The merging of medicine and management--McGill University's MD-MBA degree.

A business outlook can have a positive influence on the health-care system despite the often negative stigma among the general public. There is more to business than the stereotypes of extreme profit-seeking and two-tiered healthcare encouraging a divide among rich and poor. Nonetheless, the inevitable pressures for the merging of these two worlds, in attempt to cut the rising costs of health-care and increase efficiency, must be approached with caution so that medicine does not become a business and so that the needs of the patient are not compromised. Individuals trained both as physicians and managers are poised to bridge this gap as they understand the intentions and goals of both parties and are better positioned to fuse both worlds in an amicable and positive fashion. Introduced in September 1996, McGill University’s five-year MD-MBA program is currently entering its 10th year and is presently the only MD-MBA program offered in Canada. The first year of the program is spent entirely in the Faculty of Management in regular MBA classes. Business basics including of accounting, economics, finance, statistics, marketing, human resource management, information systems, and organizational behaviour are studied before beginning medical school, providing managerial insight and tools needed to understand, question and challenge existing conventions in medicine. Between the first and second year, students have the opportunity to apply their skills to specific health care issues and analyze and propose solutions to actual institutional problems. Projects in the past have included analyzing the obstacles faced in the merging of the McGill University Health Centre, working with the Public Health Department in Ottawa, investigating new pharmaceuticals at Merck, studying infection control protocols, standardizing concussion trauma scoring, comparing surgical techniques, and looking at delays in patient care. In the second year of the program, one begins the regular four-year MD,CM program with choices of advanced MBA courses including Health-Care Systems, Health-Care Management, Health-Care Economics, and Pharmaceutical Entrepreneurship taken concurrently with the MD program, to complete the MBA portion of the program. One of the strengths of McGill’s MD-MBA program is that one ultimately receives an MBA education similar to those in the mainstream two-year program and not a diluted or compromised version. As a relatively new program though, there is room for improvement. At the moment, individuals in the MD-MBA receive a general MBA with no specialization. As the program grows and the scope of health-care specific courses offered grows, a health-care specialization may be offered. This provides great potential for not only future students in the MD-MBA program, but also for nursing students, medical students, practicing physicians, and other healthcare professionals to participate. The study of business is not only numbers and figures such as seen in Accounting and Finance, but more importantly touches upon teamwork and understanding people of different abilities and backgrounds through classes such as Cross-Cultural Management and Organizational Behaviour. McGill has one of the most international classes of MBAs with students coming from all walks of life and backgrounds including doctors, dentists, lawyers, engineers, and businessmen, and from all corners of the world including not only Quebec, the rest of Canada, and the US, but also Brazil, Columbia, Croatia, Russia, China, Japan, India, Lebanon, Syria, and many more. While medicine is learned as an individual discipline, the MBA emphasizes teamwork through numerous case-studies, group projects, and presentations, as well as collaboration among individuals of different backgrounds, in order to draw upon each individual’s strength and expertise. This is similar to what occurs daily in a hospital setting as physicians collaborate not only with each other, but also with nurses, physiotherapists, dietitians, pharmacists, technicians, porters, managers, and patients alike. With rising costs as new and more advanced treatments are developed, as the burden on the health-care system grows with aging baby boomers, and as demands for high quality remain, physicians in this country will be faced with increasing challenges in balancing cost, quality, and access to health-care. On a personal level, the tools and capabilities gained in my business studies will aid in running a practice and help me understand the organizational behaviour and budgetary constraints of hospitals - practical aspects that are incredibly useful, but underemphasized in medical school. With the MBA training, whether as a physician or a physician-manager, I will be better equipped to provide care for patients in a cost-effective manner. Having knowledge of both the business and health-care environments, I will understand the feasibility of cost-reducing policies and be able to merge these with the practice of clinical medicine without adversely affecting the quality of care to the patient. Despite the belief that all businesses have profit as their bottom line, I believe that physician-managers work in a unique environment where the best quality of patient care is the goal and corporate vision. The integrity of this institution needs managers who have a MD background to understand optimal treatments in patient care and to strive to keep the patient as their primary focus. In addition, it requires physicians who have a business background to understand and proactively work with managers to maintain an efficient health-care system. Rather than turning a blind eye to problems, these individuals could face changing economic realities head-on and be involved in ensuring a strong and viable health-care system, and in maintaining the quality and integrity of our universal Canadian health-care system. These individuals will be involved in not only delivering the best possible care to patients, but by advocating sustainable medical practices, they will ensure that the quality of care patients are entitled to, remains for years to come.