“That was kind of on-the-job training,” he says. “Just because you’re wearing a higher rank than somebody else doesn’t necessarily mean that you’re going to be able to effectively motivate them to work within the team and do their job more effectively and help you do your job more effectively.
“That probably was my first time that I was desiring formalized leadership training.”
Dr. Spoja, now 40 and a chief hospitalist in Nampa, Idaho, and regional medical director for Sound Physicians, has made the decision to pursue a Master of Medical Management (MMM) degree—a choice that will mean even crazier hours than he already has now, more hard work, and regular trips from Idaho to Los Angeles. Not exactly a snap to pull off for someone who’s married and has four kids.
But it makes sense for him, because he would like the option of pursuing a chief medical officer position eventually, he says.
“You’re going to get to interact with professors,” he says. “It shows a level of commitment, I think, to leadership.”
A Great Debate
The question of getting an advanced management degree—such as an MMM, a Master of Business Administration (MBA), a Master of Public Health (MPH), or a Master of Hospital Administration (MHA)—poses a great dilemma for many hospitalists.
Job experience and exposure to so many facets of hospital operations make hospitalists good candidates for administrative posts.
But that experience, some hospitalists find, is really only enough to place them into a gray area. Hospitalists’ experience and managerial abilities lay the groundwork for moving up the hospital ladder to the C-suite and might pique their interest in doing so; however, the question remains whether that experience alone is enough. And how to go about deciding whether to get an advanced management degree—and then where and how to pursue it—sets up a complex choice with lots of variables.
Key recommendations from educators, career counselors, and physicians who have gone through the decision process include the following:
- Seek advice from those in the positions you seek;
- Use resources like the American College of Physician Executives (ACPE); and
- Hone your leadership skills through in-house programs before embarking on an expensive and time-consuming formal degree.
Advanced degrees can cost as much as $40,000 per year, just for tuition, and can take a year or two to complete. Options range from an on-campus program to online programs to a combination of the two. The choice of which degree to pursue might be difficult for some, ranging from the traditional MBA to the more quality improvement-focused MMM.
Michael Guthrie, MD, MBA, executive-in-residence at the University of Colorado-Denver School of Business, says making the choice requires thorough consideration.
“Here’s something that could cost you $75,000, maybe more, depending on what you pick,” says Dr. Guthrie, a frequent speaker on the topic at SHM annual meetings. Plus, “time, energy, distraction, and time away from family. There are significant issues about cost, not just financial. And you have to really have a sense of what’s the return on investment.”
Those with degrees generally do make more money than those without, according to the 2011 Cejka Executive Search and ACPE Physician Executive Compensation Survey. Physician CEOs with an MBA made $24,000 more in 2011 than those without an advanced degree; CMOs with the degree made $44,000 more.
But having a management degree doesn’t automatically translate to more money in every executive position. Physician CEOs with an MMM made $37,000 less than those without a degree; CMOs with an MMM made $51,000 more than those without a degree—a difference based partially on the reality that an MMM often is a degree pursued by aspiring CMOs.
—Rebekah Apple, MA, senior manager of physician services and support, career counselor, American College of Physician Executives
One of the most fundamental questions facing hospitalists with advancement aspirations is “Can I get to the C-suite without that extra degree?”
In some cases, the answer is “no.”
At Banner Health, a system with facilities throughout the western U.S., all C-suite executives have to have an advanced degree of some kind, generally an MBA or MHA, says Kathy Bollinger, president of the Arizona West Region at Banner. She recently hired former hospitalist Steve Narang, MD, MHCM, FAAP, MBA, as CEO of Banner Good Samaritan Medical Center in Phoenix.
It wasn’t merely Dr. Narang’s MBA that earned him the position. Bollinger says his knowledge, experience, and her own confidence in him during a transitional period in the U.S. healthcare landscape played key roles in the decision.
But the degree rule is in place, she notes, because at Banner, the degree is seen as so crucial to cultivating the kind of knowledge and person capable of being a good hospital administrator.
“His business degree is clearly part of him and part of his effectiveness,” Bollinger says. “So I’m not sure that I could have observed in Steve the things that I observed in Steve had not he not been more globally trained, if you will.”
Doctors and administrators, she says, tend not to think alike.
“I would say physicians, medical staff members of a hospital, and administrators of a hospital historically, in a stereotyped way, have been predisposed to be at odds with one another,” she says. The formal education is a way to expand a physician’s way of thinking, she adds.
“The business thinking and financial aptitude that is required at our big hospitals is such that it would be a stretch for somebody who didn’t either have a degree or was deep into it from an experience standpoint,” she says. “For me, that was very significant.”
When the Cleveland Clinic was looking for a new CEO at South Pointe Hospital in 2012, they tapped a doctor without a management degree—Brian Harte, MD, SFHM, a hospitalist who had been chief operating officer at another hospital within the system. At the time of Dr. Harte’s promotion, Cleveland Clinic Regional Hospitals President David Bronson, MD, who also does not have an advanced management degree, praised Dr. Harte’s experience.
“His expertise in quality will help South Pointe Hospital continue to provide the best experience for patients,” Dr. Bronson said in a news release at the time.
What can’t be denied, however, is that many physicians in executive roles do, in fact, have post-graduate degrees. According to the ACPE’s survey, 40% of the doctors surveyed had an MBA, an MMM, an MPH, or an MHA. Of those, 52% had an MBA. The survey includes everyone from CEOs to associate professors.
Even so, an advanced degree is not a magic wand.
“The MBA doesn’t get you a job,” Dr. Guthrie says. “People are looking at what you can do and what you’ve done and not at how smart and schooled you are. It’s helpful. It’s useful. I believe that the current terminology is ‘preferred ‘ or ‘encouraged,’ but it isn’t essential.”
Robert Zipper, MD, MMM, SFHM, chief medical officer of Sound Physicians’ West Region and chair of SHM’s Leadership Committee, earned his business degree at Carnegie Mellon in Pittsburgh. He says it’s important that hospitalists have experience before pursuing the degree. This will help them “see the business side through a clinician’s eyes first.”
“There were some people in my cohort at Carnegie Mellon who didn’t have enough experience to make the programmatic elements all that relevant to their practice, to their world,” he says. “You want to be able to reflect on the mistakes that you’ve made and the things that you’ve done really well and have a deeper understanding of what worked and what didn’t if you want to get the most out of it.”
That said, he acknowledges that those circumstances apparently aren’t a requirement for success—one of his Carnegie Mellon classmates is a CEO.
Which kind of degree to pursue is a whole other question. Experts say that while getting the degree will give you a leg up to some extent, certain degrees will be preferable over others depending on what you want to do. For someone who wants to run a start-up medical company, an MBA might be best. For someone who wants to work in quality improvement, the MMM might be best.
An online degree—or at least one that’s completed partially online—might be more practical for a doctor who wants to continue with practice. Some programs require students to be on campus for every class, and some require occasional on-campus work, while others never require a doctor to set foot on a campus.
“The issue becomes, what are the individual’s degrees of freedom?” Dr. Guthrie says. “Individuals’ personal circumstances really drive which kind of program they look at. And then where they’re located may have a lot to do with what they choose.”
Rebekah Apple, MA, senior manager of physician services and support at the ACPE and the primary career counselor there, says that when doctors ask her about getting an advanced management degree, she starts by asking them what they want to be doing in three to five years. If the answer is not realistic, she helps them revise those goals. Once that’s settled, she helps them figure out whether the degree makes sense.
From that point, she says, there is no hard-and-fast rule.
“It’s very driven by the individual,” she says.
Plunging into management training probably isn’t best suited for those fresh out of residency with little leadership exposure at their institution or for those only a few years from retirement.
She tries to open physicians’ eyes to the wide range of C-suite positions available, including some they might not have heard of. Chief medical officer is traditionally what doctors think of when they consider executive positions, but other positions, such as chief information technology officer or chief patient experience officer, should be considered.
“The conversations are changing very much,” Apple says. “There are a lot of other emerging roles. I think sometimes that the varied opportunities that exist, whether or not people know about them at the beginning of our conversation, can really color the decisions that people make later.”
A love of learning should be a main motivator. Dr. Guthrie emphasizes the importance of pursuing a degree that you’re interested in. Without that interest, he says, a hospitalist might want to reconsider.
“It goes by very quickly—it’s also fun,” he says. “Physicians are great students usually, and by the time they get into it, [they] realize, ‘You know, this is really kind of a hoot.’”
Tom Collins is a freelance writer living in South Florida.