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For other articles and previous issues click here. September 13, 2004 Reading
Rooms & Boardrooms David Larson seems like any number of high-flying radiology residents across the nation. He works long, hard days. He’s dedicated to his craft. He anticipates a promising career in the imaging sciences—once he jumps through a few more hoops. But what sets Larson apart from most residents is his second valuable skill set. He’s a graduate of both the Yale School of Medicine and the Yale School of Management. David Larson, MD, MBA, is fluent in both the language of the reading room and the boardroom. Notably, he earned his degrees simultaneously—in arguably the finest joint MD/MBA program in the nation. Once virtually unheard of in the healthcare arena, people like Larson, 30, typify an emerging breed of medical professionals—the “physician-manager”—whose skills, many observers say, are needed to bring order to a bloated, beleaguered, and Byzantine American healthcare system. As the nation’s healthcare crisis sharpens, a leader of the MD/MBA movement asserts that radiology is in need of top-notch managers and maintains that adopting the best practices of the business world will translate into better care for patients. Amateur Hour Is Over According to Howard P. Forman, MD, MBA—director of the joint MD/MBA degree program in medicine and management at Yale—the rise of the physician-manager (or physician-executive) is good for the industry and nation. “On the macro level,” he says, “the ultimate goal of the Yale joint MD/MBA program is to improve the efficiency of the delivery of healthcare services so that more people can receive better-quality healthcare.” Forman discounts scattered concern that physicians will soon be donning green eyeshades. “I wish we had infinite resources to be able to deliver healthcare to every single person without thought toward cost or how to deliver it,” he says. “But this has never existed and never will. I think it is far better for well-educated physicians with management science training to be playing these roles than so-called bean counters and consultants who have absolutely no experience in practicing clinical medicine yet make decisions about the practice of clinical medicine in a very naive manner.” Larson agrees and points to recent research he coauthored with Forman and Maria Chandler, MD, MBA, in Academic Medicine. Their study found a sea change in healthcare leadership nationwide paired with a surging demand for management training among new physicians. It also documented the proliferation of MD/MBA programs nationwide (approximately four dozen today, comprising roughly one-third of all medical schools) and forecast more than 100 such graduates each year. “I think the opportunity to do an MD and MBA simultaneously gives one a needed global perspective on medicine,” says American College of Radiologists Board of Chancellors Chairman James Borgstede, MD, FACR. “We need to spend our fixed healthcare dollars wisely. An advanced business education is really the way to go.” Roger Schenke, MBA, executive vice president of the American College of Physician Executives, adds, “We as an organization are very supportive of physicians getting training beyond their medicine, particularly in leadership and management. It helps make them [better doctors] when they understand that there’s more involved in medicine and healthcare than what’s between them and the patient—that there is a whole system of supports involved.” That said, Schenke says new physicians should consider getting more clinical experience under their belts before pursuing advanced management training. Despite the Yale joint MD/MBA program being less than five years old, Forman thinks it is already beginning to make ripples. “Our students,” he says, “are truly the creme de la creme. We have a wonderfully motivated group [that] I really believe embodies the best of humankind. Yale is unique because it really integrates the two degrees. Our students train at both the medical school and business school. Another distinguishing feature of the Yale program is that graduates typically go on to clinical residencies, and nearly all of Yale’s students participate in healthcare-related internships within government, academic medicine, or not-for-profit spheres.” Typically, Forman’s students attend business seminars even before entering the school of management. During the course of their studies, the students rub shoulders with major players in the healthcare world, including industry leaders in pharmaceuticals, biotech, research, education, policy, and politics. “Not a single other program among the four dozen that exist right now,” he says, “can offer even a fraction of what we’re doing.” Staying Clinical Looking at the big picture, he says the Yale program opens students’ eyes to career tracks that might not have ever crossed their minds. “With the exception of Sen Bill Frist, [MD,] who would even think a physician could play a role in politics?” he says. “But now they realize the world is wide open to them and the opportunities are vast. This summer, I have a student working at the FDA, another at the Centers for Medicare & Medicaid Services, another as interim executive director of a not-for-profit organization.” Among the Yale classes of 2002 and 2003, 10 MD/MBA students received residency matches, two in diagnostic radiology: Larson (University of Colorado Health Sciences Center) and Daniel Saketkhoo, MD, MBA (University of Pennsylvania). Californian Saketkhoo notes that all MD/MBA students follow a core curriculum at the Yale School of Management. Among the roughly 250 students, half are international students, producing a rich educational experience. “The MBA program,” he notes, “has people from many backgrounds: finance, sports marketing, consulting, New York investment bankers. During the first year, we all took accounting, marketing, economic theory, leadership, operations management, decision analysis, and game theory. The second year, we chose a concentration—typically healthcare leadership—and [took] whatever elective courses we wanted.” Healthcare Leadership Although flexible, the five-year program typically sees students attending three years of medical school, followed by one year of business school, and finishing with a final combined year at both schools. “No matter what,” Larson says, “you’re going to interrupt your medical training. The best time to do that is probably between your third year of medical school and first year of residency.” “The workload,” Saketkhoo recalls, “was probably the heaviest during the second year of medical school, but the core curriculum of business school was very demanding. At medical school, we participated in a Wednesday evening continuity clinic to keep our feet in medicine and to keep our clinical practice going so we didn’t forget things.” Reflecting on the grueling yet surprisingly exhilarating academic slog, he says, “While you’re in medical school, it’s overwhelming to some degree because you’re just being bombarded with information. Every time you go on a new rotation, it’s like starting a new job.” Saketkhoo received his BS in chemistry from Stanford University. Larson was a mechanical engineering undergraduate at Brigham Young University and completed the full two years of the MBA program and a summer internship. The Business of Radiology “Some people are skeptical,” he says. “They suspect that I’m using my [MD/MBA degree] to climb the ladder more quickly—that I’m using my business background strictly to my advantage. But the reason why I and most of my fellow students went into the MD/MBA program had nothing to do with simply making money or enhancing our careers. We feel this is the best way we can contribute to patient care. Gaining a background in the science of management and intelligently understanding and dealing with complex systems is a great way for physicians to improve care on both ends.” Forman, an MBA and accomplished radiologist, agrees. “In the field of radiology,” he says, “the need for management training is much greater than it is in fields like internal medicine because we are involved in a series of processes that can be delivered much more efficiently when you take advantage of management sciences. This has worked in every other field that deals with processes, and radiology is so fast-moving that adopting some of the best practices can only mean better-quality care to more patients.” Saketkhoo concurs. “I think in some specialties—such as internal medicine—an MBA would be frowned upon. Most of the people I spoke with in radiology are MBAs themselves and understand the application of management principles to radiology. For some reason, medicine and business were viewed by the internal medicine people as not really being compatible. In radiology, it was viewed as potentially synergistic. Synergy occurs when you can apply financial management skills to the delivery of care so that you can deliver the most care in the most cost-effective manner in a well-distributed manner.” Continuing, he says, “I’ve seen a lot more MBAs in radiology than in other specialties, maybe because organizational skills are a little more important in radiology. First, you’re dealing with very large departments and subdepartments. Quite often, you’re contracting with GE or Siemens, or contracting with private practice physician groups for referrals and such. To some degree, what heads of radiology departments are thinking is: ‘How can we maximize throughput with an MR scanner? How can we maximize workflow and minimize downtime? By its nature, in radiology, you’re thinking big picture, even though for each individual study or scan, you’re doing your best for that individual patient in his or her specific clinical situation.” Broadening the focus, Forman offers, “The only way any given practice can continue to provide care to the uninsured is for them to be so efficient with their other care that they have something left over. So even in the most charitable way, you actually have to become quite savvy to the market.” — Matthew Robb is a freelance writer based in suburban Washington, D.C. He is a frequent contributor to Radiology Today. The Big Question: “Traditionally, the forces of medicine and business have pushed against each other,” he says. “The joint MD/MBA raised eyebrows from some of my colleagues at first—until I explained what I wanted to do with it. Ultimately, my goal is to improve patient care and to help doctors do what they do best, but help them do it better. “We’re in a serious situation in this country,” he says. “Medical care is out of control in terms of cost, safety, and equity. I’m trying to bring the science of management, the science of dealing with logistical complexity, to healthcare. To say that you can ignore that—to say this issue is nonessential—is putting your head in the sand. Any complex system, industry, or service relies on intelligent management.” Says Daniel Saketkhoo, MD, MBA, “The application of the management concepts that we learned in business to the healthcare field can be a very positive thing.” Most people in healthcare will agree that it’s better than the alternative—where “bean counters” call the shots. — MR |
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