M.(D.B.A.)

Medicine, business, or both? As we discussed the neo-liberalization of higher education in class, we alluded to the impact and shift in other ideally ‘welfare’ fields- such as healthcare. Although it should not be new news to anyone reading this that the health care industry is indeed a business industry, and certainly they are further developed as a neo-liberal industry than higher education, we might still want to think of our physicians as patient-focused practitioners who have only one focus in their work: our medical care.

The rise in the number of combined M.D./M.B.A. programs however indicates that some physicians are focusing not only on patient care and developing the latest medical breakthroughs to help heal us, but also on the business side of their industry. As cited in a September New York times article, over the last 20 years, 60 new combined M.D./M.B.A graduate programs have been developed. The Association of M.D./M.B.A Programs is a professional association of such combined programs throughout the US and Canada which seeks to develop connections and support mechanisms for the dual-degree programs. M.D./M.B.A programs are everywhere from Yale and Dartmouth to CU-Health Sciences to three institutions in the University of California system. The reasons that a future physician may want an M.B.A. to compliment the M.D. degree are varied, but include practical business skills for future doctors who plan to own their own medical practice, career opportunities in health care management and/or related fields such as pharmaceuticals and/or medical technology, and to understand and/or manage the financial implications of healthcare reform on their industry. Some may not ever have intentions of practicing medicine, but see the medical training as a useful supplement, or marketing tool, for their plans to pursue a business goal related to the health care industry. Reading between the lines, I also see a motivation for the dual-degree related to future earning potential. Although physicians in general earn a high salary (particularly compared to educators…), given the massive debt load of the vast majority of medical school graduates, opportunities to earn on the higher end of their already high earnings spectrum are actively sought by many M.D.s, and the M.B.A. may be just the ticket.

If I learned that my physician was also an M.B.A., I think that my initial (albeit irrational) reaction would be that she might be out to make a buck off my health, and that in some way that could compromise the integrity of the medical treatment that I would receive from her. However, for the most part, I think that this is an unfounded concern. Physicians take the Hippocratic Oath (or a contemporary version of it), must abide by a strict Code of Ethics, and are held accountable by the American Medical Association (AMA). Likewise, fear of malpractice suits are high, and action on the part of a physician which favored business gain over patient health/safety would be ripe for litigation.

In any case, I have a few thoughts to consider related to the growth in M.D./M.B.A joint programs. Is medicine carving a path that others in traditionally welfare industries might follow? Would a joint HESAL PhD/M.B.A. program serve us, our institutions, and our students well, given the state of our country and economy? I think that it might. If a full fledged M.B.A. program in conjunction with a HESAL program is not a fit, how might our HESAL curriculum be adapted to ensure that we are adequately prepared to function in the neo-liberal state as higher education and business leaders? Although one elective course (HESA 683- Finance and Resource Management in Higher Education and Student Affairs Leadership) explicitly addresses the business side of our field, and arguably others (including this course) touch on it, might additional offerings enhance our preparation for the current and future state in which we will operate?

Also, given the state in which we operate (regardless of whether we are prepared for it or not…), I wonder how we, as a profession, can look to our friends in medicine to help better balance our responsibilities related to student learning with pressures related to revenue generation and related outcomes. Although we have ethical codes of sorts through our professional associations, higher education lacks the widespread, shared ethical expectations that exist within medicine. And, although I’m not suggesting we go this route, individual practitioners in higher education are virtually immune from ‘malpractice’ suits, even in the event that we were advising students based on business outcomes, rather than learning outcomes. Although many of us are quick to judge our for-profit colleagues for less than ethical practices, how far behind is public and not-for-profit private higher education? I’ll save that for another post on the for-profit blog, but for now I think that a review of our ethical standards- across all sectors- is in order, and a mechanism for holding one another accountable is too.

The Master's Degree is the New Bachelor's Degree

The master’s degree is becoming the necessary entry-level credential in many career fields. For example, “The National Academy of Engineering expressed this concern in areport, ‘Educating the Engineer of 2020 – Adapting Engineering Education to the New Century.’ In this report, recommendation number one was to consider the bachelor’s degree as a pre-professional degree.” While researching this topic I came across an article from the Journal of Professional Issues in in Engineering and Education published back in October 2000. Interestingly, the author of that article noted that ASCE had been encouraging the master’s level degree as the entry-level credential for several years and that was more than a decade ago.

In fact, the American Society of Civil Engineering authored policy 465 in 1998, and then revised that policy in 2001, 2004, and again in 2007. The crux of the policy states that, “Admission to the practice of civil engineering at the professional level…will typically include a combination of: a baccalaureate degree in civil engineering; a master's degree, or approximately 30coordinated graduate or upper level undergraduate technical and/or professional practice credits; and appropriate experience based upon broad technical and professional practice guidelines which provide sufficient flexibility for a wide range of roles in engineering practice.” In other words, the professional organization of civil engineers is suggesting that engineering needs to be a 6-year professional degree program,similar in duration to medical, law, architecture, pharmacy and other “learned”professions. They go on to blame the “lowered esteem of engineering” within the United States to the fact that engineers have only four years of education(although in the US, most college students are now taking at least five years to complete their B.S. degrees).

I support the concept of education; otherwise, I would not have chosen the career path that I have. At the same time, I am realistic when it comes to the daunting prospect of encouraging students to take on even more debt while delaying entry into the job market for an additional two years. Few people have the assets for that to be a realistic vision.

Civil Engineering is not alone in this transition. According to a New York Times article from July of this year, “Among the new breed of master’s, there are indeedample fields, including construction management and fire science and administration.” Fire science degrees were the topic of an articlein today’s Inside HigherEd. According to that story, master’s degrees help firefighters to advance in their careers and increase their salaries. When does higher education become too much education? Richard K. Vedder, professor of economics at Ohio University and director of the Center for College Affordability and Productivity is quoted as saying, “In 20 years, you’ll need a Ph.D. to be a janitor.” At least those in my cohort will be prepared for that career by then.