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World J Surg (2018) 42:1655–1665

graduates and 93% considered the dual degree to have had a ‘‘significant ROI’’ in terms of job flexibility. Sherrill [12] reports that physician executives found a balance between clinical and non-clinical opportunities and expressed satisfaction from being able to pursue the per sonal interest that the doctor had for gaining business knowledge. Goldman [13] concluded that 89% of MD/ MBA graduates reported being very satisfied with their careers and their lifestyles. Butcher [29] and Patel [21] studies found that PEs reported being very satisfied overall in terms of their career, lifestyle and home life. Figure 2 is a heat map summary of findings from the current study, organized according to publication (hori zontal axis) and the competitive benefits of an MBA degree for PEs (vertical axis). In this literature review, we identified multiple areas in which value was added by completing the MD–MBA dual degree in this literature review study. In terms of impor tance, leadership was most commonly identified among other ‘‘value-added’’ categories as a motivator of supple mental degree pursuit by physicians or physician trainees. Finance, healthcare strategy and organizational manage ment were among other key motivating characteristics according to our literature summary. The MBA education was found to provide additional assets in areas regarding population health, team building and conflict resolution. To the best of our knowledge, this is the first systematic review to summarize the added value gained from the MD–MBA dual degree. Our review found evidence in support of leadership as a value-added benefit to students pursuing the MD–MBA dual degree. The importance of leadership development is being increasingly valuable for hospitals looking to employ PEs. As discovered in our review study, physicians are often identified and promoted to leadership positions based on their career achievements and distinction, with less emphasis on their management skills and experience. Instead, a career trajectory that includes a balance of clinical practice with early and continuous experience as a leader and manager should define the new model of physician executive development. Along this continuum, studies recommend that targeting graduates of joint doctor of medicine (MD) and MBA programs as they enter resi dency training provides the most opportunity to identify potential leaders early and cultivate the careers of future PEs. [2]. A strong, positive correlation was determined between receiving the MBA training and developing effective leadership skills. The tangible benefit provided for Discussion

investment banking, hedge fund managing and venture capitalism. Ackerly [2] identified particular development of clinical and managerial skill sets prepared physician executives to engage in critical issues as future leaders in health care. In addition, Butcher [29] found that MD/MBA graduates have significantly higher starting and average salaries, as well as received a mix of different offers for responsibilities such as department heads or entrepreneurs. Similarly, Lazarus [30] adds that many of the 50 most powerful physician executives in 2010 were physicians with MBA degree. The increased likelihood of higher incomes was reported by eight studies which compared MD/MBA graduates to their traditional medical school graduate counterparts. Parekh [24] reported that enhanced personal finances were cited as one of the top three benefits of physician graduates surveyed from three East Coast business schools. Mean while, Butcher [19] and Hall [18] found that physicians achieved higher starting salaries by supplementing their clinical responsibilities with high-level leadership roles in organizations or with ancillary business ventures than tra ditional physicians. According to Goldman [13], the aver age starting salary for the MD/MBA survey respondents was $292,500 compared to $192,196 for a medical spe cialist without an MBA during the same time period. Sherrill [12] and Butcher [29] studies revealed that the MBA degree increased the probability for higher lifetime earnings for PEs. As the demand for physician executives increases, compensation levels tend to rise in parallel. Sherill [9] concluded in a recent compensation survey that compensation packages for physician executives were reflected well above the median for clinically based prac ticing physicians. Satiani [27] found that 85% of physician respondents viewed the MBA as a positive return on investment (ROI) throughout their career cycle. The higher level of work–life balance achieved was reported by six studies. According to the study done by Parekh [24], physician executives reported a 20% increase in time allocated to administrative tasks. Their practice patterns change significantly after completion of the MBA, which helps account for the satisfaction gained from greater involvement in non-clinical activities and decision making. Similarly, Butcher [19] asserts that PEs achieve higher personal satisfaction through improved patient care through better management of the healthcare delivery model. Additionally, Butcher [19] surveyed MD/MBA Higher income (n = 9) Work–life balance (n = 6)

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