Learning to lead


When Azhar Majeed, FACP, found himself negotiating with local IPAs and health plans on behalf of his hospitalist group, he quickly realized that his medical training had done little to prepare him for dealing with contracts and other administrative responsibilities. What's worse, his IPA colleagues soon picked up on his lack of formal business training.

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“One of their representatives said to me what I think they all were thinking: ‘I hate to say it, sir, but you're just a doctor. You don't know what our cost structures are.’ That really made an impact on me,” Dr. Majeed recalled. “I thought, ‘What is the difference between him and me?’ And I realized it was an MBA.”

That conversation convinced Dr. Majeed to enroll in a one-year physician executive MBA program, much of it online, through the University of Tennessee. Now, he serves as medical director of a large hospitalist group, the Southern California Hospitalist Network, based at Citrus Valley Medical Center in Covina, Calif.

A natural fit

Hospitalists, with their wide range of experience and knowledge of a hospital's different departments and systems, can be natural choices for leadership positions. And many are now pursuing advanced management training to help them get the background they need to seek these positions—or simply to be more effective in the positions they already have. Some, like Dr. Majeed, complete full MBA programs, while others opt for less extensive leadership training courses, which hone their management skill sets but don't lead to a full-fledged degree.

Some 49 U.S. medical schools currently offer joint MD/MBA programs, according to the Association of American Medical Colleges. There are also MBA programs specifically tailored to physician executives, like the University of Tennessee's—11 of them at last count, according to the AAMC. Beyond these programs, many organizations, like the American College of Healthcare Executives, the Society of Hospital Medicine and ACP, offer various types of leadership courses and credentialing programs ().

“There does seem to be an increase in the number of physicians interested in taking on management roles,” said Deborah Bowen, FACHE, executive vice president and chief operating officer of the American College of Healthcare Executives. “We don't track how many physicians are enrolled in MBA programs, but just by the proliferation of such programs, interest must be increasing. A few years ago, you didn't find nearly as many combination programs as we see today.”

At senior levels in hospitals and health care organizations, Ms. Bowen said, most executives have advanced degrees such as an MBA or master of health administration (MHA). “In a management role, a clinical degree is a very good starting point, but there are financial decisions that have to get made and business acumen that has to be articulated,” she said. “Some people can get that on the job, but a lot of people need to go back to school to get skills in financial management, leadership and change management, negotiation, human resources and all those things that are usually not part of clinical training.”

Hospitalists and MBA programs are a natural fit, according to Dr. Majeed. “We're in the unique position of directing health care in a hospital,” he said. “There really isn't anyone else who is so in tune with the hospital overall. … So it makes sense, if you want that extra leadership skill set, to pursue advanced management training, because there are so many opportunities for hospitalists to lead.”

“If you're in any kind of leadership position in the health system, you're running a very large enterprise,” said Kevin Schulman, ACP Member, director of Duke University's health sector management program in its Fuqua School of Business. “Your skill set coming from clinical practice is usually totally divorced from things such as how to manage, how to understand the reports you're getting, how to budget, how to monitor performance, how to negotiate and how to read contracts. A core set of leaders will really need a high level of expertise to move their institutions, and their careers, to the next level. Those are the people who end up in degree programs.”

Duke's program currently includes half a dozen students in its weekend executive class who are either intensivists or hospital-based physicians, according to Dr. Schulman. “We also do short courses for people who don't need the commitment to a degree,” he said.

Setting goals

Pursuing an MBA isn't as simple as saying “Sign me up!” Doctors contemplating an MBA program should be very clear about the commitment they are making, in terms of both money and time, and what they hope to get out of it, experts say.

“Even if you don't take time off to pursue the degree, you will have to practice less to compensate for the time the program takes,” said Mary Jo Gorman, ACP Member, chief executive officer of Advanced ICU Care in St. Louis and immediate past president of the Society of Hospital Medicine. “Are you ready to make that commitment, and with what end point?”

While Dr. Gorman completed her MBA at Washington University's Olin School of Business in St. Louis, she found that she had to cut back on her clinical hours by about 25%. “So my income took a hit, plus paying tuition. So be very clear about what you're investing and what you want to achieve,” she advised.

“It's a big decision to say that you'll do an MBA while continuing your clinical practice, or quit and go full-time. It's a huge change in schedule and work-life balance,” agreed Vineet Arora, FACP, a hospitalist and associate program director of the internal medicine residency program at the University of Chicago. She coauthored an article in the November/December 2006 issue of the Journal of Hospital Medicine on leadership opportunities for academic hospitalists.

Testing the waters

If hospitalists aren't sure a full-fledged MBA is what they want or need, leadership training courses are a good way to test the waters. “The American College of Physician Executives, for example, has wonderful programs that are basically mini-MBAs,” Dr. Gorman said. “You can take courses a week at a time, and find out if this is what you want to do. In the meantime, you can also use those courses to develop your skills, find mentors and pursue achievements in your current job. These courses will help you be more effective as a junior manager before you go and spend time and money on an MBA.”

Leadership training courses can also help hospitalists identify opportunities to gain leadership experience within their current institutions. This is an essential element for career advancement, because simply being able to put “MBA” after the “MD” on your business card isn't always enough.

“This is not magic,” Dr. Gorman warned. “Many physicians ask me if they should get an MBA, but just punching that ticket doesn't guarantee that anyone will look at your application if you're trying to change jobs. You need to build a career around getting things done, and proving your management skills. While there are positions for which they won't consider anybody without an MBA, if you don't prove your management skills, they don't care how many degrees you have.”

For example, Dr. Gorman described a hospitalist she's currently advising who is in the process of completing an MBA degree. “She's a good clinician and has done a few management projects at her facility, but nobody's going to look at her until she's managed 10 people and can get provable things on her resume,” Dr. Gorman said. “If you can say that you managed this project and got 92% of staff to use this protocol, leading to a savings of $400,000—that's the kind of thing recruiters are looking for.”

“A management course can help you prepare to bring value to your organization,” said Dr. Arora. “Think strategically: Find a specific, concrete program that you're focused on, like implementation of a new billing system, restructuring of the hospitalist group or quality improvement initiatives.” If the initiative is valuable enough to the institution, Dr. Arora said, the hospital or group may absorb some of the cost of the management training program you'll need to help implement it.

Whatever path hospitalists take to leadership, the odds are that they will have a growing number of programs to choose from.

“I think the trend towards management education and training will accelerate, mirroring in medicine what we see in other fields,” predicted Duke's Dr. Schulman. “Medicine would be very naïve to think that just because you're a great clinician, you're a good manager. Managing is a whole different skill set, and we can't assume that we can master that without training.”