January 2003

M.D., M.B.A., M.N. (Master of None)

By Michael J. Katin, MD

I am now receiving mailings for my next medical school reunion, and I reminisce (otherwise known as having flashbacks) that when I was in school most of us were just trying to get through without screwing up too badly and getting it over with as soon as possible. Since many, if not most, of the readers of this column are college and high school students who have come across this site by accident, it may be surprising for them to hear that years ago there was an effort to actually finish college in 4 years and then go directly into a single postgraduate program instead of taking the opportunity for self-discovery and exploring multiple options before finally getting into a profession at age 38. When those in my era were desperately seeking an M.D. or D.O. degree there was the rare individual who was also working on a Ph.D.

There was always a somewhat convoluted explanation as to the final purpose of this but it usually involved staying in academics and also sometimes included the ability to tie into a special scholarship program that financially justified the extra effort and logistical manipulation.

I was amazed to learn that over 5,000 physicians have acquired M.B.A. degrees. This nearly matches the difference in the popular vote count in the Presidential election of 2000, although is small compared to the total number of physicians in the U.S. (690,000, which, coincidentally, is the number of barrels of oil per day transported through the Suez Canal). Presumably business schools do actually have some knowledge of marketing and sales, since they have discovered that many of us are intimidated by the realization that it's not enough to be able to know medicine and take care of patients, but also to be able to defend against constant threats to our ability to stay in practice by government regulation and predatory entrepreneurs.

There are now Executive M.B.A., Global M.B.A., and Medical M.B.A. programs, and I'm sure there are many other modifiers in development. I admire my colleagues who have gone through one of these programs for having the dedication to do this although I wonder if the physicians who have done this are the ones who already had an aptitude for business matters and that all they are doing is getting a diploma to validate this (like the cowardly lion's getting a medal to validate his courage, or the scarecrow's getting a...hmmm). Is a "medical" M.B.A. likely to impress a hardcore business type who got a major league non-prefixed degree from Harvard, NYU, or Michigan? A cynic (certainly not I) would say it would be better to put that much effort into 1. Idealistic approach: getting more medical knowledge to establish a practice pattern that could not be challenged, or else 2. Realistic approach: to get a J.D. degree and make everybody afraid to mess with you. I also feel obligated to point out that of the four most accomplished physicians (one, two, three, and four) of the past 90 years, none of them had an M.B.A. degree.

Maybe medical schools should find a way to make windfall profits by promoting Business M.D. programs and claiming that this will make investment fund managers, attorneys, politicians, and related professionals more knowledgeable about medicine and allow them to better exploit us. I'm not sure how that would best be set up and in fact could provide material for at least one future column, but maybe it could include evening sessions of being sprayed with bodily fluids and meeting hostile patient family members and then maybe a 2-week summer session of being kept up all night. That might provide at least a slight approximation of going through medical school and residency.

I again want to emphasize that I have nothing but admiration for physicians who seek to go beyond traditional limits, and it may be that the era of opportunity to distinguish oneself and find fulfillment in medicine has passed. It is significant that 2002 marked the passing of one of the most distinguished physicians of our time, and it is a shame that most of the year-end news reviews did not even mention him. And neither will I until next month.

email: mkatin@radiotherapy.com