Doctors – especially those new to the medical profession – are increasingly earning business degrees in addition to MDs.
Sometimes they complete a separate MBA program; others are flocking to hybrid programs that teach business essentials along with clinical medicine. This appears to be a response to a modern reality: healthcare is a business, and the expectation is that everyone in it has some sense of what that means. For example, doctors are under pressure to learn more – and then educate patients – about the costs of care, from individual procedures to drugs, and even what the competition is doing… as though EHRs, defensive medicine, and the lingering volume-based reimbursement models didn’t create enough of a drag on time in clinical encounters.
War of the worlds
There is a battle for the future and the soul of the healthcare industry, and it is not entirely clear whether business savvy or classic medical principles will be the dominant force in shaping change.
Doctors are under even greater pressure to know and understand the rules governing how they are paid. As practices and hospital systems shift to accommodate MACRA and weather the political storms surrounding the ACA, providers of all stripes are obliged to align caregiving within the dominant healthcare business operating models. Everyone is expected to advance LEAN practices and Six Sigma efficiency initiatives, or contribute innovative approaches to increasing patient-centeredness; arguments persist about what value looks like, how to measure it, and who is accountable for which elements.
Even absent this pressure to own the business challenges of healthcare, caregivers can suffer for abstaining from conversations about policy, technology, organization, and business models. That the design of EHR wasn’t optimized for clinical workflows right out of the gate is a reflection of whose needs drive development when it isn’t led directly by caregivers. At least remediation of technology leaves room for customization and participation; when policymakers (state, federal, or even right inside the hospital) write rules and standards without clinical input, making changes gets especially knotty.
So doctors are turning to the source for help, and pursuing careers in administration and medicine alike armed with business degrees of various shades.
The twain shall meet?
Business students will likely recognize change management as a standard topic of study and discussion; medical students may be aware of Maintenance of Certification requirements, but not necessarily how organizations and industries evolve. In theory, blending the two schools ought to help clinicians find ways to make business fundamentals serve the special context of medicine – like “capitalism with Chinese characteristics” that characterizes the Middle Kingdom’s transition from isolationist communist bloc to a quasi-socialist globalized market nation. That changes are inevitable does not make them entirely predictable or harmless. If people on the inside are committed to change, might they not be best-suited to defining, leading, and mitigating its progress?
The MBA-MD push is paralleled to some extent in the drive for RNs to earn a BSN. Here again, the benefits of the additional education are not strictly clinical as much as it is systemic; although in the case of nurses, there is evidence of improved outcomes with the BSN attainment. Advocates will point out how the BSN prepares nurses not just for caregiving functions or certification exams, but for the operations, higher-level decision-making, and bureaucracies of modern healthcare. Research and evidence-based practices are as much a business decision as they are medical necessity.
That explains in part why in 2007, the Clinical Nurse Leader became the latest nursing role designation recognized by the American Association of Colleges of Nursing; like the MBA-MD, nurse leaders are emerging as a way for non-physician providers to wear the hat of caregiver as well as manager, leader, or administrator. Giving clinical roles greater awareness of their place in the larger medical system, and firmer footing for supporting, altering, and advancing organizational standards, is all part of a general shift to making business and medicine work together, rather than in opposition.
Still a great wall
When business and medicine collide, it appears that business ends up winning. For physicians who combine both in their education, few remain clinically active once their MBAs are in hand. Whether they complete a combined program or go back to business school after time in medicine, the physician succumbs to the administrator, the banker, and the financial analyst.
This highlights what some see as a double-standard, but others (usually doctors) see as an essential truth of healthcare: business professionals often get a bad rap for trying to lead hospitals, as they take a fundamentally economic (i.e., less humane) approach to everything from problem-solving to systems engineering. By extension, politicians are criticized for legislating a profession they don’t understand, and programmers are blamed for creating products that don’t fit the needs or habits of their users. While there is some evidence to suggest doctors make better leaders in healthcare than pure-business professionals, unfortunately, doctors simply cannot be everywhere at once.
So where does this leave us? If doctors, nurses, and other clinical staff get more business and leadership training, it can’t be a bad thing for healthcare – even if it sends more clinicians away from patient care and into administration, or even out of healthcare altogether. Stemming the flow and balancing the equation, however, requires that at least some outsiders, those without clinical training, be given a chance to contribute, challenge, and perhaps even prompt engagement from within.
The future of medical education at all levels may well pivot toward this kind of inclusion, both reducing the need for business leaders to get involved, while improving tolerance for their contributions. The nature of healthcare makes it an industry resistant to change and disruption, even if that is the very thing needed for improvement to take place. Fighting inertia often requires an outside force; if that comes from the business world, there is clearly room for negotiation, if not integration.
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