Medical students swap their scrubs for pinstripes

After three years of medical school and $200,000 in school debt, Elizabeth Myers might be expected to relish the thought of starting her residency, paying off her debt and putting her expensive training into practice. Instead, Myers decided to prolong her education and trade in her stethoscope, at least for the moment, for balance sheets.

Among all the economic changes that have altered the practice of medicine, Myers is part of a growing number of young doctors who are pursuing business degrees. She is earning a joint degree in medicine and business administration at the University of Chicago.

“I think there is a growing awareness that health care is intrinsically tied with the economy, and you don’t learn about the economics of health care at medical school,” Myers said.

Experts point to a number of changes driving this trend, including managed health care, the rise in malpractice suits and the steady march of technological advances in medicine.

Medical schools are taking notice. According to M. Brownell Anderson, the senior vice president for medical education at the Association of American Medical Colleges, universities are adding courses on subjects like managed care, cost containment and quality assurance as part of their required curriculum.

There has also been an upswing in the number of medical degree/MBA programs. In 1990, 10 schools had such programs. Today, there are 47.

“Historically, there has been a disconnect between health care and business,” said John Silbernagel, the director of graduate education at Tulane University's A.B. Freeman School of Business. “But the reality today is that you can’t separate the two.”

Valerie Nelson Lilly, another medical/business student at the University of Chicago, has thought a lot about the link between health care and economics. She argued in her business school application essay that to improve the quality of health care in a capitalistic country, economic incentives should be tied to positive outcomes among patients.

For some students, the move from medicine to management sometimes requires an adjustment in perspective.

Myers found it difficult to think in terms of the bottom line. She recounted a recent argument with her business school classmates in which she was the only person in the room who believed Wal-Mart had a responsibility to provide health care insurance for its employees.

“They probably thought I was a bleeding heart liberal,” Myers laughed.

Jessica Merlin also faced an awkward transition from medicine to business.

“It was definitely a bit of a culture shock,” said Merlin, who is the co-founder of md-mba.org, a Web site created to help medical students considering the dual degree. Merlin is a recent medical/business graduate from the University of Pennsylvania. “I went from the [intensive care unit] one day to math camp,” she said, referring to a prerequisite at the business school for students from nonfinance backgrounds.

For Jason Saunders, a medical/business degree candidate at Harvard University, the transition from working one-on-one to collaborating in teams caught him by surprise at business school.

Learning the consensus building style of leadership was one of the key benefits of obtaining a master's degree in administration, according to Charisse Jimenez, the project manager of graduate programs at the American Association of Physician Executives.

Physicians who are trained to be quick on their feet and confident in their decisions can face problems when they take on an administrative role within medicine because most decisions are made through collaboration.

“They have to re-learn how to work,” Jimenez said.

Some students seek the dual degree to increase their earnings potential, but for others, monetary gain is secondary. Merlin says she would like to use the skills she has learned to work as a hospital administrator in graduate education.

Myers, who is specializing in dermatology, says she wants to use her business degree to help reach her goal of opening up clinics in underserved communities.

“I’m not really interested in maximizing my personal income,” Myers said. “I really want to follow my passion.”

E-mail: ic2170@columbia.edu