Is the MD, MBA Worth It? (Part 2)

June 6th, 2008

This is a continuation of my previous post on this subject.  I am at the halfway point in pursuit of an MBA degree and have found myself reflecting on this question once again.  The first time I did this was before I applied to the Executive MBA program at ASU.  This time it is after a year of study and a great deal of “If I knew then what I know now would I still make the same decision” thinking.  The short answer is yes but I’ve made some observations over the last year that may be of interest to any physician considering the same decision.  (For the initial three observations click on the previous post link above.)

4) Nobody will value your investment in an MBA degree more than you.  This may seem obvious but it is an extremely important point.  When you invest time during the course of your studies this time commitment will mean someone else will be responsible for covering your practice in your absence.  The people who cover you may be your business partners, employees of the hospital or colleagues who you have asked to assist you while you are away.  At first it will be easy for them to cover but if they are doing it out of the goodness of their heart that arrangement will grow thin over time.  At some point in time it will become obvious to them that if they do not feel like they are benefiting from the arrangement the deal will go bad.  While you are away studying they are covering you and despite all their initial support for your endeavors they will come to regret it.  The looser your coverage arrangements the quicker the deal will derail.  If there is some value they will get in return for your endeavors the greater the likelihood they will support you.  If they perceive no value in return, while covering for you, the greater the likelihood they will sabotage your efforts.  That is painfully obvious to me now but I was completely unaware of this a year ago.

5) An MBA degree, or any other investment in human capital for that matter, expands and alters your view of the world.  What you do with that new view is up to you so ultimately the answer to the question of whether it is worth it to pursue such a degree will always be in the hands of its possessor.  An MBA degree provides a view of the world in which you live and work that is different than the one you previously held.  It also provides specific tools you can use to re-evaluate how you approach your work.  It’s similar to what I experienced the first time I used the Internet.  I thought “That is really cool”.  Little did I know at the time how indispensable it would become in my life.  Anytime we can view the world differently and that knowledge can add a significant benefit to our lives it is worth it.

6) The immediate non-financial return on investment (ROI) from an Executive MBA program is the contact and connections you make with your classmates.  They come from a wide variety of industries and cultures but in many ways they are like minds.  They have the same love of learning and need for intellectual stimulation as you do.  They wish to acquire a new skill set and view of the world which will further open their field of opportunities.  Regarding the long-term ROI I liked the response Hugh O’Neill, the Associate Dean of the Executive MBA program at UNC, gave.  MBA programs attract “climbers”, “shifters” and “launchers”.  The climbers are already established in a company and wish to move up the corporate ladder.  The shifters are those who wish to change their career or move to a different type of job in the same industry in which they currently practice.  The launchers are the entrepreneurs who wish to start their own business.  Each of these types of people wishes to enhance the quality of their life and for that reason alone, for them, the pursuit of an MBA is worth it.  Follow this link if you want to see the relationship between an MBA and the financial ROI regarding salary.  As a general rule it increases but physicians should note well it can also decrease if they are in the shifter category.

In Pursuit of Intellectual Capital: Is the MD, MBA Worth It?

June 5th, 2008

Less than a year ago I entered the Executive MBA program at Arizona State University to scratch an intellectual itch that I’ve had for the last decade.  Throughout my career as a physician it became increasingly obvious to me that the business of health-care plays a dominant role in what we as physicians can do for our patients.  It permeates everything we do in medicine.  It determines what tests can get ordered, what medicines can be prescribed and what treatments can be provided.  Instead of fighting the beast I decided it was better to learn from it.  It begins with learning the language of business and immersing oneself in the culture.  It is like the Grateful Dead once sang, “What a long strange trip it’s been.”

Since I have another year to go before I complete the program and actually receive an MBA degree it is a bit premature for me to make any grand conclusions to the question I proposed.  What I can do is offer a few observations I’ve made so far.  In future posts I plan to add to the list.

1) Physicians, particularly older docs (myself included) tend to prefer to either work alone or work within a pyramidal type of team structure.  I know that may sound harsh but it’s true for many of us.  In our program we are assigned to groups and much of the work done for class is the result of teamwork.  When I first met with my team I explained to them that they need to understand that as a Trauma Surgeon my idea of teamwork is when they do what I tell them to do.  It was meant as a joke but the one or two nervous laughs it got proved it wasn’t all that funny.  It is easy to forget that there are different types of teams with different approaches to problem solving.  A pyramidal form may work well with a severely injured patient in the trauma room but can be a disaster when leadership must be a shared activity.  I learned a great deal from my team members and classmates this past year and so far that has made it worth it.

2) Physicians tend to be suspicious of physicians who study business.  I was warned about this prior to starting the program but considered it paranoid thinking on the part of the person who said it.  It’s amazing but if a physician develops their human capital through lessons on golf, skiing, painting, gardening, woodworking, wine-tasting, a new language, statistical methods or any other form to improve their mental or physical capacity they are rewarded by their colleagues with smiles and approval.  Mention an MBA degree and all you will see is raised eyebrows.  Since beginning the program I’ve been told that I have “gone over to the dark side”, “taken up with the enemy” and begun to “practice in the dark arts.”  It has been a disappointment to see so many who value education so highly to so easily dismiss the value of a business education.  It reminds me of Plato’s Allegory of the Cave.  Once you leave the cave there may be no turning back.

3) An MBA is to the business world as an MD is to the medical world.  It’s a starting point.  It lays the groundwork for understanding how that world functions.  It is not meant to replace the real world knowledge and experience gained through years of training under the guidance of senior management or attending physicians.  The degree is a way to get your ticket punched and it is the punched ticket which allows you to access the next level where the practical education occurs. 

Human Capital:Our Most Valuable Asset

May 30th, 2008

It is with great dismay we watch one of the Wall Street giants take a tumble today.  In just over a year Bear Stearns Cos. went from a market capitalization valued at $25 billion down to its fire sale value of $1.4 billion.  What is even more disconcerting is that 7000 of its employees will be searching for new jobs according to the WSJ.  Despite the massive loss of financial capital the more pressing concern for these former employees is what to do in the short-term. 

In Charles Wheelan’s book, Naked Economics, he defines human capital as, “…the sum total of skills embodied within an individual: education, intelligence, charisma, creativity, work experience, entrepreneurial vigor, and even the ability to throw a baseball fast.”  Well, there probably will not be any Bear Stearns employees fighting for a position in the baseball draft but this disruption will release an enormous amount of human capital.  There will be tough times for many in the coming months but ultimately this is a group of people who will rally back and use this experience to their benefit as well as ours.  It is the most painful but necessary part of what Joseph Schumpeter described as creative destruction.  Out with the old and in with the new as some would say. 

While we have gotten use to to layoffs and mass reductions in the workforce as a blue collar phenomenon the 21st century has demonstrated a predilection for those of the white collar type.  At the level of the individual there are very few people who ever considered losing their job as a good thing regardless of their job description.  My heart goes out to these fine people.  Some may have been directly involved in the practices that led to the downfall of Bear Stearns but most were not.  All is not lost though as they still possess their most valuable asset: human capital.

The Cornerman

May 29th, 2008

Years ago as a child I asked my father for money in order to buy some ice cream.  He said he would give it to me but I had to promise to memorize something he was going to tell me.  It seemed like a fairly straight forward deal so I agreed.  He then said, “always remember to make sure your cornerman is in your corner.”  He made me repeat it back to him so I did but I must have looked a little puzzled when I did it.  At the time I wasn’t really sure what he meant by that comment so I asked him, “so why must you always make sure your cornerman is in your corner?”  As he handed me a dollar bill he said quite simply, “because sometimes he isn’t.”  I was seven years old at the time but I never forgot that message even though it took me a few years to fully understand its meaning.

 My father, much like his father, was a boxer in his youth.  He trained as a teenager in a gym his father owned on the near north side of Chicago back in the 1920’s and 1930’s.  My grandfather trained local youths in the sport of boxing.  The gym not only supplemented his income but served as a front for his real source of income, a saloon known as the “Shamrock Verein”.  It was there he taught my father the importance of the cornerman.  In boxing the cornerman is your trainer and coach.  When you enter the ring against your opponent it is this trusted individual who supports, advises and watches out for you.  Your cornerman can make or break you in a close match.  Sometimes, as you may have guessed, your cornerman is not always in your corner.

There are two main reasons why your cornerman may not be “in your corner”.  The first is that they may not be competent enough to be there in the first place.  They may lack adequate experience and be providing poor advise.  It doesn’t take more than a couple of ass-kickings to figure out if this is the reason.  If everyone your cornerman trains gets beat then the problem is most likely the cornerman.  There is another reason why the cornerman may not be in your corner.  This one is more subtle and dangerous.  That is because your cornerman has sold you out.  He has either bet against you or at the very least his interests are not aligned with yours.  (This is referred to as the principal-agent problem.)  The problem is one of asymmetric information and the solution is one of aligning incentives so that both boxer and cornerman approach the ring with the same goal.

Everyone needs a cornerman.  It could be your coach, trainer, agent, consultant, financial advisor, priest, minister, rabbi, physician, mentor, attorney, or anyone who assists and guides you in life.  It doesn’t matter if they get paid for it or they volunteer.  Part of their best interest must include your best interest for them to be granted this trusted position.  So heed these words, “always remember to make sure your corner man is in your corner.”

My New Site

May 28th, 2008

So I finally made the leap.  It’s now official.  After being under “construction” for years my new website is open for blogging.  My previous blog was at TransformingCrisis.blogspot.com.  The primary focus of that blog was to describe what I saw as some of the reasons for our current healthcare crisis.  As much as I love discussing this topic there is so much more I also love to write about.  I will continue to comment on this subject but will open it up to a more diverse range of topics.  Bear with me as I navigate the new format.