To understand why so many medical students (and pre-meds) (and doctors) contemplate business training, let’s consider two real-life examples: Dr. Bob Kocher and Dr. Bijan Salehizadeh. Both trained as physicians, both are currently healthcare investors, and both shared their stories with Lisa Suennen and me on our Tech Tonics podcast. (Kocher’s interview can be found here; Salehizadeh’s will available at the end of the month.)
(My usual disclosure: I work at a cloud genomics company in Silicon Valley; neither my company nor I have a financial relationship with Kocher, Salehizadeh, or their firms.)
Bob Kocher: The Hospital Consultant
Kocher is currently a partner at Venrock’s Palo Alto office, and is perhaps best known for his previous role working in the White House developing the Affordable Care Act in collaboration with Zeke Emanuel and others.
When he was growing up Seattle, Kocher says, his “dream was to be a leukemia and lymphoma doctor at the Fred Hutchinson Cancer Research Center.” He went to medical school, trained in internal medicine at the Beth Israel Hospital in Boston, and was accepted into a prized oncology fellowship at the Dana Farber Cancer Institute.
However, Kocher explained, “as I watched how we took care of the patients, I was just astonished by the fact that we didn’t always do it right, and that the system wasn’t working as hard as I was to improve.”
In particular, Kocher was appalled by the amount of influence “the least experienced doctor in the hospital” could wield. “The idea that you’d have the lowest level, least-trained person in the organization making these most critical decision made no sense.” Added Kocher, “You don’t have the youngest pilot fly the biggest plane.”
“We were taught at Harvard that every patient is a chance to learn,” Kocher recalled. “While that’s on one level inspiring, it seems bad for the patient.”
Ultimately, thought Kocher:
I want to help patients be better and I’d really like to treat cancer patients, but I began thinking that maybe I could help them more if I made the hospital work better for them…. I was worried that if I was just a kind of a traditional academic doctor, that the system I’m working in wasn’t going to be good enough to help the patients do as well as they could and that we would spend all of our time trying to optimize one part of it and then we’d let like the 80% which is the execution mess it up.
As Kocher tells it, he marched himself into the office of the late Jim Mongan, the well-respected head of MGH at the time, and said, “Why do you let us do it the way we do it – we could do it better?” As Mongan searched for a response, Kocher pressed him, “How can I get your job someday? I think I can do this because I understand what we do and I understand how to do it better.”
Finally, Mongan responded, “Well, doctors don’t know anything about how to run anything. You can’t add. You don’t understand how hospitals make money. You don’t understand how to manage people. You’re just a narcissistic crazy resident. Go away and get an MBA.”
When Kocher’s wife nixed the idea of him continuing to go to school, he asked Mongan about Plan B, and was encouraged to pursue management consulting. “You have to learn business,” Mongan told him. “Hospitals care about patients but they actually have to run and you don’t know how to do that.”
Kocher eventually went to McKinsey, but unlike most consultants who become generalists, Kocher managed to focus exclusively on hospitals, traveling to 42 different countries to work on hospitals and healthcare systems. This experience led directly to his subsequent roles in the White House and at Venrock.
Kocher’s bottom line, which he shared with me via email:
“MDs benefit a great deal from getting business training — and that a MBA is one approach that works but that there are many others. Going to McKinsey, Bain, or BCG for a few years can give you a great foundation. Working at company with terrific career paths and training like Google, IBM, or Kaiser is another approach. Finally, being inflection changing in a high growth start-up can also give you a broad range of experiences and learning — though this is a much higher risk path. I do think that to be effective, MDs need to learn how to use Excel, read a balance sheet, make a financial model, synthesize data into understandable presentations, and understand how value is created for customers and enterprises. They also need to learn how to humbly work on teams, make others’ successful, and add lots of tangible value.”
Bijan Salehizadeh: Leadership Lessons From The MBA
Bijan Salehizadeh, now a healthcare investor at a firm he co-founded called Navimed, in the DC area, realized he was interested in a non-traditional medical career at an even earlier point then Kocher. While in medical school at Columbia, in the late 90s, Salehizadeh, inspired by several physician-entrepreneurs (including Dr. Oz, in his pre-raspberry ketone period), caught the start-up bug, and departed for a health IT startup in Silicon Valley, which rapidly went public and then was acquired.
After a couple of years at a large device company, Salehizadeh decided to pursue the MBA. He completed the program at Harvard, joined a healthcare venture firm, opened their Silicon Valley office, progressed to the point of becoming partner, then started his own firm.
Salehizadeh says he chose to get his MBA because he realized he wanted to be a healthcare investor and felt that most of the leaders in this area seemed to have this training and degree.
He expected to learn a series of business skills, which he did, but apparently the most valuable effect of his time in business school, he says, was the “chance to develop my own voice” — confidence about his expertise and ability to contribute, and increased willingness to speak out without perfect knowledge.
For Salehizadeh, and apparently many others, the enduring lessons of business school involve leadership, not Excel skills. As he explained in an email (lightly edited for clarity):
“Harvard (like many other schools) prides itself on teaching general management — not finance. And general management is really about how to make tough decisions in the trenches and how to lead people. To do that, you need equal parts confidence, analysis, self-awareness, and the ability to articulate your thoughts so others are compelled by them. The MBA is also about learning how to listen and digest, when it’s time to do that.”
Salehizadeh was particularly struck by the contrast he observed between the way leadership is manifested in business and in medicine. In particular, he thought that in medicine, students and trainees are indoctrinated into a sort of obedience, a respect for the next level above you, that essentially demands you do what you’re told and try to please you supervisor.
As he told me:
“Surgeons/MDs demand respect — almost a subservient sort of vibe you see in many ORs and on rounds (not all of course). This contrasts with CEO confidence — which (at least in entrepreneurial CEOs) demands their team argue with them, poke apart their ideas, and churn out the best idea at the end.”
I don’t disagree with either Salehizadeh’s description of, essentially, “how to succeed in medicine by kissing ass and staying out of trouble,” though I’m not sure this is unique to medicine: I’ve seen more than a few business environments where this approach seemed equally well established (and effective).
In my experience, it’s the rare leader (MD, MBA, or both) who authentically encourages debate, and has the confidence and the wisdom to welcome serious discussion.
If, in fact, MBA training can develop more of these courageous leaders – that would be (as some MBA might put it) a real value-add – and perhaps nowhere more so than in healthcare.
David Shaywitz is based in Mountain View, California. He is Chief Medical Officer at DNAnexus, a Mountain View based company and holds an adjunct appointment, Visiting Scientist, in the Department of Biomedical Informatics at Harvard Medical School.