Getting an MBA can help the practice and health care reform

A better understanding of business principles can help physicians manage their practices as well as move health care reform forward.

In an age when the practice of medicine is intertwined with industry and politics, many physicians are obtaining masters of business administration degrees to learn the business of medicine.

Ocular Surgery News spoke to three ophthalmologists with MBA degrees and one in an MBA program and asked about their reasons for pursuing the additional credentials. All agreed that an MBA program is not for everyone. Pursuing the degree is time-consuming and expensive, in addition to working full-time. If the interest is there, however, earning a business degree can be rewarding.

Mixing business with medicine

Joseph C. Noreika, MD, MBA, a member of the Practice Management section of the OSN Editorial Board, pursued his MBA when the fields of medicine and business were more separate, and physicians seldom crossed over. Dr. Noreika earned his degree in 1986 at Case Western Reserve University in Ohio. At the time, physicians with business degrees raised eyebrows, but the sentiment is changing, he said. Even now, physicians with MBAs may not be fully appreciated in a practice.

“That’s changing somewhat, but even 17 years after I began that MBA, many are still leery about embracing a physician who has a business interest. It gets back to the idea that the profession should keep an arms-length relationship that we not only practice, but we also make money,” he said.

For that reason, physicians with a MBA may not be fully valued under another’s direction. In addition, many physicians would just as soon hire a manager than become one. After opening his practice in 1984, Dr. Noreika said he quickly recognized a need for business skills and decided to return to school. Information technology was emerging, and he knew it would play a role in his career.

“I needed help with a small business I anticipated was going to be larger, and I didn’t have any of the financial, personnel management and marketing tools,” he said. “I didn’t understand the science of it. I also realized that information technology was going to become a larger piece of the medical puzzle.”

The commitment was significant, he said. Not only the time spent on class work but also the cost of time spent out of the office and away from family, but the timing was right and the MBA has paid off in many ways. He said the degree has helped him be more analytical in his business decisions and in how he deals with personnel. For him, the challenge of learning continues, and he periodically attends executive seminars at major business schools.

“When I was in my first practice and questioned the senior physician about my performance bonus, he said, ‘This is business,’ and did that stimulate me. I thought, I may not know now, but thought someday I would,” Dr. Noreika said.

Changing times

Like Dr. Noreika, Nina Taggart, MD, found she lacked the business skills that are part of a practice and of being medical director of quality for Blue Cross of Northeastern Pennsylvania. Dr. Taggart attends an online program from Alvernia College in Reading, Pa., for a health care MBA.

“I saw the health care delivery system changing all around me. I was lucky enough to be involved with the medical staff and well integrated into the health care delivery system for our region, but I thought I needed to know more. I wasn’t speaking the same language as the operations people at the table, so I felt at a disadvantage,” Dr. Taggart said.

She said the program has made business principles concrete and has allowed her to see how terms such as economies of scale affect the practice of medicine. By understanding the foundation, she can see why problems arise in the health care industry.

“It’s an imperfect fit; the challenge is trying to decide a problem, especially as medical director. You’re approaching it from both sides … it’s a question of what’s the most productive way to look at it, which is usually done on an individual or small scale,” she said.

Quality care vs. business issues

While business skills can advance a physician’s career, it can also help represent physician and patient interests in the managed care and political arenas. Melissa Brown, MD, MBA, of Flourtown, Pa., became interested in pursuing an MBA after helping her husband, also an ophthalmologist, launch a physician-owned insurance company in Pennsylvania. In the process, she became politically motivated to be involved with health care reform. As she was finishing her MBA coursework in 1998, Dr. Brown was campaigning for the U.S. congressional nomination in her district.

Both she and her husband, Gary Brown, MD, were students at St. Joseph’s University in Philadelphia for a strategic management MBA. She said the experience was invaluable, but she learned the differences between practicing medicine and management are vast.

She said she learned there is little sympathy for physician issues in the industry because according to business practice, the laws of supply and demand dictate policies.

“As a physician and as a nurse, you see your patients one-on-one. When you get into health issues, you practically close your office to figure out how you can take care of someone. In the business world, it’s very different. What you learn is how they think,” Dr. Brown said.

The MBA helped her combine business tools with her medical background. In an effort to influence health care reform, she has been instrumental in developing a vast standardized utility database for quality-of-life measurement. She is measuring the quality of life from different interventions for various health states, she said. Her goal is to create accurate numbers for cost-effective health care. She said she is pleased with the interest shown at the federal level in cost-effectiveness of medical interventions.

Right for you?

From applying an MBA to the practice, the hospital, the health care industry or politics, getting an MBA will not advance you without a personal interest in business. The additional schooling carries a significant amount of work, and although medical school is the same, returning as a professional may prove to be a humbling experience, said Barrett Katz, MD, MBA, OSN Neuro-Sciences Section Editor.

Dr. Katz attended the Simon School of Business Administration at the University of Rochester. He said the program was interesting but heavily quantitative, which may have been why he found it difficult. He attended a program for working adults, and the coursework took about 20 hours a week in addition to class meetings.

Other programs, like Dr. Taggart’s online degree program, meet periodically at the school or via the Internet. For Dr. Taggart, being able to set her own schedule eliminated her commuting time, but the amount of time spent at home was still significant. However, the return is worthwhile. Faculty members give constructive feedback, and professional endeavors can become class projects, she said.

“You need to look at why you want to do it,” she said. “It’s a long-term commitment, and things can sometimes change quickly in people’s lives. You want to have some value to the courses as well as some value to the degree.”

For Drs. Brown and Katz, they believe if more physicians had MBA degrees, they would have a greater representation in the health politics of the day.

“There are many physicians that are leaving [Pennsylvania] or leaving … the practice of medicine. This could open … up their practice in business related ways, or as I’ve done to move health care reform forward so we can move in the direction of maintaining access,” Dr. Brown said. “If we as physicians get a business background, then we begin to move more intelligently forward.”

“If more physicians had gotten involved in the business of medicine years ago, we wouldn’t be in the difficult and painful position we are in now,” Dr. Katz said. “If more physicians had been active in managing and directing the business enterprise of delivering clinical care, we as physicians and as patients would be much better off.”

For Your Information:

• Joseph C. Noreika, MD, MBA, can be reached at 3424 Old Hickory Lane, Medina, OH 44256, (330) 723-2070; fax: (330) 725-4900; e-mail: jcnmd@aol.com.
• Nina Taggart, MD, can be reached at 1725 East Broad St., Hazleton, PA 18201; (570) 200-4375; fax: (570) 200-6822.
• Melissa Brown, MD, MBA, can be reached at 1107 Bethlehem Pike, Suite 210, Flourtown, PA 19031; (215) 233-9277; fax: (215) 233-1974.
• Barrett Katz, MD, MBA, can be reached at the George Washington University, department of ophthalmology, 2150 Pennsylvania Ave. NW, Washington, DC 20037; (202) 741-2825; fax: (202) 741-2821; e-mail: bkatz@mfa.gwu.edu.