Today MBA classrooms are filled with a variety of people from all walks of life - including doctors. It isn't unusual to find a few physicians among the pupils, with their beepers at their sides, ready to exit class early in case of an emergency. Other students may wonder why a doctor would need or want a Master's in Business Administration, but with the increasing complexity of the healthcare industry, many physicians find that there is more to their jobs than just practicing medicine. What doctors are discovering is that an MBA enables them to be better prepared to make management decisions and face the many business challenges that arise in healthcare.

"Physicians have always gotten a bad rap as poor businesspeople," says Douglas E. Hough, Ph.D., director of the business medical programs with Johns Hopkins University, Columbia, Md. "Over the past 10 years more and more physicians have had the opportunity to run businesses through solo and group practices." Johns Hopkins University is just one of many schools that is seeing a growing number of physicians enter the MBA program. Since 1994 the school has offered a four-year course certification program to physicians; since 1999 they have offered an MBA program. So far, 275 students have earned certificates, 50 have earned MBAs and 85 more are working toward their degrees.

Physicians are needed as leaders in the development and management of healthcare facilities; biotechnology-focused industries, health insurance/managed care firms and pharmaceutical, medical supply and medical equipment companies. According to Joan E. Shook, M.D., director of the Baylor College of Medicine/Rice University, Jesse H. Jones School of Management MD/MBA programs, people enter the program for several different reasons. Through this program students spend five years to earn both an M.D. and an MBA. "These young students are drawn to the program because they believe that the combination of the two skills sets will allow them greater freedom and flexibility when they enter the job market," Dr. Shook says. Some students have strong leadership skills and think that they will enter leadership positions in medical schools, physician groups, hospitals or managed care organizations. "Most of these people are in a leadership position and feel that they need more business skills in order to make their enterprise successful or they are frustrated by their current position and seek a career change," she says. "A few of the people that I have spoken to are entrepreneurs at heart and are seeking the skills to bring their innovations to market."

What do physicians need to become better managers? A basic set of skills for doctor-managers would include accounting, budgeting, human resource management, strategic planning and perhaps marketing, negotiation, communication and organizational theory. However, physicians need to know more than marketing and finance; they need to be familiar with both the practices and theories of managed care and how to manage the health of the population.

Working in the anesthesiology department at Children's Hospital in Columbus, Ohio, Russell Sauder, M.D., decided he needed to get his MBA in order to not only negotiate with businesspeople but to learn what it would take to start his own practice. He is currently enrolled in the MBA program at Capital University in Columbus. "I had no background in finance and accounting," Dr. Sauder explains. "I wanted to stay in medicine but know how to talk business." Due to the complexities of managed care, Dr. Sauder knew he had to understand how to deal with medicine as a business. "If someone throws a balance sheet in front of me I need to understand all about cost and revenue."

Dr. Sauder admits that when he started the program he wanted to learn how to be a better businessman, but now he is actually considering starting his own business. "This just reflects the different generations," he notes. "Our parents worked with one company their whole lives, but we need changes." Even doctors need choices. Steven Meltzer, M.D., MBA, received his medical degree from the University of Southern California in 1981. He served a pediatric residency at Children's Hospital of Los Angeles from 1981 to 1984 and then fellowship in allergy/immunology at Kaiser Foundation Hospital in Los Angeles from 1984 through 1986. "While at Kaiser, it became apparent that managed care was going in a direction that doctors were going to either be the `managers' or the `managees,' " Dr. Meltzer says. With this understanding, he entered the MBA program at Cal State Long Beach in the fall of 1986. He joined an allergy private practice in Long Beach, Calif., on a part-time basis while pursuing the degree.

It took Dr. Meltzer six years to attain his degree, taking two courses each semester and at least one summer course. He says the reason it took him so long was the prerequisites needed for graduate business classes. "Nevertheless, it was beneficial to be exposed to other MBA students in different industries as I could appreciate the insulation of the healthcare field that so many of us take for granted," he says.

Because he was just starting his practice when he went to school, his patient load didn't affect his studies. He felt it was somewhat of an advantage to be in school while starting a practice because the lessons could be more quickly applied. "My business professors were usually considerate of my professional obligations but not always," he explains. "In some respects, some of the faculty seemed to be challenged in a positive manner by my presence in their classes. Some of the professors had definite misconceptions regarding physicians and hospitals, so I felt compelled to provide some education to them in return."

Initially, he had planned to become a financial planner for physicians, but unfortunately he did not like the difficulties of dealing with physicians and their money. "I was more attracted to marketing, more specifically patient and physician behaviors with respect to advertising for the pharmaceutical industry," he explains. "This has helped greatly in building my practice as well as consulting activities for pharmaceutical companies. Most importantly, it made me a better physician in understanding my patients' needs and wants."

For Dr. Meltzer the most important lesson from business school is the ability to think strategically. "Many physicians and healthcare concerns have a very short-sighted viewpoint. Taking into account internal and external factors over a three- to five-year horizon provides immense benefits to planning a career and the tools needed for success," he notes. "Over time, my practice has grown exponentially while maintaining the commitment to provide quality healthcare."

Unfortunately, most MBA programs have been designed for full-time students or professionals with schedules that are not as demanding as a physician's schedule. "I've had physicians who were paged and had to leave in the middle of class," Dr. Hough says. "We do whatever we can to accommodate." One school that has certainly made an effort to accommodate doctors is Denver-based Regis University. The school has just started to offer the very first online MBA program designed specifically for physicians. The program is available to doctors via the Internet 24 hours a day, seven days a week. The added benefit is that no classroom attendance is ever required. "We wanted to reach out to people who, for whatever reason, cannot attain the degree in class," says Michael Goess, chairperson of the university's MBA program. "So far it is working out very well; the physicians like it."

Doctors who participate in the program earn Continuing Medical Education Category 1 credit toward the AMA Physicians Recognition Award. A maximum of 121 credits can be earned for the complete degree program, which includes a total of 12 courses. According to Goess, videos in which professors discuss different topics are provided to the students. Also, class discussions are held through the bulletin board and students can ask their professors questions through a chat room.

Physicians are trained in medical school to be in charge of the patient and not be concerned with the costs for care. However, they need to start thinking like businesspeople: Which costs reports should the accountant do? Finding a better way to negotiate a managed care contract. With the growing complexities of the healthcare industry, doctors who can relate to both the medical and business sides of the sector will undoubtedly enhance the lives of all who depend on their care. - SHERRI PFEIL, Staff Writer