AAMC Reporter: October 2005

Steven Klasko, M.D., M.B.A., Vice President, USF Health Dean, College of Medicine, Univ. of South Florida

Viewpoint: "What They Don't Teach You in Business School"

"I want to fly out to Louisiana and help." That was the first instinct of hundreds of our faculty at the University of South Florida as Katrina struck the Gulf Coast. And despite pleas that volunteers should work through organized venues, many did go out on their own and satisfy a need that exists in all physicians and scientists—helping one patient at a time. Fast forward a few days to a call I received from one of my business colleagues that the power brokers in the New Orleans region were already planning the rebuilding of New Orleans, a project to make the city even more attractive to tourists and more "profitable" to those involved.

Never was the dichotomy between my physician mind and my MBA mind clearer. Former Governor Richard Lamm of Colorado said it well: "American medicine is practiced one patient at a time. What makes a person a wonderful practitioner by definition makes them a poor allocator of resources."

So is that it? Should we feel comfortable training the next generation of physicians in a virtual business vacuum, secure that we are protecting them from the "dark side" of the business of health care?

Almost 10 years ago, I embarked on a project to examine the medical mind versus the business mind. It involved interviews and case studies with several hundred medical students, residents, and academic and private physicians, with similar studies for MBA students, men and women in business, and MBA professors. Our data accentuate a gulf between physicians and MBAs. In one case study, participants needed to question the "rules" and be creative in order to come up with a win-win scenario. Of the physician group, 87 percent "blindly followed the rules" and preferred the more mainstream "win-lose" strategy. Of the MBAs, only 18 percent fell into that trap.

Were they smarter than we? Probably not. We have trained individuals in academic medicine around several biases: autonomy, hierarchy, competition, and non-creativity—attributes that may work in academic and clinical settings. Can we change those biases and de-program the cult of "physician-hood"? I would challenge us all to write a "history of the future." What needs to happen in 2005, 2006, 2007, etc., to create an optimistic future for academic medicine?

What we found is that even conservative academicians recognize the need for changes in the way we educate and select physicians. Some key issues:

• Are GPAs and MCATs still the "gold standard" for predicting success in a future where the differential diagnosis is as close as your palm (electronic or anatomic)? Simply put:Would a candidate with a 3.2 GPA and 26 in her MCATs, with superb communication skills, coordination proven on her simulation tests, and a finely tuned eye as evidenced by her fine-arts college minor be a better practitioner in the information world of 2020 than a candidate selected by traditional means?


• We can no longer relegate the real-world curriculum to a few "business" courses. Leadership in medicine is not about teaching "Excel for Dummies." Instead, there was unanimity in our findings that there is no optimistic future in academic medicine without training physician scientists who understand collaborative negotiations, small- and large-group communications, making patients happy, running an effective meeting, and how to be an individual in an organization. When we taught these skills to residents, their optimism about the future of medicine increased, along with their desire to be creative.


• Professionalism is not just a competency for academic physicians; it is our lifeblood. As a dean who has had the honor of presiding over two medical schools, neither of which owns a hospital, I am convinced that uncompromising dedication to the principles of professionalism that are unique to academic health care allows us to train our future generation with the tools of the business world without being lost to "the dark side." From the closing of MCP Hospital during my tenure at Drexel, to town-gown issues at the University of South Florida, solutions have come not from my Wharton education, but from applying the passion and professionalism inherent in our academic health-care DNA.

As an MD-MBA, I am caught between a love of academic health care and a stark realization of the business imperative. My Wharton professors used to preach the importance of "getting back to business basics" during periods of stress. In reality, nothing could be further from the truth. Spreadsheets don't solve these challenges. Our ability to succeed gets down to people, or what my business colleagues call "human assets." Further, our ability to maximize those assets depends on leadership—defined as creativity, communication, negotiation, and team building.

For our colleagues and graduates—for the stewards of medical education—how we educate and select those assets will never be more important. We can ill afford not to teach our students leadership in the business world while preserving what made them interested in medicine. And while integrity and professionalism will predicate our success in a new future, those attributes will never show up on any spreadsheet.

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