The traitor complex MD/MBA students struggle with medicine vs. management dilemma

Physician Executive, Jan-Feb, 2005 by Windsor W. Sherrill

The transition from clinical roles to administrative functions has always been challenging for physician executives. Caught between the desire to help patients and responsibilities to shareholders, physician executives deal with conflicting expectations.

Concerns about conflicts between managers and physicians in the health care system also emerged in a recent study of MD/MBA students. Students from six programs were interviewed concerning career plans.

An interesting finding from the interviews was the frequency with which these students expressed concern about the perceptions of other physicians of their plans and desire to seek business training.

Of 40 students interviewed, 19 discussed the concept of being a traitor to the medical field. Related ideas were referenced 26 different times in the interviews.

Students are aware that many of their colleagues are suspicious of their interest in business education, particularly whether they are focusing inappropriately on business issues to the detriment of patient interests. Interviewees mentioned reactions of fellow students, practicing physicians and even faculty members.

Students were asked, "How do you think that your medical school classmates feel about you taking business courses?"

Examples of comments included:

* "Some people are positive and think it is great. Some people think it is sort of a sell-out or that we are going to the other side of the camp."

* "Some think it is a great idea, but others think I am a traitor, especially with all the changes, people do not like it or are threatened by it."

* "I hear lots of arguments. Some are gung-ho and say we need physician executives, and some say what are you doing and say we are here to be doctors--that I will compromise the MD."

* "Many physicians are excited and happy that students are taking this initiative, but one physician called me a traitor because he said I couldn't have both business and patient interests in mind at once."

* "Some [of my classmates] think it will carry me far, others say I am not dedicated to being a doctor and question whether or not I am going to end up in medicine or be a good doctor if I am always thinking about the business of it."

* "There was a strong feeling first year in medical school that it was a waste of time, and I must be out to make money. This was not just classmates, it was also some professors."

* "I think a lot of them are hostile and are not exactly open to it. They tend to think of us like they think of the HMOs and things doing all these terrible things to patients. In that sense, I think that they think we are in it more for the money. Maybe they think that we are not as compassionate as they are toward patients."

* "I have thought about this [issue]. When I get ready to interview ... I think it will be different because I wonder how physicians will view us and what they will think about our motivation."

Similar responses were received when students were asked whether physicians talked with them about physicians in management and their impressions of physician executives.

* "Older physicians (from the old school) over 65 see physician executives as folks who sold out and went into health administration."

[ILLUSTRATION OMITTED]

* "I think there are a handful of physician executives in top levels that are giving the impression that people are doing this for the money."

* "My impressions are that the HMO ones [physician executives] have gone away from their roots a little. Sometimes they are criticized by their fellow physicians that they sold out."

These perspectives of dual degree MD/MBA students offer insight into the challenging role of physician executives, particularly related to the inherent conflict between clinical and organizational goals.

Perhaps MD/MBA students will be able to overcome many of the obstacles that have made the transition from clinical work to management a difficult one. Dual degree students are acutely aware of the need to bridge the gap that exists between physicians and managers.

And this early awareness may help create physician leaders who understand the business of health care but can also stay focused on their medical foundation.

Windsor W. Sherrill, PhD, MHA is an assistant professor in the health sciences department at Clemson University in Clemson, S.C. She can be reached at 864-656-0263 or wsherri@clemson.edu

[ILLUSTRATION OMITTED]