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.
I found Braelin's article to be very significant from a general philosophical viewpoint; an article that raises (for me) the general question: to what extent does for-profit incentives and training impact professional performance across disciplines? To answer this question, I decided to turn to the available research literature.
ReplyDeleteA cursory investigation has yielded some interesting results in the following fields:
HEALTH CARE: According to a panel of researchers from Harvard (see: http://www.bmj.com/content/342/bmj.d108.full ), their study showed that explicit financial incentives did not improve the quality of care and clinical outcomes for patients with hypertension in primary care in the United Kingdom (the researchers did remark how little comparative research has been done in this field).
A Canadian peer-reviewed study (see: http://www.cmaj.ca/content/166/11/1399.full ) analyzed mortality outcomes in Canada and concluded that that private for-profit ownership of hospitals, in comparison with private not-for-profit ownership, results in a higher risk of death for patients to a degree giving cause for concern.
A report by the U.S. Dept. of Health and Human Services found that Not-for-profit homes are more likely than for-profit ones to provide good care, in relation to a similar study by ConsumerReports.org (see: http://news.consumerreports.org/money/2008/09/more-evidence-f.html ), which also determined that independently run homes were more likely to provide good care than those that were part of chains.
HIGHER EDUCATION: According to a recent study conducted by the National Center Performance Incentives at Vanderbilt, which supposedly takes no advocacy position on the issue, offering primary- and secondary-level math teachers incentives of up to $15,000 to improve student test scores produced no discernible difference in academic performance.
Does this cursory lit.review conclusively prove that linking MBA and business-related education and training with professional programs such as medicine and higher education is a bad thing? No, I am not saying that at all. What I am suggesting, based on literature reviewed thus far, is that such mergers may be very helpful from an administrative point of view, but insofar as delivery of client services goes, linking the profit motive directly to client/patient care could prove detrimental to client populations in certain cases.
Interesting post, Braelin. I see these degree programs from a different perspective. Many MD's are doing MBA's so that they can make savvy decisions when creating their practices from scratch. Especially for family/internal medicine, these doctors don't possess the high salaries that we think about when the word "doctor" is tossed around. I think it makes a lot of sense to develop the MBA/MD, but I also see how the the perception of abuse can happen easily. Private practice or not, an MBA does make sense because unfortunately, healthcare in the U.S. is a business instead of being a right for its citizens.
ReplyDeleteI agree that it would be helpful to have additional components of our degree program focused on business preparation. I think most degree programs, at each level, should include more business foundation. I see more and more students entering college with a desire for a business major (or the parents are pushing it). Really, the whole world is a business...healthcare, education, the criminal justice system, sport, and many other career fields operate more as a business than they did a few decades ago. Perhaps our modern-day liberal arts education should include more about finance, marketing strategies, and project/people management principles.
ReplyDeleteBraelin...very interesting post! I hadn't heard about the MD/MBA combination and would have the same initial response as you if my doctor would have a combined degree. Actually with her I would be shocked...she is a very holistic, Boulder-type doctor...so an MBA is so not her.
ReplyDeleteBut the thought of combining the HESAL degree with something else to prepare for the future of our field and the "neo-liberal" culture that is evolving is interesting.
Actually, I think it would be more interesting to have faculty need to do a handful of student affairs classes in order to teach at a college or university.