Health system changes inspire more med students to pursue dual degrees

As they contemplate careers in a rapidly changing health care landscape, a growing number of medical students are deciding that a medical degree is not enough.

Most U.S. medical schools offer students the chance simultaneously to get advanced degrees in a variety of other areas, such as public health, law, business administration, mass communications and the sciences. Some schools have offered the programs for more than two decades. However, more recently, dual degrees are growing in popularity as prospective physicians feel they must develop expertise beyond medicine to compete in a dynamic health care market.

Combined enrollment nationwide in MD/PhD, MD/JD and MD/MBA programs alone has increased 36%, from 3,921 in 2002 to 5,349 in 2011, according to the Assn. of American Medical Colleges. Most of them, 5,023, are in MD/PhD programs. The AAMC suspects its MD/JD and MD/MBA tallies are undercounted.

“Our reason for providing dual-degree programs stems from the realization that the standard medical school curriculum will not adequately prepare all students for medicine as it will be practiced over the next 30 years,” said Joseph P. Grande, MD, PhD, associate dean for academic affairs at Mayo Medical School in Rochester, Minn. “There will be sweeping changes in delivery of medical care, medical care policy, and the relationship between the medical care establishment and government.”

More schools are adding dual-degree programs, and more students are enrolling in them, said Henry Sondheimer, MD, AAMC senior director for student affairs and student programs. Enrollment in MD/PhD and MD/MBA programs in particular are increasing as the health care system moves toward the medical home model of care, accountable care organizations and evidence-based practice.

The AAMC only tracks dual degree programs offered for allopathic students. Twenty-one of the nation’s 26 colleges of osteopathic medicine offer at least one dual-degree option, with DO/Master of Science, DO/MPH and DO/MBA programs among the most common, according to the American Assn. of Colleges of Osteopathic Medicine.

An increase in MD/MBA programs has been driven largely by student demand, said Maria Chandler, MD, MBA, president of the Assn. of MD/MBA Programs and associate clinical professor at the University of California, Irvine, School of Medicine. Nationwide, at least 65 medical schools offer MD/MBA programs, up from six programs in 1993 and 33 in 2001, according to Dr. Chandler’s organization. As a result, the number of students graduating from MD/MBA programs has gone from essentially zero 20 years ago to as many as 500 students a year. That association’s numbers were not included in the AAMC’s dual-degree estimate.

At the Perelman School of Medicine at the University of Pennsylvania, 76 of 140 medical students are pursuing credentials beyond medicine in the form of a certificate or dual-degree program, said Gail Morrison, MD, professor and the medical school’s senior vice dean for education. About 35% of students are getting a dual degree, up from about 12% of students 15 years ago, she said.

“Now more than half of the class is doing these other programs,” Dr. Morrison said. “That absolutely was not happening 15 years ago.”

The number of dual-degree programs also continues to grow. In some cases, medical schools are branching out to other universities. For example, a partnership started in 2007 between Mayo Medical School and Arizona State University allowed the medical school to offer several new dual-degree options in areas such as business, law, biomedical informatics, biomedical engineering, mass communications, and clinical and translational science.

In Virginia, a partnership announced in 2009 between Edward Via Virginia College of Osteopathic Medicine (VCOM) and Virginia Tech’s Pamplin College of Business allows students to simultaneously pursue a DO/MBA, according to a VCOM announcement.

The benefits of added skills

University of Pennsylvania medical student David Fajgenbaum is pursuing his MD/MBA and hopes to go into health care management. He got his first exposure to business as an undergraduate student after his mother died of brain cancer. In her honor, he formed Students of AMF, a national support organization for college students coping with the loss of loved ones.

His experience directing the nonprofit taught him both the elation of helping others and the challenges of managing a large organization. He hopes his dual degree will help enable him to contribute to wide-scale health care improvements.

“I felt as though an MBA degree could help me with the training that unfortunately you don’t get in medical school,” he said.

Different dual-degree programs offer different benefits, said Shalini Reddy, MD, associate professor and associate dean of student programs and professional development at the University of Chicago Pritzker School of Medicine. Students getting a PhD learn about research methodology and what it means to work in a laboratory.

With a business degree, students learn to solve problems and increase productivity, Dr. Chandler said. Having those skills helps prepare them to practice in a health care system that is increasingly focused on improving outcomes and efficiencies, she said.

“We’re living in a society where it is recognized that health care is a business, and we need people who can speak the language of business as well as the language of medicine,” she said.

Pritzker student Jon Lee hopes his MD/MBA will allow him to extend beyond his clinical practice to satisfy what he calls his “entrepreneurial itch.” He is taking a break from medical school to launch a startup company with four business school classmates. The company, Agile Diagnosis, is developing a mobile computer application that would guide physicians through current best practices at the bedside.

Lee said he sees startup companies as a way to foster positive change in health care.

“As a medical student, you really get very little exposure to the business side of medicine,” Lee said. “A lot of times physicians have no concept of how much medicines or imaging are costing. Many of us go into medical school because we want to take care of patients, but we have to make sure that the system is sustainable and viable in order to do that.”

Years more schooling

Dual degrees are not for everybody, and students should weigh carefully the benefits against the additional time and cost of getting a dual degree, said Stan Kozakowski, MD, director of medical education at the American Academy of Family Physicians.

Such programs can require up to nine years of additional schooling, depending on the program and the degree.

“There’s always the risk of, ‘Is it worth the cost?’ ” Dr. Reddy said. “If you’re thinking about doing a dual degree, make sure you have some clear goals about what you’re going to do with it.”

Economic concerns are always a factor. Duke University School of Medicine in Durham, N.C., has seen a recent decline in the number of students pursuing an MD/MPH, said Stacey R. McCorison, the school’s associate dean for medical education administration. Enrollment in the program, which is offered through a partnership with the University of North Carolina, has fallen in recent years in part because Duke no longer can pay for the UNC portion of the program, she said.

Despite those issues, most schools offering dual-degree programs expect their popularity to keep growing.

“These are students who view health care in a way that is bigger than the traditional practice model,” Dr. Kozakowski said. “They see the dual degree as providing them with a competitive advantage as they go into the workplace.”