Back to school?!

When Dr. Paul Levy became a heart surgeon, he thought that was enough. He’d worked hard, making it through medical school and internship and fellowships. During the next 25 years, he rose to the top of his profession as one of the senior members of the New Mexico Heart Institute, named the number-one cardiac surgeon in Albuquerque in 2010 by Albuquerque The Magazine.

But by 2009, the world of medicine was changing rapidly. What had always been enough for Levy wasn’t anymore. “I’ve been in a patient’s chest for 20 to 25 years,” Levy says. “That’s where I’ve had my head. I know I can do this job, but I realized one day it was time for me to expand my horizons. I really need to know more about what’s going on.”

Levy signed up for the University of Tennessee’s Physician Executive MBA program, or PEMBA. In doing so, he joined a growing number of physicians who’ve decided to pursue an advanced degree, like an MBA or JD, in addition to their medical diploma.

Why another degree?

The reasons physicians pursue additional degrees vary. Many, like Levy, pursue degrees as a response to the current medical climate. “You’ve got to be aware of what’s going on in health care to stay in business these days,” Levy says. “There are a lot of doctors who are frustrated. There are a lot of doctors moving toward business degrees. They’re concerned about their profession.”

Some want to expand their career options. Dr. Mike Ward, who is currently completing a two-year operations research fellowship and pursuing a master’s in quantitative analysis through the University of Cincinnati, received his M.D. and his MBA from Emory University.

“The MBA brings diversity and opportunity,” he says. “It lets individuals know what you’re interested in and capable of doing.” Ward, one of the founders of the National Association of MD/MBA Students, thinks an MBA on a physician CV opens doors for more leadership roles in clinical medicine, as well as administrative and academic positions.

Opportunities for M.D./MBA and M.D./JD

Mike Stahl, Ph.D., program director of the University of Tennessee’s Physician Executive MBA program, reports that many doctors who enroll in the PEMBA program go on to use those skills in a number of jobs, including heading up large medical practices or medical groups, chairing executive committees, as department chairs at hospitals, chief medical officers, chief operating officers, or working with pharmaceutical or health insurance companies.

“The commonality is physicians leading others in the delivery of quality health care,” Stahl says. Dr. Jerome Thompson, otolaryngology department chair and professor at the University of Tennessee Health Science Center College of Medicine, had an established medical practice when he returned to UCLA to pursue his MBA. “I continued to practice medicine and opportunities came up for me within medicine,” he says. “I became an associate chief medical officer and then an associate dean as a result of my MBA.”

Though a business degree may open up new opportunities within medicine, Dr. Allan McLeod, who in addition to his D.O. has an MBA and a law degree, feels most physicians who pursue law degrees face a choice. “People realize that if you get a medical degree and a law degree, you’re really going to end up only practicing one of the two,” he says. “There are very few people who practice both. You have to make a choice to stay in law or stay in medicine.”

Those who stay in law often become malpractice attorneys, or they may become expert witnesses specializing in malpractice cases. McLeod chose to stay in medicine and oversees third and fourth year medical students at the Philadelphia College of Osteopathic Medicine. Even physicians who have no interest in changing careers acquire useful new skills in the pursuit of an additional degree. McLeod says his law background helps in reading and negotiating contracts and affiliate agreements.

He serves on the risk management committee and is the chairperson of the compliance committee at PCOM. “I get to put my knowledge to use that way, not directly practicing law, but being a member of these committees,” he says. “The major advantage of having an MBA was to give me the ability to speak another language,” says Thompson. “That was the financial language.”

“The finance stuff is a different language,” Levy agrees. “I’ve mastered the foreign language of medicine with 25 to 30 years of practice. But as much as I was expected to be present at meetings and aware of what was going on, I really had no idea. Now I’m learning the language of finance, to the point where I can carry on a reasonable conversation and understand what’s going on.”

Still other physicians find themselves in positions where they need more education to do the job. Stahl reports that many doctors who enroll in the PEMBA program find themselves in this situation. “The majority are already in a leadership role, and they recognize that their clinical skills don’t necessarily prepare them for that,” Stahl says. “In fact, some would argue that clinical skills are anti-leadership, in the sense that most clinical skills are taught on the assumption of the physician being a command and control leader of a physician team.

If the physician says something, the rest of the team should jump. That kind of approach doesn’t work very well when one is leading other professionals in a non-emergency setting.”

Practical considerations

Physicians who decide to pursue additional advanced degrees face many choices, including what degree to pursue, and whether to go to school full or part time, at night or online. All offer advantages and disadvantages. Ward completed a medical degree and an MBA concurrently in a five-year program at Emory University. The compressed timeline meant less time spent in school, but it didn’t allow as much depth in some courses as he might have realized in a full-time MBA program.

While enrolled in an executive MBA program at UCLA, Thompson practiced three days a week and went to school three days a week. The program he was in was a general executive MBA program, not one specifically for physicians. He reports that his classmates went on to become executives for Exxon, Hewlett-Packard and Amgen. McLeod attended St. Joseph’s University three nights a week to get his MBA. When he decided to add a law degree, he attended Temple University in the evenings. The University of Tennessee’s PEMBA program combines online classes with on-campus instruction.

During the one-year program, students attend online classes each Saturday morning from 9 to noon EST. They participate in the classes via two-way audio and data transmission. In addition to these 40 classes, plus online assignments, students attend one week of classes at the University of Tennessee campus each quarter, for a total of four weeks. No matter which route to a degree physicians pursue, they face the challenge of time management. “It was painful,” Thompson says of his days pursuing his MBA while running a practice and taking care of a family. \

“My family was stressed by it, but they understood me and tolerated it.” McLeod remembers his time in night school: “You work all day and you have to go to school in the evening, and you get home at night and you still have to find time to read 300 pages for the next set of classes. That was the toughest
part, finding time to put it all into your life.”

Ward purposely chose to work in the emergency department so he could more easily arrange his work shifts around his class schedule. He also had the full support of his supervisors. Levy gave up working on committees, pursuing special projects and much of his socializing to pursue the year-long
PEMBA program. He also enjoys support from his practice partners and the hospital. Executive MBA programs, geared toward working executives—and especially those programs catering to working physicians—offer flexibility for physicians.

“The professors understand we have day jobs,” Levy says. “They’re not going to let us slide, but they understand that a patient’s life can take precedence over a due date.” Once you’ve selected a program you want to attend, you’ll need to complete an application. Depending on the program, you may also have to pass an entrance exam. Law schools require prospective students to pass the LSAT, while some MBA programs require either the Graduate Management Admissions Test (GMAT) or the Graduate Records Examination (GRE). Other programs may accept a medical degree or business experience in lieu of the entrance exam requirement.

You’ll also need to rearrange your schedule with both your family and your colleagues to accommodate classes. This could mean a reduction in clinic and hospital hours, adjusting oncall schedules and resigning from various committees. Physicians with families may need to coordinate child care arrangements with a working spouse, postpone or reschedule family vacations, and elicit their partner’s support for this new venture.

Affording another degree

Physicians who pursue additional degrees give up free time, sleep and social activities. They also surrender not insignificant sums of money. For instance, tuition for the University of Tennessee’s PEMBA program is $62,000 plus some expenses, such as travel to the on-campus sessions, lodging and a computer. Yale offers a two-year executive MBA focusing on leadership in healthcare for $142,000.

In addition to tuition, physicians should be prepared to pay for books, travel expenses to attend on-site classes for online MBA programs, campus fees and the cost of entrance exams. The cost of taking these tests, plus study programs to prepare for them, can run several hundred to several thousand dollars.

These costs come at a time when the physician will likely realize a drop in income, due to less time spent practicing medicine while enrolled in classes.
Stahl reports that physicians pay for their education in a variety of ways. Some pay out of savings. Others have part of the cost covered by their partnership or by a hospital with which they’re associated. Others take out loans. Some schools offer scholarships. Ward is typical of many M.D./MBAs. He financed his education through a combination of loans, scholarships and savings.

Challenges and changes

Pursuing an additional degree requires physicians to shift their mindset. “When you go into medicine or the sciences, two plus two always equals four,” McLeod says. “When you go to law school, you come to realize that two plus two equals whatever you can make a good argument for. That’s the difference in the mindset between the two professions. It’s one of the things that fascinates me about law.”

Hitting the books again can be daunting when you’ve been away from school for a while. “Maybe it was because I was older, but I thought law school was harder than medical school,” McLeod says. “You had to study hard in medical school, but I thought the amount of studying I had to do to get through law school was a magnitude higher.”

For physicians who’ve been at the top of their profession, struggling with subjects such as business economics or calculus can be humbling. For Levy, pursuing his MBA has forced him to think differently about more than his medical practice. One of his first assignments in the PEMBA program was to write his own eulogy. Thinking about the legacy he wanted to leave behind led him to make changes in his life. “It’s not only learning financing and marketing and strategy,” he says of his time in school. “It’s learning about yourself.”

Should you or shouldn’t you go back?

Are the advantages of a second degree in addition to a medical diploma worth it? The answer depends on the individual physician’s temperament and goals. For people like McLeod, the love of learning led him to pursue not only a D.O., but an MBA and a JD. “Law school for me was just for the fun of it,” he says. “It wasn’t because I wanted to become a lawyer.” He’s currently contemplating pursuing a Ph.D. Thompson cautions fellow physicians to “think twice” before taking the plunge to extend their education.

Though he calls his time at UCLA “a fantastic experience,” he isn’t sure everyone will benefit from this path. “A lot of people I’ve found who are successful in medical economics would have been successful without the MBA,” he says. “They already knew how to do everything, they just needed another credential to show that they’re worthy to be a senior executive for a major corporation.” Ward recommends physicians research their options thoroughly. “Network and talk to other people.”

The National Association of MD/MBA Students has a number of online resources, as well as an annual convention where doctors can meet with others who are pursuing the same goals. Stahl offers his perspective as someone who oversees physicians in an MBA program: “If they’re thinking about doing this just because they want to know a little bit more about what’s going on in the healthcare industry, but their career goal is 100 percent clinical, that person doesn’t need an MBA,” he says.

“If, on the other hand, they’re in a leadership role or they aspire to a leadership role, then this program may be for them.” For those on the fence, Stahl recommends they take a non-degree short course on some aspect of the business side of healthcare. That will allow them to test the water and see if this is where their interest lies. For Levy, the choice to pursue his MBA came down to one thing. “I think with the challenges in healthcare, to be just a doctor these days is not enough,” he says.

“You need to be aware of the business climate. You need to be aware of your margins. You can be the best doctor in the world, but if you aren’t aware of your margins and you can’t keep the lights on anymore, you’re sunk. It’s not enough to be a great doc anymore.”