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Program Weds Medical and Business Studies for Doctor of Tomorrow

The joint degree plan at UCLA grew out of recognition
that medicine is not practiced in a vacuum.

By Rhonda Hillbery

When he first decided on a career in pathology and laboratory medicine, Adrian Correa thought he would spend 90% of his time working with patients and doing clinical tasks. But in medical school he was surprised to learn that about half the work of a pathologist involves decidedly nonmedical matters.

"I started to find a lot of what I would do as a practicing pathologist would be managing not only patients but also lab staff, equipment purchases, contracting, all these things that fall under the realm of business," says Correa, 30, now in his residency at the UCLA Center for Health Sciences.

Deciding he had to become business-savvy, he looked around and discovered that a joint degree program was being planned between UCLA's medical school and the Anderson School, its graduate business school. In June, Correa and a classmate were the first graduates of a new MBA/MD program that marries medicine to management studies.

He is one in a new generation of doctors who hope to gain financial tools that will give them perspective--and some control--over how health-care resources are managed and spent.

"There's a valid concern that few physicians are trained or equipped to make financial decisions that affect the whole health-care system, because that's just not what we're taught in medical schools," Correa says. "Because of that, it's come to the businesspeople to make those tough financially based decisions."

The program allowed him to graduate in just five years, shaving a year off the time it would have taken to complete the programs separately. The abbreviated timetable required him to complete medical "clerkships" over two summers.

The new program is one of several at UCLA that combine MBA studies with another discipline, such as engineering, law or public health. This program and a few like it around the country reflect the recognition that medicine is not practiced in a vacuum, but is inexorably tied to other forces, especially financial ones. Correa considered similar programs offered at other universities including Northwestern, Dartmouth and the University of Pennsylvania.

Given the unrelenting demands of today's managed health-care world, Correa expects to spend even more time managing and supervising when he enters private practice in a few years. He hopes to build a group practice and perhaps become its chief executive.

He's already learned that the definition of "maximizing results" transcends mere profit. "It can be profit, but it can also be patient care, which you can maximize by running an organization well."

Designed to allow students to tailor their business studies to their medical specialties, the UCLA program requires students to complete three years of medical school before applying to the MBA program. Their fourth year is spent in MBA courses; the fifth is half-and-half.

While some students plan to become administrators, others intend to practice medicine or perhaps combine the two, says John Mamer, the Anderson School's interim dean. Opportunities also exist in the pharmaceutical industry, biotechnology and medical equipment companies.

"It's pretty clear that management issues surrounding health care have become pretty significant issues, so it's not hard to imagine how someone might think of this," Mamer says of the program. One measure of interest in MBA studies is that practicing doctors comprise 14% of the part-time executive MBA class of 1999.

Given the challenges inherent in health-care delivery and administration today, interest is not likely to wane any time soon. "This is sort of an important new arena for us in the business school," Mamer says.

One of seven students making up the first "official" MBA/MD class this year at UCLA, Jeannine Rahimian, 23, plans to work in a field where she can mix patient work with administration in a group practice. She is considering obstetrics-gynecology and internal medicine as her specialties.

"When I was in medical school I realized we had no background in business," says Rahimian, engrossed in her first-year MBA classes. "Now to be a really good physician, you have to understand the economics behind health-care delivery."

Her MBA studies will span accounting, economics, statistics, human relations, finance, marketing and operations, and electives such as health-care management. So far, applying those disciplines to medicine seems more than plausible. "I'm surprised how everything makes sense. It's very logical and applicable to everyday life," she says.

It's too bad that the doctor-patient alliance can't be like it used to be, Rahimian says. "With cost constraints, it's difficult to have the same relationship with patients. That's the downside, but it's necessary because we are able to treat more patients with good management."

A classmate, 25-year-old Jabari Reeves, says he wants to make a difference "on a larger scale," and thinks his business studies will help. The inescapable rules of managed care mean that "in order to make changes, you need to be able to speak to both sides," he says.

Planning to practice emergency medicine, which he says suits his personality and interests, Reeves may eventually try to work in policy or administration at an agency such as the World Health Organization. He sees himself "not necessarily just working for an HMO behind a desk, but doing something to really make a difference."

Reeves is serving a clerkship this year at Martin Luther King Jr. Hospital in Watts, which offers a sobering look at the challenges of delivering health care in inner-city Los Angeles.

"Working there really puts things in perspective," he says. "In the county system, the shortage of resources has made me realize what it means not to have health care or health insurance. I want to work toward a place in time where everyone has basic health care."

Reeves says he realizes that he cannot single-handedly change the way health care is delivered, but he thinks business training will at least better equip him to try.