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AN INTERVIEW WITH MARIAN C. HILL // Director, USF's physicians MBA program

Published Jul. 6, 2006

Physicians who face big changes in how they run their practices are increasingly turning to modern business techniques to help manage their offices. But few have been trained in understanding contracts, keeping customers satisfied or measuring their efficiency.

The University of South Florida's master of business administration program for physicians is designed to help doctors solve some of those problems.

Although the program requires basic business classes, like accounting and marketing, it also has been adapted to the special needs of doctors. For example, case studies used in physicians MBA classes generally refer to health-care businesses, and some courses focus on topics like legal issues for doctors and quality assurance in health-care fields.

The physicians MBA, which began in 1992, has about 40 graduates a year. It is scheduled to allow doctors intensive study in two-week sessions, which make it easier to them to arrange classes around their practices.

Times staff writer Sarah Cohen recently chatted with Marian C. Hill, director of the physicians MBA program, about how doctors feel about their occupation and what they need to learn about health-care economics and business.

Q. Doctors are facing new kinds of contracts, new laws that determine what they can invest in, and new pressures to change the way they do business. What's the reaction?

A. Uncertainty. They (the physicians) entered an occupation that was known as one that was both socially responsible and economically rewarding. Now it seems like it's changing. A number of them have mentioned that they feel more embattled. They're accountable to insurance companies and managed-care companies and a number of institutions that they hadn't anticipated. So I'm not sure it's so much anger as it is uncertainty about where medicine is going.

Q. What do you think consumers should understand about the economics and business of health care in the United States?

A. Coming from Britain, I was used to the nationalized medicine (run by the government). You just go and get whatever you need. When I first came to the States, I found it hard to understand.

But I've been pleased by the quality.

The consumer is a different beast here. They're much more demanding. Under nationalized medicine, if you need an operation, depending on the severity, you go on a waiting list. They may call you six months later when your name comes up. Consumers here are much more used to getting what they need right away.

I've been really impressed with how conscientious the doctors in the program are about their patients. Money really isn't discussed that much. . . .

The discussions I hear are much more concerned about quality, where it's going to go, what's going to happen with research funding. . . . It's not, "Oh, gee, I'm only getting $7.50 per patient."

Q. We hear that a growing number of doctors are fed up with the profession and are retiring or moving on to other careers. An MBA seems like a natural background for that kind of move. How much does that happen?

A. Surprisingly, only about one per session. And typically, they're not leaving by choice but because of some medical condition that makes it impossible for them to get (malpractice) insurance.

The person who felt this way in the last class was leaving not because of the economics, but because of the patients. They're tired of being the God-like physicians, responsible for all of these problems, especially when patients won't make changes in their lifestyles that would make them better. They want a pill or an operation.

Q. Some doctors complain that Medicare, Medicaid and even some private insurance companies don't pay enough to keep them in the profession. How's the money?

A. These are people who are pretty compulsive. They've run their figures accurately, they know their break-even point. They're not coming in as ignoramuses in the economic field. . . .

They always felt that if you were going to run an efficient practice, there would always be time constraints. But at least in the past they had control over it. One allergist said she'd decided to spend a half-hour with patients, because you learn things that don't come out on the forms. In the past, she could say, "That's my money. I can decide not to make so much." She's losing that flexibility.

Q. How does the program help doctors learn about quality-control techniques, like evaluating the cost and effectiveness of their treatments?

A. Quality is one of the areas that definitely needs to be addressed. One issue is that patients haven't been traditionally thought of as customers. There was more of a professional relationship. Even though they had large waiting rooms, doctors continually ran late. It you were late, it was a big deal. But they were a half-hour late all the time.

One of the things we've done here is take the doctors to Disney or Busch Gardens. Disney is a large, service-oriented organization. It's the largest employer in the area. But they also process a huge number of people every day, and most of them usually have a positive experience.

When you look at what they're doing, it's very effective. They're getting them to come to this place where it's really quite hot, they've got all of these people they're employing who are basically minimum-wage kids. And they're getting (customers) to stand in line for hours in the hot sun. They'll still come out and say they had a positive experience.

We ask, what is it that you can do in your own practice that could change people's attitudes about coming in and possibly having to wait?