People talk about the art and science of medicine. In recent years, the business of medicine has demanded physicians’ attention as well. More and more physicians are pursuing business education, whether it’s to help them prepare for increased administrative responsibilities or a career outside of clinical practice or simply to develop skills that will make their practices more successful.

The burgeoning number of degree programs marketed to physicians is indicative of the growing interest, and directors of these programs report significant growth in the number of applicants and requests for program literature. Continuing medical education (CME) has also evolved to include courses that reflect physicians’ increased interest in the business of health care.

If you want to join the ranks of physicians who are going back to school to learn the business of medicine, you’ve got more options to choose from than ever before.

Plotting your course

Whether a master’s degree, certificate program or introductory course would be the best choice for you depends largely on your experience and on your goals and how well you’ve defined them. Family physicians who’ve earned business degrees say that before making a big investment, physicians should thoroughly examine their own career goals and set realistic expectations about what they might gain from getting a business education. They should also seek the advice of peers who’ve gotten the education they’re contemplating, individuals who are doing the kind of work they aspire to and, if it makes sense, their employer or potential employer. Then, they say, keep asking questions until you have a clear sense of what you need to learn and how you will apply it.

George Xakellis, MD, MBA, program director of the AAFP’s Fundamentals of Management (FOM) course and associate professor in the Department of Family and Community Medicine at the University of California – Davis, advises physicians to take an introductory training course before deciding to pursue a certificate or a master’s degree. “You need to dip your big toe in the water and see if you feel like jumping in,” says Xakellis.

Sheila Sawyer, MD, MMM, opted for that approach, taking three American College of Physician Executives (ACPE) seminars to confirm her interest in management before deciding to pursue a certificate, and later, a Master’s in Medical Management (MMM). After the third course, she says, “I was hooked.” Sawyer began her career in solo family practice, was regional medical director for Iowa’s Integra Health for six years and currently is president of Agile Health Strategies, a company providing integrated solutions to health care organizations for improving efficiency. She earned both her certificate in medical management (CMM) and her MMM through a program offered jointly by Tulane University in New Orleans and ACPE, which allowed her to apply her seminar course work toward the completion of the programs. (The University of Southern California and Carnegie Mellon University in Pittsburgh also offer the MMM degree through partnerships with ACPE.) Sawyer elected to do the additional work required for the MMM and says it was worth it. In addition to enabling her to better manage her administrative responsibilities, Sawyer says, the MMM credential demonstrates her level of commitment to her management role and gives her additional credibility with other health care executives and physicians as well.

A. Clinton MacKinney, MD, MS, earned a Master’s of Science in Administrative Medicine through the Department of Preventive Medicine at the University of Wisconsin – Madison. Today, MacKinney is medical director for HealthPartners Central Minnesota Clinics in St. Cloud, Minn., where he practices family medicine two days a week and devotes the other three to administrative responsibilities.

MacKinney says the introductory programs he took helped him to develop leadership skills, but that a master’s program was necessary for him to develop the skills that would make him an effective manager. “I wanted to be able to make wiser management decisions, and the education gave me the foundation to do that,” he says. “It provided the vocabulary and an understanding of relatively complex business issues I hadn’t encountered every day as a physician.”

David C. Kibbe, MD, MBA, CEO of Canopy Systems, Inc., an Internet clinical software application and services firm based in Chapel Hill, N.C., and a contributing editor to Family Practice Management, completed the University of Texas – Austin’s traditional MBA program. “An unbuffered approach to management from the business and entrepreneurial side has a lot to commend itself and has proven to be a wise investment for me,” he says.

Kibbe urges family physicians to set realistic expectations and not expect an immediate return on their investment. “The programs sell the idea that once you have this degree or certificate or seminar experience, you’ll be set for life,” he says. “But the recruiters will tell you that employers are looking for people with experience and a proven track record of managing resources, people and money.” If you don’t have that, the certificate or degree might only enable you to get an entry-level management job, Kibbe says.

Getting down to business

Management training opportunities for physicians break down into three broad categories. They’re described below, starting with those that require the greatest commitment of time, money and energy. (The table provides more information about several programs in each of these categories and a list of Web directories that include links to programs’ Web sites.)

Master’s degree programs. Many options exist for physicians interested in pursuing an advanced degree. These include a variety of Master’s in Business Administration (MBA) degrees (traditional MBAs and MBAs with health-care-specific and, in some cases, physician-specific, content) as well as other types of health-care-related master’s degrees in areas more closely related to health care (Master’s in Public Health, Master’s in Health Administration, Master’s in Medical Management and Master’s in Administrative Medicine, to name a few). Many MBAs and other master’s degree programs are offered in traditional formats as well as “executive” formats designed for students who are employed and need to fit course work around a full schedule of work. Executive formats can range from evening to weekend to correspondence courses, each requiring some degree of on-campus course work. The length and frequency of the on-campus periods vary significantly among programs depending in part on the amount of distance-learning involved.

As you weigh your options, keep in mind that you can’t judge a program by the name of the degree it offers. Curricula can vary significantly among programs that offer the same degrees or vary only slightly among programs that offer different degrees. Look carefully at course descriptions. As a general rule, health-care-related degree programs based in the business/management schools of universities and colleges tend to have a greater emphasis on business education than ones based in schools of medicine or public health.

Marc L. Rivo, MD, MPH, earned his MPH at the University of California – Berkeley as part of a joint MD/MPH program. “It provided me with an excellent foundation for my career in administrative medicine, public health and health policy,” he says. Rivo is South Florida regional medical director for AvMed Health Plan, Miami, and medical editor of Family Practice Management. “If your major focus is simply to be skilled in the financial and personnel management side, then it may make more sense to consider an MBA,” Rivo says. “In a Master’s of Public Health program that offers a specialty focus in health care administration, you get a broad view of the health care system and the population-based approach to care as well as the business skills that an MBA provides,” says Rivo.

There are 29 accredited Schools of Public Health, many of which offer programs with distance learning and limited on-campus periods. Dual family medicine-preventive medicine residencies provide another route to an MPH. Currently about 10 such programs offer eligibility for certification by both boards and an MPH degree, and several can be completed on a part-time basis, Rivo says. (For more information about these and other MPH programs, go to http://www.acpm.org/?GME_MedStudents and www.asph.org.)

Certificate programs. These are popular among physicians who aren’t sure they want or need a master’s degree. ACPE offers a CMM to physicians who complete seven of its seminars, an exam and a presentation. The seminars are offered over long weekends in various cities across the U.S. The CMM program offers 30 hours of CME credit.

The American College of Healthcare Executives (ACHE; www.ache.org) and the American College of Medical Practice Executives (ACMPE, the professional development and credentialing arm of the Medical Group Management Association; www.mgma.com/acmpe) also offer certificate programs, although physicians account for a relatively small percentage of the participants. The ACPE, ACHE and ACMPE certify members with advanced study and experience in management and advance some members to the level of fellow, with the credentials CPE and FACPE, CHE and FACHE or CMPE and FACMPE, respectively. These programs also allow you to earn CME credit.

Introductory programs. Most physicians who want to learn more about the business of health care simply attend one or more regional or national CME programs. The AAFP offers FOM, a year-long, management-training program, which includes 10 days of coursework divided into two segments and an individual project. The FOM course has been recognized by ACPE as equivalent to its Physicians in Management Seminar I.

Lydia Lawson, MD, a family physician with Lovelace Health Systems, an Albuquerque, N.M., multispecialty group, took the FOM course after being elected a member of the physician subcommittee of the Lovelace Health System Medical Practice Board. She says small class sizes, experiential learning and a family medicine focus made FOM more useful to her than many courses she’s taken in the past.

“I needed to be able to communicate with the organization’s senior management in financial terms,” Lawson says. “I wanted better skills in that area, like learning how to read profit-and-loss statements and balance sheets. My other motivation was to learn how to bridge the communication gap between physicians and medical managers, and FOM helped me with that.”

Lawson is typical of most graduates of FOM and introductory programs like it in that she spends 60 to 80 percent of her work week in direct patient care and the remainder doing administrative work.

Intensive management seminars, such as those offered by Harvard University, are another option. They introduce participants to a broader range of health care management topics than a traditional CME course can, and they also help reorient physicians to the classroom.

Doing your homework

Deciding whether to pursue an introductory training program, a degree program or something in between is only half the job. Use the following list of considerations to help you identify the particular program that’s right for you:

Curriculum. To what extent is the curriculum health-care-focused? For example, many MBA programs offer a traditional MBA curriculum infused with case studies from the health care industry. Some also offer health-care-specific courses, such as health care finance and health care law, or courses that integrate clinical and managerial subjects. The program director should be able to tell you what percentage of the overall curriculum is health-care-focused. The focus of the curriculum is also influenced by the school or schools within the institution that offer the program (e.g., the College of Business, School of Medicine or the School of Public Health).

You should also determine whether the curriculum includes an organizational behavior component. Not all programs cover this, but it’s important, says Xakellis, who earned his MBA at the University of Iowa’s executive MBA program. “The biggest challenges facing physician executives are the human aspects of organizational performance, communication, inspiring people and setting visions, missions and goals,” he says.

Mode of instruction. Other than the traditional master’s degree program that involves full-time study on campus, most programs blend several modes of instruction, and you will want to evaluate the blend for each program you consider. How much of the course work occurs in the classroom? Are course projects designed to be directly applicable to challenges you face in your job? How much distance learning does the program involve, and what form does it take? Does it involve Web-based materials, Web-based courses, teleconferences and sharing ideas and discussing projects with classmates in online chat rooms?

Jonathan A. Swartz, MD, MBA, vice chair of the Department of Family Medicine at Montefiore Medical Center and medical director of a division of Montefiore Medical Group, Bronx, N.Y., earned his MBA from the University of Tennessee – Knoxville’s Physician Executive MBA program, which offers equal amounts of traditional classroom instruction and distance learning. He chose the program because it’s an executive MBA program designed specifically for physicians and because of the convenience of distance learning.

It was even easier than a local program would have been, Swartz says. “It took me five minutes to get my coffee and go downstairs for ‘cyberclass’ as opposed to driving an hour into the city to go to a class locally,” he says. “The program began with an intense residency week, so when we had our first cyberclass, it was easy to connect names with faces.” The software incorporates PowerPoint slides and live audio, and the teacher controls the microphone and the slides, Swartz explains. “It literally took me just one session to feel like I was in a classroom.”

Whatever the instructional media, beware of programs that involve a large proportion of lectures. “The more interactive the course work, the better,” Xakellis says. “Hearing the concepts in a lecture is not enough. You have to be able to practice a new style of interacting with others. As a physician manager, you won’t always be doing the task. You’ll be coaching and motivating others to do it.”

Cost. Who’s footing the bill? You? Your practice? Your employer? Most degree programs cost between $25,000 and $60,000 for tuition, fees, room and board. You’ll also have to pay for travel costs, which could vary significantly depending on where the program is located. The certificate programs can also be expensive, with tuition costs as high as $20,000. If the program grants CME credit and you have a CME allowance, discuss with your employer how much of the total cost it will cover. If the program doesn’t grant CME, check to see whether you can apply your CME allowance anyway.

Time commitment. Money isn’t the only thing you’ll have to invest in getting a business education. Both degree and certificate programs take considerable amounts of time. Many nontraditional degree programs have “residency periods” from one weekend up to 1 1/2 weeks long during which participants have to be on campus. Some physicians find it easier to commit to an occasional residency period than to an every-Saturday schedule. “I could probably have attended class every weekend had I chosen a program close to home, but I couldn’t guarantee that I’d have time to prepare for it every week. I knew that with two months between classes I could finish a project and read the materials for the next class,” Sawyer says.

You should also try to get a good estimate of how much time you’ll have to spend on course work in between the residency periods. If the program literature says you’ll spend 20 hours a week on course work, you might want to plan on 25 or 30. Whatever the case, don’t tell yourself you’ll be able to get the work done in less time than the program suggests.

You should also factor completion time into your decision. How long will it take you to finish – and how long will you be allowed to take? Most of the nontraditional MBA programs take about two years to complete. Some certificate programs allow physicians a more generous amount of time to complete the program requirements.

History and reputation. Is the program accredited? How long has it existed? How many physicians (and others) have completed it? What do graduates, as well as other physicians, say about it? If you’re committed to continuing to work in your local community, you might be better-served by choosing a program that is well-known and respected locally and that will enable you to develop a network of contacts in your area, says Xakellis.

Participants. To the extent that health care has a lot to learn from other industries, it might be beneficial to have people in your class who don’t work in health care. On the other hand, you’ll want to share ideas and build camaraderie with other physicians and health care executives. Try to find out about previous participants’ backgrounds and goals. While you’re at it, ask how many family physicians have completed the program. Sawyer says she keeps in close contact with physicians she met through the program. “I now have a broad network of contacts I can call to ask how they’re handling certain issues in their part of the country.”

Support

Your choice about which type of program to pursue should be based not only on which path might best further your career goals but also on the level of support (both financial and emotional) you’ll have from your family and your employer or, if you’re in private practice, your partners. Physicians who’ve completed business degree programs identify family support as a key to their success.

“I devoted about 20 hours a week over and above my full-time job to getting my degree,” said Xakellis. “My family life was impacted substantially. You’re not just physically absent more often, your mental energies are flowing in a different direction. You need to have your family’s support.”

MacKinney began his master’s program when his twin boys were six months old. The program required that he spend about five weeks on campus per year, but the remainder of the course work could be done remotely. MacKinney says the program was supposed to have taken about 15 hours a week, but he found it took 20. At the time, he was practicing full time. When he wasn’t on call (three days out of four), his day started with rounds at 6 a.m. He began seeing patients at his clinic at 7 a.m. and worked straight through the noon hour until 2 p.m. He was usually home by 3 p.m. and studied until 8 p.m., when he put his sons to bed and sat down for dinner with his wife. He wrote approximately 80 papers in the two years it took him to earn his degree.

“It was the most fascinating two years of my professional life,” he says. “It took a lot of planning, time management and sacrifice by my family and me, but it was worth it.”

Learning never ends

Once you’ve plotted your course, you can look forward to applying what you learn. “The challenge for physician managers is to take all their new technical managerial knowledge and apply it in a way that allows you and those around you to enjoy your work more, improve the patient care you deliver and be financially successful – or at least economically viable,” says Xakellis.