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Results Study respondents Among 247 graduates in the sample, 59.9% (148/247) completed the questionnaire, and among those respondents, approximately 89.9% (133/148) provided free-text responses. The majority of respondents were male (85.1%, 126/148), although this trend declined slightly over time. There were no significant differences in gender between respondents and nonrespondents. The majority of respondents entered residency training (79.7%, 118/148); however, this rate steadily declined from the 1980s (96.3%, 26/27) to the most recent decade of graduates (70.7%, 53/75) (Table 1). Among all respondents, 51.4% (76/148) obtained an MD before the MBA compared with 44.6% (66/148) that obtained the degrees simultaneously. The rate of having an MD before the MBA was higher among graduates from the 1980s (70.4%, 19/27) and then stayed consistent for the subsequent two decades of graduates (46%–47%; 21/46 and 35/75). Very few respondents reported obtaining their MD after the MBA (2.0%, 3/148), typically representing those that took time off early in medical school and who were not in a dual-degree program. reported a primary work sector. One hundred sixteen respondents reported entering residency, and the more time that had elapsed since graduation, the less likely they were to identify clinical practice as their primary work sector (Figure 1). Among respondents within their first decade after graduation from the MBA program, 46.2% (24/52) Career trends Among the 148 respondents, 145

• Please describe ways (if any) you use the combination of your MD/medical training and MBA in your professional life; • Please describe ways (if any) the MD/ medical training or MBA, or the combination, has hurt or limited your professional life; and • Please reflect on the role of combined MD–MBA training. What role has it had on your career? What role does it have on society? Please state its advantages and disadvantages. Data analysis We divided survey responses into three groups based on the number of years since the respondent graduated from the MBA program (1–10, 11–20, and 21–30) to evaluate participants’ differences in primary work sector and perceptions based on their experience and the stage of their career. We analyzed content from the free text responses using grounded theory. First, three reviewers (Mitesh S.P., V.A., Mamta S.P.) read responses to each question to identify common themes. Second, to ensure that each reviewer coded comments appropriately, we selected 25% of the responses for each question at random and used them as the training set. Two reviewers (V.A., Mamta S.P.) worked together using the training set to assign themes to each of the responses. Responses could be assigned multiple themes or none at all. Through that process, we modified the original set of themes to a more consistent set to which all reviewers agreed. Third, the remaining responses made up the evaluation set, and the two reviewers worked independently to code these responses. Fourth, for comments with differences in coding between the two reviewers, a third reviewer (Mitesh S.P.) was used to adjudicate the disagreement to finalize the coding for the presence or absence of themes. We combined the coding of all responses into a single set for analysis. Interrater reliability between the two reviewers (V.A., Mamta S.P.) was assessed by using STATA statistical software, version 12 (StataCorp LP, College Station, Texas) to calculate kappa scores. This study was reviewed by the institutional review board at the University of Pennsylvania and classified as exempt.

reported clinical practice as their primary work sector compared with 39.5% (15/38) among respondents 11 to 20 years after graduation and 19.2% (5/26) of respondents 21 to 30 years after graduation. Two primary work sectors with the largest absolute increase between less experienced and more experienced respondents were entrepreneurship, startup, or venture capital (5.8%; 7/52 to 5/26) and hospital administration or provider organization (5.8%; 7/52 to 5/26) (Figure 1). The three sectors with the largest relative increases were consulting or marketing (100%; 2/52 to 2/26), insurance or managed care (100%; 1/52 to 1/26), and nonprofit or philanthropy (100%; 1/52 to 1/26). Only 1 respondent had 21 to 30 years of experience post graduation and reported consulting or marketing as the primary work sector. Among the 21 respondents with 1 to 10 years post graduation who did not enter residency, 33.3% (7/21) reported biotechnology, pharmaceuticals, or medical device as their primary work sector; 23.8% (5/21) reported consulting or marketing; 19.0% (4/21) reported investment banking, hedge fund, or equity management; and 14.3% (3/21) reported entrepreneurship, startup, or venture capital. Aside from clinical practice, the roles of the MD on professional life were most commonly reported as informing business perspective and analysis, and medical expertise (Table 2). However, later in their careers, significantly fewer reported the MD as providing medical expertise (3.7% [1/27] with 21–30 years post graduation versus 22.7% [17/75] with 1–10 years after). The MD There were 29 respondents in the sample who did not enter residency.

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Table 1 Characteristics of 148 Physicians Who Obtained an MBA From the Wharton School of the University of Pennsylvania, 1981–2010, From a Study of the Role of MD and MBA Training on Professional Development

Years after MBA graduation

Characteristic

1–10

11–20

21–30

Sample size, no.

75

46

27

Male gender, no. (%)

60 (80.0)

41 (80.2)

25 (92.6)

Mean age, years

34.3

43.4

53.4

Entered residency, no. (%)

53 (70.7) 35 (46.7)

39 (84.8) 25 (54.3)

26 (96.3) 7 (25.9)

Currently practicing clinically, no. (%)

Abbreviation: MBA indicates master of business administration.

1283

Academic Medicine, Vol. 89, No. 9 / September 2014