Tuesday, March 15, 2005

The Ten Day MBA

On the topic of highly-paid MBA's without scientific or clinical knowledge, training or experience acting as bulls in a china shop in healthcare, I have been reading a book "The Ten Day MBA: A step-by-step guide to mastering the skills taught in America's top business schools" by Steven Silbiger (Quill William Morrow, 1993, rev. 1999). In the introduction, the author, an MBA, relates that "one can grasp the fundamentals of an MBA without losing two years' wages and incurring a $50,000 debt for tuition and expenses."

After working in for-profit industry (Comdisco Healthcare Group) and then managing a 50+ staff Merck pharmaceutical research support department and a multimillion dollar budget - to under 1% of "estimated actuals" (budget allocations) each quarter for over three years running - I can say the information in this book appears quite useful and probably a good summary of the major issues in the MBA's education. I learned a lot of this type of material in just interacting with financial folks and strategic planning committees in running my department.

I cannot imagine a comparable book for the clinical professions. Titles such as "The Ten Day M.D.", "Endocrinology Expert in 30 Days", or "Dummy's Guide to Pediatric Neurosurgery" are simply too absurd to even contemplate. The rigors of medical education, from background sciences (in high school and college), graduate preclinical (basic) sciences, clinical sciences, preliminary clinical training (as a medical student), post-doctoral training (internship and residency), and subspecialty training required to obtain required expertise and licensure, make such a concept ludicrous.

As pointed out in another entry on this blog, "Do Physicians Have "the Knowledge to Run These Hospitals?" - Maybe More than Do MBAs", a typical businessperson without a clinical background is likely overextending their expertise on a regular basis, ultimately at the expense of patient care.

It is my view that in order to hold a high leadership position in a healthcare organization, a person needs a strong business-oriented background but also needs a significant clinical or biomedical science background. A dual background is needed in order to understand the clinical decision making process and not interfere in a deleterious manner through defective decisionmaking.

The fictitious "Ten Day M.D."-level background just won't cut it. In healthcare IT my colleagues and I have encountered the lame CEO, the megalomaniacal micromanaging COO, the scheming and technologically-challenged CIO, the airhead deputy CIO's and technology people, the Catbert-style HR managers, the skinflint CFO and financial managers, and the incompetent or dilettante managers and management consultants (J.D. Kleinke's "Oxymorons" incarnate), enough to make the following deliberately outlandish statement for the sake of argument:

"Healthcare is not likely to make major strides in true quality improvement and cost reduction until the MBA-executive leadership is either educated in medicine and science, or removed from their positions of authority and replaced with those who are."

"Medicine for patients and clinicians" could be an appropriate slogan for healthcare reform.

-- SS

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