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Some doctors seeking business experience to deal with changing health care

Sidney Davis | Tribune-Review
Dr. Eric Gardner, a hospitalist at UPMC Shadyside, on Friday May 17, 2013. Dr. Gardner took a mini-MBA program at Pitt for UPMC physicians.

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Saturday, May 25, 2013, 9:00 p.m.
 

Health care has become a business, a fact that may make some doctors squirm.

But an increasing number of physicians have accepted the situation and are seeking business training as they adjust to pressures that they cut costs and improve the quality of health care.

“What we really need to do is bring the art and practice of medicine together with the business of health care,” said Dr. Eric Gardner, an adult medicine physician at UPMC Shadyside hospital.

“It can no longer be separate,” said Gardner, who spent the spring semester learning about business management, leadership and other topics typically taught for a master of business administration degree in the Marshall Webster Physician Leadership Program, offered by University of Pittsburgh's Katz Graduate School of Business for UPMC doctors.

The program, which has been training 30 to 40 UPMC doctors a year since 2007, is an example of a trend developing across the country, said Dr. Gary Price, a board member of the Physician's Foundation, which advocates for doctors and provides funding for medical training.

“The foundation believes that there are a number of pressures on physicians that make it critical they get this type of training,” said Price, who has an MBA and is a clinical assistant professor of surgery at the Yale University School of Medicine.

The foundation sponsors a program in business leadership for doctors at the Kellogg School of Management at Northwestern University in Evanston, Ill., which has graduated 100 physicians in the last three years, Price said.

Business training hasn't traditionally been included in medical schools, but that is starting to change. There are 54 universities that offered dual MD-MBA degrees, up from 39 in 2003, according to Association of MD MBA Programs.

“Doctors are getting business training because there is more equipment, personnel issues and marketing that is required to run a practice than ever before,” said Amelia Pare, president of the Allegheny County Medical Society and a McMurray plastic surgeon. “And if you are an employed physician (at a hospital) you must show value for your continued employment.”

Runaway costs in the American health care system are driving a focus on efficiency and better, less costly outcomes for patients. Spending on health care was about $2.6 trillion in 2010, more than 10 times higher than what was spent in 1980, according to the Kaiser Family Foundation.

“The rate of growth in recent years has slowed relative to the late 1990s and early 2000s, but is still expected to grow faster than national income over the foreseeable future,” the foundation said.

The Affordable Care Act, also known as Obamacare, includes provisions meant to control unnecessary costs, such as penalizing hospitals with high rates of readmissions.

But hospital systems and their doctors must push the changes for them to be effective. Dr. Saul Silver, a cardiologist at UPMC Shadyside, is in the same program with Gardner and said he sought the training so that he could be part of the solution.

“We spend more money on health care than any country in the world and yet we're not the healthiest in the world,” Silver said.

Three main lessons of the program have stayed with Silver, he said.

The first is learning that for a hospital to function properly, everyone must work as a team. “I can't do squat without the person who cleans up the operating room,” he said.

Secondly, he gained a greater understanding for how UPMC executives manage the huge and complex organization of 19 hospitals, numerous clinics and offices, 3,300 doctors and 56,000 employees.

And thirdly, Silver said, he has gained an appreciation for how important it is to understand how much procedures, tests and supplies cost and where the waste is.

“We have no idea what our costs are,” he said of the health care system in general. “There's no business in the world that works without knowing its costs except health care.”

UPMC competitor Highmark, which acquired West Penn Allegheny Health System and other hospitals, has stated that one of its core missions is to change the way medical services are delivered and paid for. It wants to pay doctors and hospitals based on performance, rather than for each procedure and test, which can drive up costs, Highmark CEO William Winkenwerder has said. Winkenwerder is a medical doctor and holds an MBA from the Wharton School at University of Pennsylvania.

West Penn Allegheny previously offered its physician leaders an executive management program through Wharton similar to the Katz program, spokesman Dan Laurent said. The five-hospital system is no longer in the program and is looking for an alternative, he said.

Doctors who are knowledgeable about the business of health care are going to be essential to fixing the system, said Carrie Leana, professor of organizations and management at Katz who runs the Marshall Webster Physician Leadership Program.

“There is a realization that if there is going to be true and sustainable reform, that has got to come from physicians,” she said. “Most systems are not run by physicians.”

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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