Teaching the business of medicine Informatics: Johns Hopkins is among several schools across the nation teaching medical professionals the administrative side of medicine. The programs can let doctors add an MBA to their clinical credentials.


The students trickle in, some drifting, most bustling. There are men in business suits and women in blazers and skirts. But many are wearing lab coats with their names in stitched script. One rushes in in surgical scrubs.

At the back of the amphitheater-style lecture hall in the Johns Hopkins medical school complex is a table with pretzels and cut-up fresh vegetables, pots of coffee, cans of Coke. The students help themselves as they settle in. Class begins. A pager sounds, and one of the lab-coated students rushes out to a phone.

It is indeed a medical class, but the topic is not anatomy or antibiotics. It is medical informatics -- the use of computers to track patient records, billings and so on. And the students, mostly Hopkins doctors, are studying for a master's degree -- in business.

Having done battle with business, these medical professionals have decided not so much to join it, but to understand it, to arm themselves by learning its language and thought systems and methods.

When Hopkins began offering its business-of-health program three years ago as a joint effort of the Office of Continuing Medical Education at the medical school and the Division of Business and Management at the university's School of Continuing Studies, it was hoping to attract about 25 students for the first class.

It got about 100 inquiries, according to Patricia D. Wafer, senior program director at the School of Continuing Studies. It launched a class of 35 in September 1994, another class of 35 in January 1995 and another class of 30 in March 1995. The program has continued to fill three classes a year; the eighth class began Wednesday.

Students can study for a year and receive a certificate, but the majority have chosen to attend for four years and get a business master's degree. Originally limited to Hopkins doctors, enrollment has been opened to the non-Hopkins world and now includes other clinical professionals, such as nurses, and some health administrators who are not clinicians.


The growth and popularity of the Hopkins program is clearly part of a national trend. As HMOs and other dollar-conscious managed care plans grew rapidly in the 1990s, doctors found themselves interacting with the marketplace in unfamiliar ways.

Some enroll in hopes of preparing themselves for administrative positions in the hospital or medical school, such as Dr. Howard Kaufman and Dr. Jeffrey Bender, Hopkins surgeons who started the program last week. "I'm here because my wife convinced me that to get ahead, I'm going to need to know stuff like this," Bender says.

But many say they feel they need familiarity with business tools to do their current jobs.

"I think we're all here because we realize there are a lot of business practices that are being applied to the practice of medicine," says Dr. Mark Richardson, deputy director of the department of otolaryngology at Hopkins, who has been in the program for two years. "We need to regain control of medicine."

"I'm a marrow transplanter," says Dr. Georgia Vogelsang, an associate professor of oncology at Hopkins who is a classmate of Richardson. "All of a sudden, I was being asked, 'How much does it cost to transplant someone?' Suddenly, we had to negotiate contracts with huge insurance companies."

As one class project in the program, she did a business study of outpatient bone marrow transplants -- and now her department has started to do them.

"Survival is the big thing" that attracts students to the Hopkins program, says David P. Heaphy, assistant dean of the Hopkins medical school. "Managed care was like a wave coming across the country, and they wanted to be prepared."

Chance for schools

Changes in health care and insurance also presented an opportunity to schools of business, health administration and related fields. "A lot of business schools were seeing a decrease in their traditional market, and they see health as a new market. A lot of health administration programs realized they could enroll physicians, a group they had never enrolled before," says Alice Sanborn, director of educational development for the American College of Physician Executives, a professional organization for doctors with management training or responsibility.

And for the schools, it works. For example, Paul Feldstein, coordinator of the two-year Health Care Executive MBA program at University of California at Irvine, says that despite a price tag of $52,000 (about to go up to $56,000), there is always a waiting list and enrollment "is just limited by the size of our lecture room."

Membership in Sanborn's organization is one measure of the growth of the "physician executive" -- from about 2,000 in 1985 to about 6,000 in 1990 to 12,000 now.

A survey last spring of physician executives by Witt/Kieffer, Ford, Hadelman & Lloyd, an executive search firm in Oak Brook, Ill., found that 18 percent had a business or management degree. A survey three years earlier, which may not be exactly comparable because of changes in survey methods, found 9 percent of doctor/managers with business or health administration degrees. In 1990, the figure was 6 percent; in 1979, zero.

And programs are popping up rapidly to meet the demand. A few began in the late 1980s, but most have started in the last three years, and more are in the planning stages. There are several different models:

* Programs, such as the one at Hopkins, providing graduate business training specifically for doctors and other health professionals. Some are short-term, such as the University of Utah, which has a ten-week course, and the University of Tennessee at Chattanooga School of Business, which offers a 14-week mini-course to help doctors manage their practices. Others offer full-scale master's degree programs aimed at physicians and other clinicians, such as the ones at Duke, the University of Wisconsin and University of California at Irvine.

* Joint M.D.-MBA programs, in which students work toward a medical degree and a business master's at the same time. Usually, the program takes five years. Often, this occurs at universities with both business and medical schools, such as Georgetown University and the University of Chicago. At Tufts University, 15 of the 173 members of this year's entering medical school class chose the joint degree option. And the University of Southern California offers joint MBA programs with its dental, pharmacy, nursing and gerontology programs as well.

* "Executive MBA" programs, which attract substantial numbers of doctors. Executive MBA programs offer courses during evenings and/or weekends to attract students who have full-time jobs. Among those reporting physician enrollment in general executive MBA programs are the University of Florida and Rensselaer Polytechnic Institute. Among schools offering executive MBA programs with a health emphasis, the University of Connecticut has a number of doctors studying in a class that also includes hospital administrators, HMO executives and insurance officials.

For master's programs, the diploma awarded may be an MBA, but it may be a master's in health administration, public health, medical management or something else, such as Hopkins' "master of science in business with a concentration in medical services management."

"It's basically an alphabet soup as to the types of degrees," says Patrick Sobczak, president of the Accrediting Commission on Education in Health Services Administration. He said his organization has identified 36 different graduate degrees that include course work in health administration.

Mix of programs

Along with the mix of degrees, there is a mix of ways of delivering the instruction. Many programs try to draw students from a wide area, and offer weekend classes with housing for those who need it. A few are starting to offer "distance learning," including Internet connections.

The Hopkins version is designed around a clientele that is heavily Hopkins-based. Classes are on Tuesday, Wednesday or Thursday from 5: 30 to 8: 30 p.m. The pretzels and vegetables are provided to sustain students. Because the courses are all at the medical complex, Hopkins doctors who are enrolled can attend to medical emergencies and return to class.

Last year at a certificate ceremony, Wafer said, one "graduate" of the program was beeped, went across the street and delivered two babies, changed back into a dress and was handed her certificate.

Students take one course at a time, for 10n three-hour classes. Each entering class stays together as a "cohort" throughout the program. Tuition is $6,000 a year; $5,200 for Hopkins employees.

Given the popularity of the program and others like it, Heaphy says, Hopkins is considering a variety of ways to expand it, including possibly a distance learning component.

Hopkins program at a glance

Courses: Each course is ten classes, meeting three hours in the evening on the medical campus.

Tuition: $1,500 per course, or $6,000 a year.

Students: More than 200 students have enrolled since the program began in September 1994, 86 percent of them physicians.

Certificate program: Four courses -- managed care, accounting, finance and leadership.

Master's program: Three more years of courses beyond the one-year certificate curriculum, including medical economics, clinical practice improvement, legal issues in health care, strategic planning for health organizations. Also requires a major project. Degree: master of science in business with a concentration in medical services management.

Pub Date: 1/12/97

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