where they practise medicine. Others work as administrators of large medical groups, in academia or in non-profit organisations; some become entrepreneurs who develop new diagnostics, medical devices or treatments. Very rarely, some graduates pursue careers in investment banking, private equity and consulting.
“[Graduates] are going into a turbulent economy,” says Kevin Schulman, professor of medicine and business administration at Fuqua. “They understand that something fundamental is changing in the healthcare industry. They have a genuine interest in learning the issues, and the majority are committed to medicine as a career.”
Woodrow Myers, who received an MD degree from Harvard Medical School and, years later, an MBA from Stanford, is a former New York City health commissioner who has also worked in the private sector.
Dr Myers is a proponent of the sequential dual degree, rather than working on the degrees simultaneously. “It helps you become a better business school student if you have some experience of making a budget, hiring people, firing people, and trying to make an organisation successful,” he says.