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programs. Furthermore, changes in leadership or focus within the MBA program can affect career trends over time among graduates, and we were not able to adjust for this in our analysis. However, because this is the oldest program in the country, it provides the longest interval for evaluation. Third, although we compare differences between graduates across three decades, we cannot assume that these trends are temporal, and some findings may be due to the wwenvironment at the time of graduation as opposed to an evolution since graduation. Graduates with MD and MBA training report mostly positive attitudes towards their training’s impact on their career and professional lives. Many of these physicians are pursuing leadership and primarily nonclinical roles, particularly later in their careers. Given the significant increase in medical schools that offer this training, our findings reveal new insights and may have significant implications for policies affecting physician workforce, such as the potential for hospital leadership tracks or administrative pathways. Further study is necessary to evaluate whether similar trends exist more broadly. Funding/Support: Dr. Patel was supported by the Department of Veterans Affairs and the Robert Wood Johnson Foundation. Ethical approval: This study was reviewed by the human subjects committee of the University of Pennsylvania and classified as exempt. Dr. Patel is Robert Wood Johnson Foundation Clinical Scholar, University of Pennsylvania, Philadelphia, Pennsylvania, and ambulatory fellow, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania. Mr. Arora is an undergraduate student, University of Pennsylvania, Philadelphia, Pennsylvania. Ms. Patel is a masters of business administration student, Health Care Management Program, Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania. Ms. Kinney is associate director, Health Care Management Program, Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Pauly is professor of health care management and business economics and public policy, Wharton School of the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Asch is a physician, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; professor of medicine, medical ethics and health policy, and anesthesiology and critical care medicine, Perelman School of Medicine, University of Pennsylvania; professor of health care management Other disclosures: None reported.

Table 2 Identified Themes From 148 Physicians’ Responses About the Role of MD and MBA Training, Grouped by Topic and Displayed With Their Frequencies, 1981–2010, From a Study of the Role of MD and MBA Training on Professional Development

No. (%) of physicians who identified topics and themes, by years after MBA graduation a 1–10, n = 75 11–20, n = 46 21–30, n = 27

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Topic and theme

Role of MD on professional life Clinical practice Informs business perspective and analysis

Mi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 02/11/2024

33 (44.0) 29 (38.7) 17 (22.7) 15 (20.0)

20 (43.5) 15 (32.6) 13 (28.3) 6 (13.0)

11 (40.7) 11 (40.7)

Medical expertise

1 (3.7)

Professional credibility

5 (18.5) 4 (14.8)

Knowledge of health care delivery system 12 (16.0)

2 (4.3)

Research Teaching

8 (10.7)

7 (15.2)

0 (0.0)

3 (4.0)

4 (8.7)

4 (14.8)

Role of MBA on professional life Leadership, management, and administrative

27 (36.0)

22 (47.8)

15 (55.6)

Business foundation Analytical business skills

29 (38.7) 16 (21.3) 11 (14.7) 10 (13.3) 8 (10.7) 8 (10.7)

14 (30.4) 13 (28.3) 5 (10.9)

9 (33.3) 3 (11.1)

Understanding the business side of health systems

2 (7.4)

Professional credibility

0 (0.0) 4 (8.7) 3 (6.5) 3 (6.5)

4 (14.8)

Networking

1 (3.7) 1 (3.7) 1 (3.7)

Research

Negotiations

7 (9.3)

Role of MD and MBA combination on professional life Informs business perspective and analysis 20 (26.7)

18 (39.1) 10 (21.7) 10 (21.7)

7 (25.9) 12 (44.4) 7 (25.9)

Multidisciplinary experience Leadership, management, and administrative

20 (26.7) 10 (13.3)

Effective communication between disciplines

5 (6.7) 5 (6.7) 6 (8.0)

4 (8.7) 4 (8.7) 1 (2.2)

3 (11.1)

Professional credibility

2 (7.4) 1 (3.7)

Research

MD and MBA has hurt or limited professional life MBA perceived as distraction 13 (17.3)

3 (6.5)

4 (14.8)

MD pigeonholed them

4 (5.3) 6 (8.0) 5 (6.7) 5 (6.7)

5 (10.9)

2 (7.4) 0 (0.0) 1 (3.7) 0 (0.0)

Lack of focus

3 (6.5) 3 (6.5) 3 (6.5)

Opportunity cost of time Increase debt burden

Role of MD and MBA on career and society Interdisciplinary perspective

22 (29.7) 15 (20.0) 16 (21.6) 9 (12.0) 12 (16.0) 9 (12.0)

9 (19.6) 11 (23.9) 5 (10.8) 5 (10.9)

8 (29.6) 4 (14.8)

Professional flexibility Career acceleration

1 (3.7) 2 (7.4)

Challenge with dual disciplines Impact on health care reform Increased time and debt Decreasing cost of medicine

2 (4.4) 1 (2.2) 2 (4.3)

3 (11.1) 5 (18.5)

5 (6.7)

0 (0.0)

a Abbreviation: MBA indicates master of business administration. Kappa scores: mean 0.67, range 0.36 to 0.95.

Our study has several limitations. First, as with any survey evaluation, our analysis is limited because of nonreporter bias.

Second, our study was a single-center evaluation, and the findings may not be generalizable to graduates from other

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