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From MD to MBA; why the business of medicine is sending the region's physicians back to school for business skills.

When Dr Ken Ouriel was named CEO of Sheikh Khalifa Medical City, Abu Dhabi, earlier this year, he had been practicing medicine for more than 15 years.

He was chairman of the Cleveland Clinic Division of Surgery, had received the Liebig Foundation Award for excellence in vascular surgical research and had been regularly billed among America's top surgeons. Still, he felt underequipped for the job.

"Ok, I understood the clinical side of things as I'm a vascular surgeon," he explains. "I understood the administrative side through my experience at the Cleveland Clinic; but what I didn't understand was the business."

Ouriel is one of a growing number of physicians who are realising that an exemplary clinical record isn't the calling card it once was. In a sector faced by shrinking reimbursement, rising expenses and growing competition, sharp business acumen is more prized than ever.

To compete in the top tier, physicians need to match their skills in the exam room to their expertise in the back room. Now, a rising number of clinicians are adding MBA to the letters after their name in a bid to meet the bar.

Ouriel is halfway through an executive MBA in global business run jointly by Columbia and London Business Schools. The course, he says frankly, has had an immediate impact on his daily practices.

"Increasingly, more of what we do requires an understanding of the business," he admits. "Skills I've learnt over the last year have helped me out tremendously."

Managing change

This breed of hybrid managers with clinical expertise is the result of a turbulent healthcare sector, says Mike Stahl, Ph.D, director of the physician executive MBA (PEMBA) programme at the University of Tennessee and co-author of The Physician's Essential MBA: What Every Physician Leader Needs to Know.

The course is the qualification of choice for King Faisal Specialist Hospital, Saudi Arabia, which has, to date, seen five of its physicians graduate from the programme.

"Healthcare has changed dramatically," Stahl notes. "We've seen unprecedented demand for services, the explosion of information systems, the issues of quality improvement, and we still have to deal with the issue of how to pay, who to pay, and how much to pay for these changes.

"Physicians typically don't have the skills to answer these questions."

Universities have been quick to capitalise on this trend, and more are offering MBA programmes tailored to healthcare professionals, including some designed specifically for physicians.

Tennessee's PEMBA programme aims to bridge the gap between medicine and management and students learn from case studies pulled from hospital boardrooms.

It's a customised curriculum designed to help improve the delivery of care within the constraints of the marketplace. "The theme is physician leadership. We take the subjects you would find on a typical MBA course and drive them down to specific issues in the healthcare industry," Stahl says.

As public-private partnerships create larger healthcare organisations, doctors need formal business training to avoid floundering on the financial front. The number of physicians choosing to head back to school suggests clinicians are not taking their managerial duties lightly.

"There is a lot more recognition on the part of doctors that, as physicians, we are being asked to participate in system issues we historically have no background in," says Dr Kevin Schulman, a professor of business administration and director of the health sector management programme at the Fuqua School of Business, Duke University.

"Here at Duke, for example, the department of medicine is a more than $100 million a year operation. You can't, in due conscience, manage that kind of organisation without general business skills."

But the benefits of these additional skills are not limited to the boardroom.

Schulman, whose course has recently expanded to accommodate the increase in physician applicants, believes that lessons learnt from business can be directly applied to improve patient outcomes.

"Healthcare is still a business, which can be optimised towards a general outcome," he says. "There is no reason why those optimisation skills can't bring you an improved outcome on health or efficiency within the organisation."

Fighting back

Ambition aside, industry experts agree that physician executives are typically driven by one of two reasons. Some, like Ouriel, start moving into leadership positions and feel they lack the requisite background. More commonly, their motivation is disillusionment.

Physicians, report Stahl, increasingly feel their hands are tied by red tape, and are searching for a way to regain control of their profession.

"Physicians are sick and tired of not being able to deliver the changes in healthcare they want. They're looking to acquire the knowledge and skills set to fight back."

Surprisingly few physicians see MBAs as a way to jump ship into a non-practising role. It's an accurate assumption, Schulman notes, because the initials alone won't jumpstart your career. "The minority of students are trying to switch careers," he explains, "but it isn't a substitute for experience. The degree doesn't make you a senior partner at an investment firm."

So what are the benefits of a blue-chip qualification and do you need one? If you need to ask, says Ouriel, chances are the answer is no.

"I don't think - not by a long shot - that every physician needs an MBA," he stresses; "Only those who are really going to get involved in the high-powered financial analysis."

While all physicians should understand the basics of business- such as how reimbursement systems are structured, outlining a budget, and how to understand a financial statement - there are less time-consuming courses available to teach them.

"The average physician who wants to manage a practice, or manage a department with 10 or 12 doctors; they need courses in management in medical school," Ouriel advises. "Tackle it like any other knowledge gap you have in clinical practice."

But for physicians with their sights set firmly on an MBA, make no mistake; it's a gruelling degree. Expect to interrupt your career, disrupt your family, and invest a substantial amount of money in the process.

Even courses tailored for practicing physicians demand a significant amount of time, and nearly all require some degree of face-to-face learning. Ouriel recommends considering carefully whether you can devote the time required to complete the course successfully. "It's certainly challenging," he admits. "I have a day job where I'm working 14-hour days, and I need to add four hours to that to incorporate my course demands. I'm learning to sleep less!"

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