Business education gives a boost to clinical practice

Investing in a Master of Business Administration degree or some other type of business education can significantly improve an ophthalmologist’s clinical practice and provide enterprising opportunities.

Jai G. Parekh, MD, MBA, FAAO, managing partner at Brar-Parekh Eye Associates in Woodland Park and Edison, New Jersey, said earning an MBA is analogous to having undergone refractive surgery. “I see through a different lens now as everything is more ‘macro’ to me, after having practiced for so many years in a ‘micro’ fashion,” he said.

Parekh received his MD from the combined medical program at Boston University in 1993, followed by an MBA in general management with an emphasis in health care, leadership, strategy and marketing from the Fuqua School of Business at Duke University in 2008.

“On the practice side, my MBA certainly helped me with practice attributes, including marketing, physician leadership, cost accounting, innovation and overhead management,” Parekh said. “And a few of these principles spilled over into some of our surgical centers, a large hospital’s research institute and network building.”

Parekh is also “humbled and flattered” to have had a plethora of consulting opportunities after obtaining his MBA and to have been a principal at a few small start-up companies. “I also had the opportunity of becoming involved with the venture capital side of the business, which was a whole new way of looking at investments and helping drive innovation.” he said. Currently, in addition to his boutique practice, he is vice president of Global EyeCare Medical Affairs at Allergan plc, where it is “great to have a practicing physician voice at the table.”

Image: Visco DM

Parekh acknowledged, however, that he used to have “thicker hair which thinned out a bit” during business school, in part due to three busy practice locations, a surgical practice, three young kids, an ill father, a hectic travel schedule, and speaking and consulting engagements. There was also tuition and associated costs, which totaled well more than $175,000.

“Fortunately, I had a patient and forgiving wife,” Parekh said. “Yes, it was somewhat stressful, but so worthwhile. I feel I have become an awesome time manager ever since.”

Parekh said that business principles are evident in the current health care landscape. “While an MBA may not be for everyone, and it is certainly not, I still think it is important for every eye care provider to learn some business,” he said. This can encompass speaking to one’s accountants or financial advisers, attending local business meetings at hospitals or state societies, finding a mentor who knows business, reading medical business journals, attending eye care meetings where some business principles are taught, attending weekend programs at local or national business schools, or even utilizing online learning.

Parekh cited a 2014 article from The Atlantic that speaks of the importance of an MD/MBA for those who want to purse positions of leadership in hospitals, health care systems and industry. Interestingly, a 2011 study found that hospitals with physician CEOs outperformed those that had nonmedical leadership, he said.

Another article, from American Journal of Managed Care in 2016, identified the myriad reasons that physicians decide to go to business school and what they end up doing with their MBAs. “Not surprisingly, clinical activity and primary employment in a clinical role decreased after receiving an MBA,” Parekh said.

Future excitement

Denise M. Visco, MD, who earned her MD from Thomas Jefferson University in Philadelphia in 1991, is pursuing an online MBA through Jack Welch Management Institute at Strayer University in Herndon, Virginia. She expects to graduate in mid-2018.

Visco’s greatest reward from her MBA to date is “excitement for the future.”

She specifically chose an all online degree program to facilitate flexibility in classwork and assignments.

With a course load emphasizing health care, Visco is required to write roughly four or five essays of around 1,000 words each every week for each class, plus every class has two or three major papers, each running up to 25 pages.

“Jack Welch’s degree program is an excellent value, considering most MBA programs, even online, cost between $80,000 and $100,000,” Visco said. “I will spend $40,000.”

Visco is medical director and president of two practices in York, Pennsylvania: Eyes of York Cataract and Laser Center, and Eyes of York Surgical Center. “My MBA has already enhanced my practice dramatically,” she said.

For example, Visco’s first two classes were leadership and business communications. As a result, she revamped her mission statement, created a detailed values statement for her two practices and established a differentiated bonus program for employees.

“I used learned negotiation and speaking skills to engage buy-in from my staff and inspired a new shared vision for both entities,” Visco said. “The importance of living out the values in our behaviors each day has renewed employee engagement and focus.”

Visco also said that revenues are up, employee turnover is lower and the practices display greater teamwork. “Not bad for the first 10 weeks of school,” she said.

Credibility in leadership and moral management are also now part of the mix. “Skills have been transferred, such as evaluating macroeconomic indicators and creating a marketing plan,” Visco said. “Using financial statements, ratios and projections is next.”

Visco is adamant that she does not want her business decisions handled by a CEO who lacks conventional medical training. “I feel medical professionals should make the decisions in medical businesses,” she said. “Even those practices run by CEOs require owners to make assessments for growth and investment. I want my MBA education to formalize and refine my expertise in balancing growth and profits with patient care.”

Visco recommended two articles from Forbes and the Wharton School of the University of Pennsylvania, both of which address “employee engagement as a core ingredient for success and the foundation of any service business, including health care,” she said.

Two books, The Leadership Challenge by Kouzes and Posner and Why Motivating People Doesn’t Work ... And What Does by Fowler, underscore that leaders “are held accountable for something they cannot do: motivate people,” Visco said. “These books reveal how to develop effective leadership skills and sustain motivation in the workplace.”

Visco is also motivated by the words of Jack Welch, former chairman and CEO of General Electric: “Control your own destiny or someone else will.”

With that in mind, “MDs pursuing a business education should have clear goals as to what they want,” Visco said. “They should understand the commitment and hold the institution accountable in delivering their value proposition.”

Limited days on campus

Jennifer Loh, MD, founder of Loh Ophthalmology Associates in Miami, completed in September the Physician CEO program through the Kellogg School of Management at Northwestern University in Chicago. The program consists of four modules — Transitioning to a Physician CEO, Positioning Your Practice for Growth, Building a High-Performance Practice, and Maximizing the Value of Your Practice — over a 9-month period.

“However, the actual number of days on campus is only 20 days; each module consists of 5 days on campus,” Loh said. Off-campus business reading and creating a business plan are also parts of the course.

Going through the program has given Loh a broader perspective on how to effectively guide her practice and how to manage her employees. “I now know how to create a great patient experience in my practice,” she said. “The program also provided me more knowledge about business management, including financials and accounting.”

Loh found the program invaluable in learning how to effectively manage employees, such as how to create a dynamic team structure and a culture for her practice and team that she believes in. “Previously, I did not understand the significance that an office culture could have on a practice,” Loh said.

Because of the program, Loh has created a strategy that emphasizes patient satisfaction and a high-touch experience for the patient, which was accomplished through staff training on patient interactions.

Loh, who received her MD from Indiana University in Indianapolis in 2007, said the business program taught her to look more closely at the logistics of patient flow, patient scheduling and how to organize the practice overall for employee positions and roles.

The program also opened Loh’s mind to explore business opportunities with local health care companies.

“I do not think there is any disadvantage in pursuing a business education,” Loh said. “People can look at cost and time away from home and the office as disadvantages, but I think that they are part of learning and getting a valuable education.”

Loh’s tuition was $37,000.

“As physicians, we have already spent so much time learning our profession,” Loh said. “Adding to our knowledge base the best way to run our practice will help further excellent patient care, instead of allowing those who have less clinical experience be the ones in charge.”

Loh feels empowered by her business education because she understands more of the business world than before. “Now when I speak to an individual with an MBA or to someone with real business experience, I have more of an idea of their terminology and their mindset,” she said. “It makes me feel I can make better decisions for my practice and myself and my patients.”

Formalized management training

OSN Retina/Vitreous Section Editor Andrew A. Moshfeghi, MD, MBA, an associate professor of clinical ophthalmology at the USC Roski Eye Institute in Los Angeles, received his MBA from the University of Miami in Florida in 2009, which was 10 years after earning an MD from Tulane University School of Medicine in New Orleans.

Moshfeghi enrolled in an executive MBA track, concentrating in health sector management and policy, shortly after he had accepted a leadership position at Bascom Palmer Eye Institute. “I felt like I needed some formalized management training,” he said. “Although I thought I had a critical mindset before the MBA program, what I learned during the program helped me tremendously with my interactions with clinic and departmental leadership, physicians, surgery center staff, vendors and patients, as well as colleagues.”

However, having an MBA has not directly resulted in Moshfeghi seeing more patients, doing more surgery or getting more referrals. “Indirectly, though, it has changed the way I view the clinical enterprise and has made me a more efficient deliverer of retina services,” he said.

Moshfeghi was fairly involved in independent consulting before the MBA program, and his consulting has increased since. In fact, some of his consulting clients have told him that having the MBA title after his name has made him a more desirable consultant to approach.

“My MBA program did not have significant exposure to entrepreneurship training, but I have used many of the skills I learned in my training to help me develop several ventures that continue to this day,” Moshfeghi said. “My recommendation to someone who is considering doing an MBA specifically because they have a strong interest in entrepreneurship is to seek out a program that specializes in entrepreneurship or at least offers non-degree granting formalized executive training in entrepreneurship, such as Babson College in Massachusetts.”

The biggest sacrifice Moshfeghi made to earn his MBA was time. His program met on campus once a month for 3 days, from Friday to Sunday, for 24 consecutive months. “This was ideal, insofar it was not every weekend, like many programs,” Moshfeghi said.

In addition to this classroom time, Moshfeghi generally met once or twice per month in small groups to work on projects.

Moshfeghi’s academic productivity in ophthalmology dropped significantly during the 2 years he pursued his MBA, “so for those in academics, this should also be considered,” he said.

On the other hand, Moshfeghi received a full-tuition scholarship. “Tuition for these programs can approach $100,000 or more, when all is said and done,” he said.

Moshfeghi suggested that an employer or practice might fully cover or partially cover the tuition, and in some instances tuition is tax deductible.

“Of course, the tuition alone is not the only financial impact,” Moshfeghi said. “The cost of being absent from clinic and the operating room during the MBA years must also be considered. MBA-related travel, lodging and textbooks are additional financial considerations.”

Moshfeghi believes pursuing an MBA is “one of the best investments of time and money you will ever make.” And, upon completion, “you will never think about decisions and processes the same way again.”

Valuing human resources

For Robert J. Noecker, MD, MBA, director of glaucoma at Ophthalmic Consultants of Connecticut in Fairfield, the goal of an MBA was to become more comfortable with the “numbers” of business. “However, the best thing I took away was the value of strategic human resources,” he said.

It was exactly 10 years between the time Noecker received his MD from the University of North Carolina at Chapel Hill in 1990 and an MBA from the University of Arizona in Tucson in 2000, with an emphasis in finance (forecasting).

“In health care, we are in a people business, and the value of each employee’s ability to deal with the public is really important,” Noecker said. “Being able to hire the right personality for this job is the most important thing. We need people who like dealing with the public, can acquire some technical capabilities and be team players.”

Noecker believes that having an MBA can improve patient outcomes and patient satisfaction. “Having the right staff in place to work with patients and the other people in the practice is of utmost importance,” he said. “Being able to evaluate flow issues and work out efficiency metrics are also important.”

Noecker’s grasp of financial numbers would likely allow him to execute an orderly exit strategy of his practice, with minimal downside. In addition, his knowledge of entrepreneurship gleaned from an MBA has resulted in a “business mind that will translate into another line of work, such as consulting or medical monitoring.”

He noted, though, that he was unable to watch any television during his 2-year MBA program.

Noecker said that MDs are not educated to think in a business-like manner. “We think like scientists and artists,” he said. “Creativity in problem-solving is emphasized, as well as following guidelines of best practice.”

Clinicians need to value their practice by how they take care of patients. “If we do this well, we have more resources to grow the services we can provide and do a better job of taking care of patients, while at the same time improving the chance of doing better financially,” Noecker said. – by Bob Kronemyer

• References:
• Declining employee loyalty: A casualty of the new workplace. http://knowledge.wharton.upenn.edu/article/declining-employee-loyalty-a-casualty-of-the-new-workplace. Published May 9, 2012.
• Efron L. How transformational leadership saved this company: Ceridian’s story. Forbes. http://www.forbes.com/sites/louisefron/2016/07/06/how-transformational-leadership-saved-this-company-ceridians-story/#4eb889d15f6b. Published July 6, 2016.
• Fowler S. Why Motivating People Doesn’t Work ... And What Does. Berrett-Koehler Publishers; 2014.
• Kouzes J, Posner B. The Leadership Challenge. 5th ed. Jossey-Bass; 2012.
• Ljuboja D, et al. Am J Manag Care. 2016;22(6):196-198.
• Saunders L. The Wall Street Journal. Good news for M.B.A. students: Tuition is now more deductible. http://www.wsj.com/articles/good-news-for-m-b-a-students-tuition-is-now-more-deductible-1471013805. Published Aug. 12, 2016.
• Viswanathan V. The Atlantic. The rise of the M.D./M.B.A. degree. https://www.theatlantic.com/education/archive/2014/09/the-rise-of-the-mdmba-degree/380683. Published Sept. 29, 2014.
• Welch J, Welch S. Winning. Harper Business; 2005.

• For more information:
• Jennifer Loh, MD, can be reached at Loh Ophthalmology Associates, 6705 Red Road, Coral Gables, FL 33143; email: jenniferlohmd@gmail.com.
• Andrew A. Moshfeghi, MD, MBA, can be reached at USC Roski Eye Institute, 1450 San Pablo Street, 4th Floor, Los Angeles, CA 90033; email: andrew.moshfeghi@usc.edu.
• Robert J. Noecker, MD, MBA, can be reached at Ophthalmic Consultants of Connecticut, 1375 Kings Highway, Fairfield, CT 06824; email: noeckerrj@gmail.com.
• Jai G. Parekh, MD, MBA, FAAO, can be reached at Brar-Parekh Eye Associates, 1031 McBride Ave., Woodland Park, NJ 07424; email: kerajai@gmail.com.
• Denise M. Visco, MD, can be reached at Eyes of York Cataract & Laser Center, 1880 Kenneth Road, Suite 1, York, PA 17408; email: dvisco@eyesofyork.com.

Disclosures: Loh, Moshfeghi, Noecker, Parekh and Visco report no relevant financial disclosures.

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