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Figure 1 Distribution of physicians who graduated with a master of business administration (MBA) from the Wharton School of the University of Pennsylvania, 1980–2010, and entered residency training across their self-reported primary work sector, displayed by percentage of cohort based on years of experience after graduation.

having an MBA. In comparison, 5 reported having a PhD, and 3 had earned an MPH. More generally, the proportion of hospitals led by physicians has decreased significantly from upwards of 35% in the past to less than 4% by 2008. 11 In our study, we found that 40% to 50% of respondents reported leadership as a key skill gained from the MBA training. Furthermore, graduates with more experience reported less time practicing clinically and more time in leadership roles within other sectors. However, less than 20% of respondents reported that hospital administration or provider organization was their primary work sector, indicating that although these physicians pursue leadership roles, many may not be directly related to managing health systems or medical practices. Yet, given the changing dynamics of hospitals that require better balance between clinical care, leadership, and business initiatives, graduates with MD and MBA training could potentially fill a growing need within the workforce. Future research and policy efforts might be focused on how to better align the interests of these graduates with train ing and development pathways that result in leadership positions within health systems or in roles that affect population health.

evaluation of graduates’ perceptions of how their training affected their career development and professional lives. Overall, MD and MBA graduates reported mostly positive attitudes towards their training and often noted the benefits of career acceleration, professional flexibility, and credibility in multidisciplinary domains. Although there were very few negative attitudes towards the training, they were focused on the opportunity costs of obtaining the degrees (e.g., time, tuition fees) and how peers in one discipline may negatively perceive the role of the other degree (e.g., MBA seen as a distraction by physician peers). More recently, physicians graduating from the Wharton School have entered residency at slightly lower rates. Those graduates who do practice clinically have tended to shift more effort towards positions in leadership and business later in their careers. Policy makers and medical educators have speculated on the leadership role that MD and MBA graduates might play among the physician workforce. 1,5,6,11,12 A 2010 survey asked radiology department chairpersons if they had earned another degree in addition to their MD. 13 Among 53 respondents, only 4 (7.5%) reported

was more often reported as providing professional credibility, whereas the MBA was commonly reported as conveying leadership, management, and business skills. The combination of degrees helped to inform business perspective, provide multidisciplinary experience, and improve communication between disciplines. Compared with older graduates, recent graduates reported that the degrees provided career acceleration at higher rates (21.6% [16/75] with 1–10 years post graduation versus 3.7% [1/27] with 21–30 years after). The majority of respondents did not report any negative impact from the degrees; however, some reported that the MD “pigeonholed” or limited their business career options, and the MBA was sometimes seen as a “distraction” from their medical career. Discussion Over the past two decades, the number of training programs that provide graduates with an MD and MBA degree has increased fivefold. 1–3 Although many reports have weighed the costs and benefits to pursing this type of training, 7–10 there is a paucity of published research on this topic. To our knowledge, this study is the first

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