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AANS Neurosurgeon | Volume 27, Number 1, 2018

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Neurosurgeons Go Back to School: The Convergence of Medicine and Business for Optimized Outcomes

At first glance, a Masters in Business Administration (MBA) may seem completely contrary to the altruistic goals of neurosurgery. Such was my prejudice, and one that I held since I embarked on a career in medicine over 20 years ago. And yet, with the changing landscape of medicine, I completed an MBA. What once I would have never considered, I had now completed. Why?

The past, present and likely future of neurosurgery resonates the theme of constant evolution. As an organized specialty not much more than 100 years old, we have made dramatic strides in advancing patient care and, in many arenas, have truly lead its evolution. As we have done this, neurosurgery has become multidimensional. A crucial dimension is the business aspect, which is given only limited exposure during our training. Yet it is the business aspect, in an era of limited financial resources, that most threatens the continued evolution of neurosurgery. According to the Office of the Actuary at the Centers for Medicare and Medicaid services, health care costs will rise from $3.5 trillion in 2015 to $5.5 trillion by 2025. Delivering quality care while controlling costs is truly a necessary mandate.

As physicians, we can make convincing and emphatic arguments regarding what is the best clinical care for our patients. Yet, not adequately coupling it with why it also makes financial sense sets us up for likely failure. There is also the potential for tremendous frustration, because there appears to be a perceived disconnect with the administrative team due to the difference between business language and clinical language. The unfortunate result in most situations is that we no longer can lead with changes that benefit patients. The loss of this leadership role and sense of no longer being able to optimize patient care within a healthcare system is likely one of the main reasons for the high burnout rate among physicians.

There are many in neurosurgery who do not need an MBA to understand the business of medicine. I was not one of them. I needed to learn the language of business to understand the implications of the changing health care laws, so that I could effectively and clinically argue the needs of my patients. Through my MBA, there were at least three salient lessons that I learned, including:

  • The language of business;
  • Business implications of the changing healthcare laws; and
  • Team management.

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The multiple spreadsheets and negotiations that are vital to businesses are a language in themselves. The language is not complex, but takes time. Understanding the multiple terms assigned to costs and the various forms of cost/revenue allocations is critical. By simply reviewing these spreadsheets, one often discovers that there may be many unnecessary costs that can easily be eliminated, allowing for greater resources in other aspects of patient care.

Relating to health care laws, a key lesson is that reimbursement is tied to quality care. The formulas created can be confusing and complex. Although they allow for some risk adjudication, neurosurgeons need to be actively involved in defining quality in neurosurgery and in determining the formulas for appropriate risk adjudication. This is a multidisciplinary effort and we do have strong advocacy in this realm, but widespread understanding can only make our advocacy stronger.

As neurosurgeons we all manage teams, but this was probably the first time I had formal education in it and studied the nuances of elevating team performance. A good portion of an MBA focuses on optimizing organization for efficient functioning.  It provides valuable insights into managing large and oftentimes complex teams and personalities. Organizational operations courses model efficiency with proven mathematical formulas to improve it. This can be applied to many aspects of health care, ranging from patient flow and staff hiring, to acquiring supplies.

For me, attending classes every other weekend to complete my executive MBA was truly worth it. It gave me new insights into multiple facets of my neurosurgical practice. I also believe it made me a better advocate for the needs of patients. Juggling clinical, family and other responsibilities along with the demands of an MBA can be challenging, but it is doable. I am also convinced that, for me, it was an essential component to regain the sense of autonomy in this rapidly changing health care landscape. It also reinforced that idea that perceived differences between financial and clinical representation is caused by a gap in communication. Being able to define clinical care in business language can eliminate this perceived gap and ultimately facilitate improved patient outcomes and the continued evolution of neurosurgery.


You can never be overdressed or overeducated –

As if completing college, medical school and residency were not enough, three prominent neurosurgeons decided to pursue additional graduate education in the fields of business, public health and law. As part of The Advice Issue, this three-part series includes their experience. They share stories, explain their motivation, discuss what they learned and reflect on the value of their over-education.

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Margaret Rose Sophia Wacker | September 10, 2018 at 3:32 pm

I am convinced that it makes sense to get more education. I have had some graduate school before medicine, and now am in my third program since. It is certainly valuable, even aside from the potential employment options.