Health care spending in the United States is expected to rise to greater than $6 trillion by 2028, an estimated 19.7% of the GDP and the highest of any developed nation.1 In spite of this, the United States continues to underperform on life expectancy and quality metrics; this has led to a push in the health care economics and strategy literature for a move towards value-based and cost effective care.2 This may seem like a job for a Fortune 500 CEO who understands how to reduce costs, improve operations and better capture value; however, for decades, such individuals have been the dominant figures in health care administration, which has led to a growing concern amongst medical practitioners of the commercialization and commodification of health care. On the contrary, the unique nature of the medical field demands leaders that are intimately aware of its intricacies and emphasize a patient-centered approach.
Clinicians are oftentimes out of touch and, at times, at odds with the hospital administrators regulating health care delivery. These individuals all too often are naïve to the clinical demands of physicians and the needs of patients. Conversely, physicians are oftentimes unaware of the micro and macroeconomic forces influencing the decision making of these individuals. The knowledge and skill set provided by a Masters of Business Administration (MBA) allows one to effectively bridge this gap and enact policy that best aligns the needs of patients with those of the health care system. As neurosurgeons, we have the necessary skills and determination to bring about real, effective change in health care administration and delivery.
It may seem a daunting task to pursue an MBA while also completing residency training or running a busy neurosurgical practice. Moreover, it might seem contradictory to the reason you chose to practice neurosurgery or medicine. There is, however, inherent value outside of the three extra letters that come after your name. Neurosurgical residency, and practice thereafter, is one of the most demanding of all medical specialties. We make a commitment to life-long learning and care of our patients and in the process we gain invaluable experience learning how to make critical decisions under pressure and how to lead an interdisciplinary team. The skills we gain during residency prepare us to deal with many difficult challenges, but there is little formal leadership development or health care systems education within neurosurgical residency or medical school for that matter. As the health care industry continues to change, it has become more apparent that physicians have an opportunity, some might say an obligation, to expand their leadership roles outside of the clinical setting to better serve the entirety of the patient population.
Regardless of whether you want to build your own practice or take on leadership roles within your department and hospital, there is something to be gained from pursuing an MBA. As the pressure builds to shift towards more cost-effective care, we have to be conscious of the decisions that affect not only our bottom line, but also the overall spending in the U.S. health care system. This requires us to learn the business language and health care economic and strategy principles that underlie these decisions, while still being able to deliver the highest quality care for patients.
Neurosurgery is a rapidly evolving specialty, and there is ample opportunity for innovation in our field. While it is difficult enough to design a novel device that creates value, it is even harder to bring it to market and capture that value. For the aspiring neurosurgeon entrepreneur, an MBA provides the necessary framework to build a strategy for getting a novel device or therapeutic from the lab to mass market. Moreover, as we are faced with decisions to incorporate new technology into our practices, we need to be mindful of the potential for diminishing returns when we use technology unnecessarily.
The majority of us come from a background in the life sciences with little exposure or formal training in economics or business strategy. An MBA not only provides this foundational knowledge but, most importantly, an alternative perspective and hence different expertise to use when confronting a particular problem. MBA pedagogy is based primarily around case studies that lie outside the field of medicine and outwardly may seem to draw no parallels to the problems we see in clinical practice. However, with further study and training in the systematic breakdown of these case studies, valuable lessons and principles can be gleaned in order to gain a greater understanding of the larger forces impacting our practices, hospitals and our health care system.
References
- Keehan SP, Cuckler GA, Poisal JA, Sisko AM, Smith SD, Madison AJ, Rennie KE, Fiore JA, Hardesty JC. National Health Expenditure Projections, 2019-28: Expected Rebound In Prices Drives Rising Spending Growth. Health Aff (Millwood). 2020 Apr;39(4):704-714. doi: 10.1377/hlthaff.2020.00094. Epub 2020 Mar 24. PMID: 32207998.
- National Research Council (US); Institute of Medicine (US). U.S. Health in International Perspective: Shorter Lives, Poorer Health. Woolf SH, Aron L, editors. Washington (DC): National Academies Press (US); 2013. PMID: 24006554.
