In the last ten years, as health care delivery systems have turned increasingly corporate and complex, physicians have assumed managerial roles in record numbers. Largely trained to function in clinical settings, these new physician-managers suddenly must handle a wide range of high-impact administrative tasks and deftly balance financial constraints with the patient care mission of their organizations. To perform effectively in this role, physicians need to acquire substantial managerial and organizational skills, but few have the luxury of postponing their careers to attend full-time MBA programs. And for many, professional development courses don't have the depth or vision they require.

A new Department of Health Policy and Management program, however, has begun to fill this gap. Called the Master of Science Program in Health Care Management, the two-year curriculum aims to provide practical management skills to mid-career physicians who have or seek leadership positions in health care organizations. Unlike conventional MBA programs that stress traditional management disciplines in other contexts, this program targets these disciplines to the health care sector. It also integrates into management classes many of the topics featured in the Master of Public Health program, such as epidemiology and environmental health.

"With disciplines like accounting, finance, and competitive strategy, it really does help to be industry-specific," says Program Director Nancy Kane. "It helps you learn and relate a lot more quickly." Arnold Epstein, John H. Foster Professor of Health Policy and Management, agrees. For Epstein, who chairs the Department of Health Policy and Management, what makes the program special is that it offers convenient part-time training with courses designed specifically to meet the needs of the mid-career physician, beginning with summer "boot camps" to facilitate networking. Participants, many subsidized by their home institutions, attend classes for three weeks over the summer and then once every eight weeks for four-day weekends. Between sessions, they convene monthly teleconferences. The program's first class, a group of 20 mid-career doctors ranging in age from 35 to 55, started in July 1999 and was joined by a second class this summer. Epstein, who originated the idea for the program, is among its 13 faculty members.

Epstein says the inspiration for the program came to him when he recognized "an increased need for health care providers with expertise in management that was more rigorous than what they had received in previous training." Kane, too, after teaching MPH doctors for 20 years, felt a desire to find ways to give them more management exposure and an opportunity to adopt a new managerial mindset. "You're not taught it in medical school," she explains. "Some people can get it through gradual immersion, but it's very tough to pick up when you're pushed into a management job." Applying principles from the highly successful Summer Program in Clinical Effectiveness, Epstein, Kane, and Program Coordinator Sharon O'Brien have fashioned the new program to help physicians make the most of their time at the School, accommodating their busy schedules and alternating class work with projects to complete back at their jobs.

The primary on-the-job challenges faced by today's physician-managers are in the areas of strategic planning, goal setting, motivational tactics, negotiation, and compensation systems design. To meet these challenges effectively, argues Kane, physicians must first address the somewhat authoritarian style in which they are trained. "They're always the expert in patient relations," she notes. "And in the hospital, they're the king or queen. But in a management situation, you often don't have that power automatically handed to you--you need to acquire skills in negotiation and in managing consensus."

Developing practical management skills comes next. "Many physicians are on boards or asked to head organizations where they don't understand a balance sheet and income statement," Kane observes, "or they don't know if they're being told the truth in a financial situation." She believes that while many of these doctors are genuinely interested in the long-term strategic direction and marketing of their organization, they are handicapped by having no framework to think about these issues.

To help physicians master these tasks, says Epstein, "we provide a framework of knowledge and tools, including negotiation skills for making the best agreements and finding synergies and technical expertise in areas such as cost accounting and quality improvement. This gives these students a comprehensive toolkit designed right around what they need."

In coursework and projects, the first-year students have thus far applied that toolkit to a host of practical situations. They've explored ways to upgrade patient services, streamline clinical operations and reduce administrative costs, improve treatment room conditions, negotiate compensation policy, and decipher financial statements and contracts. While some of their courses include lectures and exercises, most are case-based, in which students analyze a challenging situation and recommend a course of action. Problem-solving skills developed in the classroom can then be applied immediately in their jobs. For example, one negotiation skills course project requires students to help settle a conflict at their worksite.

For the students, this ongoing training in practical health care management is already paying off back home. Robert C. Amster, a network medical director for Aetna-USHealthcare in San Ramon, Calif., who is responsible for recruiting, network management, and provider contracting, came to the program despite already having an MBA. "I needed a broader balance and exposure to the health care business," he says. "This program had the best array of courses with greater diversity than any other program I investigated."

Amster has fast applied lessons from this coursework at Aetna. "The program has taught me skills in cost accounting and operations management that I have used immediately in managing my network," he says. "In addition I have been exposed to a variety of tools that I have introduced to my managers." For example, Amster is currently arranging a demo of a hospital cost accounting system that could be utilized by a health plan. His experience has also prompted him to investigate the true costs for delivering care to Aetna's members through two very different models--an integrated delivery model and a directly contracted model.

Humayun Chaudhry, director of medical education at Long Beach Medical Center, N.Y., oversees the graduate medical education of dozens of medical students, interns, and residents. He supervises about three dozen attending physician- faculty members, and recruits and selects qualified candidates for the hospital's training programs. Chaudhry decided to enroll in this program to boost his understanding of the complex changes going on in the current health care environment and to improve his management skills. Some key administrative challenges that Chaudhry faces include appropriately marketing his hospital's teaching programs in an increasingly competitive area, creating a hospital environment that encourages constructive dialogue and interaction between trainers and trainees, and improving the efficiency of existing policies and procedures as they relate to patient management.

For Chaudhry, the program has come through on all counts. For one, he's learned how to foster relationships between residents and attending physicians more effectively. "For my project in our health care negotiation and conflict resolution course, I was able to apply principles of diplomacy in successfully settling a dispute that had arisen between two individuals at our hospital," he says. "The step-by-step techniques taught by Professors Dorn and Marcus enabled me to tackle this issue effectively and expeditiously." In addition, in a project he initiated as part of an operations management course, Chaudhry reviewed how his hospital's triage nurse in the Emergency Department manages patients when they present for acute care. "Applying the principles taught, I examined the throughput times and efficiency of the encounters and determined specific ways to improve both indices," he recalls. "These findings improved patient care and allowed the emergency department to function more smoothly."

Looking for more of these success stories in years to come, Epstein has ambitious plans for the program. "Our ultimate objective," he says, "is to be the program in this country for everyone who wants to be the director of an hmo or medical center to get the right training." Kane's vision is no less optimistic. "In ten years I'm hoping to have a big network of very influential and effective managers in organizations all over the country," she says. At the very least, Kane has three main goals for the physicians who attend the program: "First, I hope they're doing their managerial jobs better. Second, I hope this opens managerial and clinical opportunities for them, and third, that they make their own organizations better places."

For more information, see http://www.hsph.harvard.edu/mhcm

Mark Dwortzan