As he acquired more responsibilities in his department, Richard H. Savel, MD, an academic intensivist at Maimonides Medical Center in Brooklyn, New York, recognized the need to develop more management skills.
In 2016, he enrolled in a course on leadership development for physicians at Harvard School of Public Health, where some fellow students had already completed a Master of Business Administration (MBA).
“Because of their ability to understand financial statements, they were at a completely different level in their ability to understand the nuances of the various cases that we were presented,” says Savel, director of adult critical care services and vice-chair for inpatient operations for the department of surgery at Maimonides. “I very much wanted to be a physician like that.”
And now he is. Savel first earned the Certified Physician Executive (CPE) credential, then spent five years working toward an MBA while maintaining his clinical and administrative responsibilities, remaining academically active — he is a professor of clinical medicine and neurology at SUNY Downstate Health Sciences University — and contributing to his professional organizations.
Teresa Dean Malcolm, MD, system vice president of diversity, equity, inclusion, and belonging at Dartmouth Health, also pursued the CPE credential and an MBA, but in the opposite order.
Malcolm was working in a busy obstetrics/gynecology practice at another health system when she and her colleagues were surprised to learn that their practice was not profitable.
Her search to understand how operations translate to profit led her to pursue an MBA in 2014. Then she earned the CPE credential, which introduced her to aspects of leadership and coaching. That led her to pursue several coaching credentials, including the professional certified coach (PCC) designation.
“I like to say I hung up my scalpel and my forceps to focus on how I could really make an impact on a larger scale,” she shares. “That’s what being a physician leader has really allowed me to do.”
Many physician leaders agree that a Doctor of Medicine (MD) degree alone is insufficient for the careers they envision for themselves, but what certifications or degrees are best to pursue?
That depends on your career goals and where you want to bolster your knowledge and skills, Savel says.
His goal is to help Maimonides function at the highest possible level, and he thinks of all the time and work invested in the CPE and MBA as a “journey of improvement” that has positioned him to do so.
“I feel that physicians must have a seat at the table in terms of helping to drive the vision and future of what healthcare looks like,” Savel says. “It is very clear to me that without these extra credentials and education, physicians will be left behind when important decisions are being made.”
Deciding Where to Start
Before choosing which certification or degree to pursue, physicians should devote the time and energy needed to clarify their career goals.
That starts by considering your values and priorities in life, Malcolm advises.
“Give yourself the opportunity to just think big without any constraints or any parameters put upon you,” she says. “What would be your ideal job? Get really granular about it. What do you see yourself doing every day? Who are you interacting with? What kind of projects are you involved in? What’s the impact that you are hoping to have?”
She encourages physicians to write out the answers to those questions, which makes thoughts more concrete and lets patterns and themes emerge. Continue the exercise by asking yourself what responsibilities or tasks you do not want to do, regardless of whether you’re good at them.
As your dream job begins to take shape, consider how having that position would change things for you, both positively and negatively. For example, moving to industry from bedside medicine might offer a better work schedule, but would you miss patient care? If yes, are you willing to give that up for the advantages of a different career? Moving into health system leadership will allow you to influence your institution, but it may change your relationship with your current colleagues. Is that acceptable?
After you get a clear picture of the type of position you want, it’s time to consider what you need to do to get there. “Maybe there’s certification or a degree that you need to have that role,” Malcolm says. “Or rather, maybe it is some mentorship or some real-life experience rather than formal education.”
Do Career Planning Early
“Start early in this journey so that you have time to achieve your leadership goals during your career,” retired cardiologist Joan Miller, MD, suggests.
When she became chief of cardiology for her institution, she began meeting regularly with colleagues who had been chosen to become the next chief medical officer (CMO) and chief quality officer (CQO). “They were all men in these positions, but I felt I had the qualities necessary to also become a CMO or CQO,” she says. “I just needed the education and the degree to pursue one of these options.”
In her late 50s at the time, she pursued a CPE as a route for advancement. She could not find a CMO or CQO position before she retired, but the CPE was valuable.
“Even while I was taking the required courses like communication and management, I was able to apply what I learned to become a better chief of cardiology,” she says. “I became more skilled in dealing with some contentious colleagues and changing their minds about my being their boss.”
JD Plus MD
Todd Sagin, MD, JD, president and medical director of Sagin Healthcare Consulting, spent the first 20 years of his career in academic medicine, eventually serving as a health system chief medical officer.
In the second half of his career, he worked as a consultant to medical staffs and hospitals, the medical director of a national physician competency assessment program, and a board member of an organization facilitating the creation of clinics across the nation to serve uninsured patients.
He pursued a law degree because of his experience working in medical ethics early in his career. “The field was relatively new and full of legal questions with unclear answers and lawyers who made up answers but didn’t know what they were talking about,” he says. “The law degree has informed my practice as a physician executive and as a healthcare consultant. In particular, it has helped me understand the due process to which physicians are entitled when their competency or conduct becomes an issue — a space in which I work extensively.”
That said, he does not advise physician leaders to pursue a law degree unless they have a driving interest in how the legal system works or how law impacts the everyday delivery of healthcare services.
“Learning law is rewarding as an intellectual exercise and provides insights that certainly are useful to practitioners in managerial or leadership roles,” he admits. “But if you enjoy being a physician, you are not likely to enjoy the actual practice of law.”
Master’s Degree Plus CPE
When Savel was working toward his CPE, approximately 25% of the physicians in his cohort had already obtained an MBA. “When I asked them why they considered that to be necessary, they stated that the focus on physician leadership was key,” he says.
He encourages physicians not to think “MBA or CPE?” because each provides training for a different skill set. The CPE provides significant real-world experience and training on how to be a physician leader while the MBA curriculum focuses on management skills and business acumen.
“The combination of the CPE and MBA really is quite excellent,” he says. “Taking a structured approach to issues such as conflict management or understanding financials has made me very confident in my current job and has allowed me to contemplate other positions as well.”
Physicians who want a management degree should compare the MBA to a master’s degree in healthcare administration, a Master of Medical Management (MMM), or other options. Savel chose an MBA program that did not focus on healthcare.
“I did that on purpose,” he says. “I had been someone who was very focused on becoming a physician from a very young age and was clearly weak in areas related to business. I was very pleased with how that worked out for me, but many people obtaining medical-related management degrees are equally satisfied.”
Robert Coates, MD, MMM, CPE, FAAPL, FAAFP, retired in 2021 after serving as vice president of medical affairs/chief medical officer (title change, same responsibilities) at a hospital for 11 years. He pursued the MMM degree after being turned down for a job because he lacked a management degree.
“I think the MMM degree is useful if you know that you are going to stay in either hospital or medical practice administration,” he advises. “An MBA gives one more flexibility in getting jobs outside of those areas, such as pharma or consulting.”
Mark W. Browne, MD, MMM, CPE, FACPE, senior vice president and chief medical officer at Covenant Health in Knoxville, Tennessee, began moving into leadership positions after just five years of clinical practice, and working toward CPE certification was an important first step.
“The farther along I got in my journey, the more I realized I needed true formal training to gain the level of expertise necessary to be successful in my growing executive roles,” he says. “The CPE provided a solid framework for the MMM going forward. As I sit here now nearly a decade and a half after completing my MMM, I still use the skills I acquired there daily.”
Browne compares the MMM to a clinical fellowship. “There are many physicians who can perform certain procedures or have a certain knowledge base, but a fellowship gives you an opportunity to gain laser focus and sharpen your tools in a particular area,” he says. “The MMM provided that training for me in the physician executive realm.”
Although executive MBA programs are more widely available, they do connect the dots to the medical profession as well as the MMM, in his view. “Any physician who is serious about a full-time career as an executive leader should definitely be pursuing an MMM, in my opinion,” he advises.
How to Make It Work
Any degree or certification that has merit requires considerable time and effort. For Miller, the CPE meant about 150 hours of coursework. “And you are also required to take on a leadership position in your institution as part of the curriculum before you can be invited to take the final exams,” she says. “It took me three to four years of attending courses or taking courses online in addition to my full-time career.”
Obtaining an MMM, an MBA, or another advanced degree is quite different from pursuing a medical degree.
Sagin found that law school and medical school both required memorizing lots of information, but with different emphases.
“In law school, the details matter less than the concepts, ideas, and principles — while in medical school, the memorization of details is more critical to the delivery of patient care,” he says. “For this reason, I found law school more intellectually stimulating than medical school, while medical school was more rewarding because of the patient contact and the meaningful difference my training made in the lives of my patients.”
Malcolm completed her MBA in two years while practicing obstetrics and gynecology full-time. Throughout that time, she spent eight to 10 hours each week on coursework, mostly on the weekends. “Because I had a call schedule, I knew I could not attend classes in person, so I had a completely virtual experience,” she says.
Savel finished his MBA in 2022 after working on it for more than five years, including the most difficult years of the COVID-19 pandemic. “It was very challenging given my clinical and administrative responsibilities to also be able to complete this MBA,” he says. But he was able to do so while remaining academically active, publishing in journals, and serving on editorial boards.
Paying for another degree may seem daunting for physicians, particularly those who are still strapped with medical school debt. Don’t assume you will have to fund your next degree entirely on your own, Malcolm says. “Reach out to your organization and find out what resources might be available to you,” she advises.
She chose to get her MBA from a university that partnered with her health system; as an employee, she received discount fees on all her courses. Malcolm also learned of a scholarship program available for health system employees who were pursuing advanced degrees. The scholarships were typically awarded to nurses, but research showed that was only because physicians had not applied for them. Malcolm did and was successful.
An extra degree is not likely to be rewarded with a significantly higher salary in your current position, although it will make you more competitive for other positions, she says. However, physician leadership positions may pay less than full-time practice for many medical specialists, particularly proceduralists.
“But if you want to move into a leadership position where you can really have an impact at scale, where you can start to change policies that really do determine how physicians practice medicine, then I think the return on your investment will be quite significant from that standpoint,” she says.