As the class convenes on Tuesday nights in a book-lined conference room in the Medical Center of North Hollywood, most of the students still are in their hospital whites and weary from the day’s work. But they concentrate hard on the teacher and blackboard in front of them.
They are sharpening their skills, but not in anatomy or anesthesiology. This intent little group of doctors and nurses is studying accounting. If the students stick with it, they also will take marketing, management, finance and all the other courses traditionally associated with business.
At a cost of $390 per 10-week course, they are working toward master of business administration degrees. They are participating in what appears to be a unique off-campus program in which Orange-based Chapman College has taken MBA classes to personnel at the 185-bed San Fernando Valley hospital since January.
Doctors Want Business Sense
It’s not unusual for nurses to get business degrees to advance their careers. But doctors?
“It’s very uncommon,” said Harry Paxton, a senior editor at Medical Economics magazine in Oradell, N.J. “I’ve hardly ever heard of such a case.”
That may be changing. Beset by increasing competition from one another and from cheaper health-maintenance organizations, pressure from third-party payers to contain costs, and the challenge of their own high income, many doctors are paying closer attention to the business side of medicine.
“In medical school they never taught us any business,” said Dr. Ellen Goudlock, a 46-year-old internist who is one of four physicians participating in the Chapman program with 10 other hospital employees.
A Key to Advancement
Among the other students are four nurses and the hospital’s nursing director, 45-year-old Phyllis Van Crombrugghe, who said advancement in nursing and hospital administration requires increased business sophistication and administrative skills.
“We got tired of financial types talking down to us,” said Van Crombrugghe, whose initiative brought the program to the medical center. “Hospitals are definitely on the way to giving more responsibility to directors of nurses.”
Van Crombrugghe, in fact, has relocated for advancement during her seven years with one hospital chain as frequently as some executives move within a non-medical corporation. She moved from a small hospital in Garden Grove to a larger one in Fresno and then to the even larger hospital in North Hollywood, each time as a nursing director.
For the physicians in the class, however, an MBA is not a ticket to promotion. They said they like practicing medicine, and plan to stay with it. They just want to run the business side of a medical practice better--and avoid making mistakes with the substantial incomes that most doctors make.
‘We Lose Money’
“Things are changing very fast,” said V. Sambasivan, a 37-year-old cardiologist who is in the program. “It’s very difficult to get good business advice without knowing how to evaluate it. We always get involved in tax shelters, and we invariably lose money.”
The Medical Center of North Hollywood is an example of the growing role of business in health care: It is part of the 157-hospital American Medical International chain, one of the largest for-profit hospital groups in the world.
“Operating a medical practice is big business, and the need for management skills is enormous,” said Michael Wiley of R. L. Hirsh Associates of Bay Shore, N.Y., which provides business consulting for doctors. Yet only 10 of 127 U.S. medical schools offer business courses, according to the Assn. of American Medical Colleges.
Offering an MBA program in a hospital may be unique, but the presence of physicians in such classes is not. Occasional seminars on the business end of a medical practice have long been available to physicians. And William Braesamle, president of the Graduate Management Admission Council in Santa Monica, said he knows of at least three doctors in the MBA program at UCLA aimed at working executives, and that several physicians are enrolled in a similar program at the University of Texas.
Medicine ‘More of a Business’
A number of consulting firms, including Hirsh Associates, do nothing but help doctors manage their businesses. Some medical groups, even those with only three or four doctors, go further: They hire full-time administrators, often with MBAs, at salaries of $40,000 or better, to manage their practices.
In the Chapman program, though, a few doctors have decided to take matters into their own hands. Chapman conducts a broad network of off-campus classes, and took its MBA program to the Medical Center of North Hollywood after enough members of the staff signed up to justify a program there.
“As medicine becomes more competitive, it becomes more of a business,” said Jonathon Serebrin, a 33-year-old emergency-room physician who enrolled in the program. “To stay competitive it becomes necessary to know more about it.”
He added that he has no desire to become a hospital administrator, which he said “has got to be the worst job in the world.”
Concerns Over Trend
“Most physicians really don’t appreciate the needs they have in the business area,” said Robert Campbell, whose Glendora firm, Campbell, Grave & Associates, advises about 300 doctors. He favors doctors studying business, he said, because it “makes our job a little easier.”
If doctors are paying closer attention to business these days, not everyone is sanguine about the idea.
“It’s understandable that even the most conscientious and ethical of physicians need to concern themselves with business matters,” said Dr. Arnold Relman, editor of the New England Journal of Medicine. “My only concern is the growing feeling among some segment of the medical profession that medicine isn’t much different from a business. I deplore that.”
Relman said it is unusual for doctors to get an MBA degree, but that the number is increasing, particularly with the growth of health-care corporations and for-profit hospitals.
Keeping a Balance
“It doesn’t disturb me that doctors want to be efficient and businesslike,” he said. “But it should concern someone if the doctor begins to think more about the bottom line than about his patients’ needs.”
Getting an MBA is difficult while practicing medicine, the doctors said, but they have high praise for the idea of courses in the hospital.
“It’s the only way I’d do this,” said Sambasivan.
They also complained about accounting, a subject notorious among business students for its difficulty. Serebrin said homework takes five hours of his weekend.
Accounting is the current subject. Before that it was economics, and marketing is next. One subject is taught at a time, once a week for four hours, 10 weeks in a row. Students must take 16 courses to get a degree, although those who have previously taken accounting, statistics, economics or marketing can be excused from some.