I recently saw an ophthalmologist for my worsening eyesight. The doctor came highly recommended and was credentialed as an MD and MBA. He founded his practice, which has grown to over a dozen practitioners. His website boasts how he works with the pharmaceutical industry to help develop and market new medications “that improve the standard of care.”
According to Open Payments data, the doctor has relationships with ten drug companies and received nearly $20,000 total compensation in 2021 – 60 percent for consulting fees and the remainder for honoraria, travel, lodging, food, and beverage. His industry payments since 2015 have been well above the U.S. mean and the mean for his specialty.
I googled the physician before my appointment. The feedback was generally positive, with occasional references to patients feeling rushed or being pushed into surgery. My exam lasted approximately 3 minutes. The doctor told me I had “dry eyes” and gave me sample medications marketed by companies with whom he had relationships. Then came the bombshell: the doctor told me I needed cataract surgery. I decided to seek a second opinion. It pains me to admit it, but I wished the doctor did not have an MBA degree or industry ties.
My pain stems from the fact that I’m guilty on both accounts. I have an MBA degree (1996) and worked in the pharmaceutical industry (2001-2014). While working in big pharma, I gave many promotional talks to physicians and visited “key opinion leaders” – that is, physicians of influence – keeping them abreast of products in the pipeline and current scientific research so they could pass the knowledge on to other physicians.
Should I apologize for my activities? Should I think less of the ophthalmologist? I don’t think so. Both of us have conflicts. Conflicts are universal in medicine. It’s not the declaration of conflicts that’s important – it’s how you manage them. Rule number one for managing conflicts of interest is to be aware of them. They’re like blind spots (no pun intended): our conflicts diminish as we develop greater insight about ourselves and begin to behave ethically. Personal integrity cannot be taught in medical or business school.
It’s often assumed that doctors with MBA degrees have sold out to big business or are at least mired in conflict. I’m not convinced that’s true. I used to tell people I have conflicts simply because I’m a psychiatrist. The fact is, I sought a second ophthalmological opinion for my own peace of mind – to ensure the initial recommendation for surgery was based on the ophthalmologist’s obligation to me as his patient and not on his role as a practice owner or pharmaceutical consultant.
The reality is that an MBA degree creates value and opens doors to new opportunities. More than ever, job descriptions will state an MBA degree is a “plus.” There is no doubt that health care organizations are in search of business-minded physicians capable of leading the “medical industrial complex.” A salary premium comes with a dual degree. Perhaps most important, MBA-trained physicians understand the language of business, just as medical students are taught the language of medicine. Fears that an MBA degree will draw physicians away from practice are unfounded.
Soon after I obtained my MBA, I wrote a book about dual-degree physicians – MDs and DOs with MBA degrees. A good friend and colleague, Kenneth Veit, DO, MBA, was an “early adaptor” and turned me on to the idea of business school. I asked him to contribute a chapter to the book, specifically addressing the value of an MBA degree to someone in his position: Dean of the Philadelphia College of Osteopathic Medicine (now emeritus).
Veit said his decision to go to business school came about with a slowly developing interest in administration. He wrote: “[An] MBA education can be applied to [operational] interactions … The MBA skills constantly function in the background. When the occasion calls, this database of knowledge moves to the foreground … [An MBA degree] provides a set of skills that is rarely directly applicable but that at the same time is constantly being used indirectly in various formats.”
A recent survey of 66 dual-degree orthopedic surgeons provided additional insight. They were asked about their motivations for obtaining an MBA degree and its perceived value. Most respondents (89.4 percent) viewed the MBA degree as either extremely valuable or valuable. Their time spent in administrative activities significantly increased – consistent with their goals – and business school allowed them to focus on learning important management theory considered a prerequisite for leading health care systems undergoing change.
I utilized my MBA degree in a somewhat different capacity while working in the pharmaceutical industry. I had an opportunity to dive deeply into marketing while in business school, and I decided to put that knowledge to good use in big pharma. I trained sales teams and reviewed all types of promotional material – for physicians and consumers – for medical accuracy, completeness, and realism.
Working as an “insider,” I guarded against potential FDA violations and was able to boost the credibility of advertising claims in areas where pharmaceutical companies struggle mightily – that is, incurring fines for false or misleading prescription drug promotion. I was asked, “Why do you stoop to popularizing medicine?” The answer rolled off my tongue: “Because advances made in the lab cannot benefit people without actions taken outside the lab.”
Butting heads with the “suits,” however, was another matter. I understood profit and loss as well as them. I was adept at reading financial statements. I understood forecasting models – heck, I formulated models in business school. One of my professors told the class he loves to make models for fun. We thought he was talking about replica cars!
Pharma politics eventually wore me down. But that’s not why I left my first job in pharma. I was asked by a salesperson to speak at a “lunch ‘n learn” at an academic medical center to promote a new drug for depression. I met the salesperson in the parking lot. He had a half-dozen large pizza boxes to bring to the conference room. I offered to carry some boxes. We entered the room together. The faculty mistook me for the salesperson.
I realized I was too deep in the big pharma marketing machinery, so I left the company for a more respectable position in R&D. Still, I lent my skills to marketing teams throughout my pharmaceutical career, including generating ideas for television commercials. My MBA degree put me on a level playing field. And who other than a physician could advise a director and actor on portraying a patient with schizophrenia or bipolar disorder?
Arthur Lazarus is a psychiatrist.