Physicians and business degrees: necessary for organizational leadership positions?

In November 2019, the American Medical Association adopted a policy aimed at ensuring medical students and residents receive training in health care economics so they can better understand the structure and financing of our current health care system. Increasingly, physician leaders are obtaining a business or management degree (MBA, MHA, MMM) after having started in clinical practice and currently there are expanded opportunities to get both degree and non-degree health care business-related education. If you are a practicing physician thinking about pursuing a leadership position in medicine the question of whether you should invest time and money to get an advanced degree is often considered.

Anthony Turner and colleagues writing in the World Journal of Surgery stated that leadership training, career-advancement, understanding financial aspects of medicine and team-building skills were enhanced among physician executives with an MBA. Paul Esselman, President & Managing Director of Cejka Search, one of the largest healthcare executive search firms in the United States, agrees that physicians who want to advance to prominent leadership positions within health care organizations need to understand the financial aspects of medicine.

“Physician leaders are being asked to understand the economics of health care reimbursement, whether its pay for performance (from the payer side) or compensation models (for employed physicians),” he said.

Time required and the need for additional training

This knowledge can be obtained without going through a formal MBA program and the lack of a formal business degree doesn’t eliminate you from an administrative leadership position. “From the client’s perspective, it is not imperative that a candidate have an MHA or MBA,” Esselman said.  Michael Canady, MD, MBA, CPE, who is the Chief Executive Officer for Holzer Health System in Gallipolis, Ohio, agrees. He also highlights a critical factor in pursuing an additional degree. As a practicing physician, “you don’t always have total control of your schedule.” He mentioned educational offerings put out by the American College of Physician Executives that allows physicians to obtain additional knowledge “at their own leisure” without having to commit to a fixed schedule. Additionally, many larger health care organizations are developing physician leadership programs, recognizing the critical need for physician leaders and helping them build the necessary skills to be effective in an administrative role with their organizations.

On the job learning

Like the practice the art of medicine, leadership is not conferred just by classroom learning but must be demonstrated on the job. Michael Cratty, MD, PhD, who is the Chief Medical Officer, Heritage Valley Health System in western Pennsylvania, learned the necessary skills of his current position on the job. As a practicing hospitalist he “knew how the hospital runs and the important metrics you and the hospital are measured on.” By building collaborative and trusting relationships with the hospital finance department, he was able to learn the necessary financial concepts that Esselman highlighted earlier. Cratty further highlighted his transition to Chief Medical Officer was made easier by the fact that he was a practicing clinician who built wide and deep relationships with nurses, physicians and other health system leaders. “I felt like being in the trenches every day really helped. From the physician side, I could understand their issues and concerns and from the administrative side I kept an open mind and tried to learn something new every day,” he said.

Do you want to leave clinical care?

The ability to communicate effectively is a foundational skill for physician leaders as is the ability to understand multiple stakeholder’s views. Additionally, there is not an “us versus them (physician versus administration)” mentality with physicians who achieve leadership positions within an organization. In clinical practice you may view leadership within the context of getting whatever an individual patient (or patients within your practice) needs and negotiating personnel and salary from a narrow perspective. When you are leading departments, service lines or hospitals, you must be able to think from a broader, strategic perspective. Therefore, the ability to take another perspective is critical. Often time this means being visible according to Canady. “Those (physician leaders) who are still grounded and understand what is going on are more likely to be successful,” he said. He mentioned shadowing various clinical and non-clinical personnel to understand the day-to-day issues they face is important in building connectivity to ensure the health system is working together on behalf of patients.

Increasingly, health care organizations are asking physicians if they are interested in pursuing leadership opportunities when they are hired. This may allow physicians to be developed internally and lead to a part-time leadership role on a smaller level before deciding whether to pursue larger administrative roles. However, a key question that all potential physician leaders must face is how far do you want to get away from patient care? Larger leadership roles mean less time spent at the bedside caring for patients, and there is a greater possibility of job loss if you are purely in an administrative role.

Final considerations

It’s also important to realize that just because you have an advanced degree doesn’t necessarily mean you will get higher compensation for the role, Esselman says.

“Compensation plans have changed over the years. What it boils down to is the role is the role and increasingly it’s being tied to expectations and accountabilities,” he said.

Increasingly, physician executive compensation has an at-risk component, meaning performance drives compensation, both upside and downside. Ultimately how physician-leaders perform in driving operational excellence, not only financially but clinically, is what health system boards and executive search firms are looking for in C-suite level positions. If you believe as a physician that obtaining a business degree will allow you to better articulate how your learning and subsequent experience has differentiated you from others-meaning how you used the degree and what the benefit has been-then pursuing a degree may make sense. If you are just considering or starting a part-time leadership position you may be better off deferring the decision until you can articulate the specific reason why you want to pursue a business degree. Similarly, if you have been able to accomplish increasingly important hospital and system operational goals without a business degree, you can supplement any business knowledge you feel you might need without a formal degree, and can still be considered a viable candidate for larger leadership roles. What is clear is that physician leaders will always be in demand.

Joseph M. Geskey, DO, MBA, MS-PopH is a Principal, Data Science & Member Insights for Vizient. He is currently working on a book examining the experience people with limited health literacy and challenging social determinants of health face in the technological era medicine is embracing.