I wasn’t planning on making a celebratory post for earning my MBA, mostly because the final steps were not as climactic as I thought it would be. I received the news that I passed the capstone Strategic Management course one quiet afternoon in a long stretch of indistinguishable quiet afternoons, punctuated only sometimes by anxiety episodes and lazy kitchen adventures. We didn’t have the euphoria of red brick photos and after-defense dinners.

We might also be the only batch of (future) MD-MBA holders who succeeded without an oral defense. We are surely the only batch who passed manuscripts that slowly became outdated and irrelevant. After all, none of us thought to put “impending pandemic” or “economic crisis due to prolonged quarantine” in our political, environmental and economic analyses. None of us wrote “what to do in case COVID-19 starts to expose the failures of society” in the contingency table in Chapter 10.

Yet I’m still going to write about getting my MBA (obviously). I think there are many incoming medical students and ASMPH hopefuls who are wondering why there’s a need for doctors with MBA, especially in a world that needs equitable medical care and public health the most. Is there a need for MD-MBAs? Who would even want to work for a dual degree?

I’ve thought about it several times over the years, over frustrations in Financial Accounting and creative sessions for Marketing Management. I’ve come up with many justifications. But I think now, more than ever, I’ve found another answer.

It also just happens to answer the question of today: why should medicine be political?

This is for you, the person on the other side of this screen; you who are privileged enough to consume personal thoughts on social media. And this is for my past self, who is still slogging through MBA notes while taking a break from vital signs, and for my future self, who better not forget.

Why an MBA: tldr version

• An MBA equips healthcare professionals with the non-clinical skills and perspectives needed to succeed as a doctor regardless of career path, specialty or setting –no other medical school will teach you about operations management, human resources, marketing, and financial accounting
• The training provided by all MBA courses stresses how all goals can only be met by a combination of internal factors and external forces
  • Yes, the external forces always include political, economic, social, technological and environmental factors
  • And yes, this also always applies –even if the goal is to improve health care or to treat just one patient

The Ateneo School of Medicine and Public Health…

isn’t the first institution to offer a dual-degree in medicine and Master of Public Health. It doesn’t even offer an MPH –the irony of which isn’t lost on all of us. But it is the first institution in South East Asia that offers a double degree in MD-MBA, while heavily incorporating public health as a running module. This challenging program has been shaping the character of ASMPH since it was established in 2007.

Every so often you’ll hear the term “doctors of the future” in the halls of ASMPH. It’s so easy to brush it off as another Atenean pretension. Worse, a Master of Business Administration feeds into the money-hungry stereotype of the rich doctor. Is this the birthing place of hospital CEOs and highbrowed clinicians?

My personal experience –as a current clerk out of water– can’t attest to the reality of “doctors of the future”. I can’t even tell you how it is to be a doctor. But my personal experiences as a public university undergraduate, as an Atenean medical student, clinical clerk, patient and Filipino have informed my idea of the gaps in the health care system, and the many ways having business acumen can change all that.

Gaps in medical education

I think a lot of what I’ll say here are just arguments I’ve already had against people who want to abolish general education, only I’ve repurposed them to fit medical school curricula instead.

What I realized very early on was that a doctor is not just a doctor. Sometimes a doctor is a clinician; sometimes they’re an epidemiologist. There is a laundry list of things a doctor can become: public health practitioners, academics and researchers, government civil servants, tech moguls, inventors. Sometimes they can be bestselling authors and social media personalities. During finals week, they can be trophy wives and husbands.

So when I imagine this kaleidoscope of career paths, I can hear very clearly the need to “use my power to help the sick to the best of my ability and judgment“. And the power comes in different wavelengths and forms. I don’t hear the Krebs cycle or the origin-insertion-action of different muscle groups (unless I am specifically imagining a future in orthopedics or rehab).

But the imagination of a first- to third-year medical student is limited. These are the things you eventually learn to hear:

• The complaints of a bantay whose alaga hasn’t been attended to for more than 6 hours in the crowded emergency room
• The chief complaint of a patient who’s had the same neck mass for 20 years, but could only get a doctor’s consult after saving enough money
• A confused question from a couple. They don’t know how they’ll get from one referral center to another; they already used up all their savings for the initial commute
• The dying notes of a dilapidated hospital, abandoned due to lack of trust and failure of service
• And the murmured grievances of clerks and interns and nurses and residents, stuck in a system that makes them work 35 hours straight with no days off and no holidays
  • At close to minimum wage.
• My personal frustration at paperwork, PhilHealth claim forms, and analog record-keeping
• An “I don’t know” from a pregnant woman, having her first OB check-up 7 months in –the only time she was allowed out of incarceration– cuffs around her hands– when asked why she wasn’t brought in earlier— and to this day I’m still wondering, horrified, at what our prison systems have become—

Reality is clearer and a lot louder. And honest voices are less likely to be placated by prescriptions or diagrams.

It’s a multi-faceted symphony. Inequitable distribution of resources due to political machinery or sheer corruption. Lack of manpower and support exacerbated by brain drain and rising costs of living. The ugliest and most polluted public transportation in this side of the metro. The failure to digitalize. Poor customer service support and patient care. Lack of compassion for workers’ rights.

In response to these problems, doctors are becoming more than just medical degree holders. Many physicians make the transition from clinical practice to public health and private enterprises. Residencies in hospitals are also becoming less and less automatic as the years pass by.

Doctors, like the healthcare system itself, exist in motion, transition and transformation. But the curricula of medical schools are disproportionately static. When it comes to training physicians, clinical knowledge and skills take precedence, while aspects of management and the realities of adult work are left behind. All of these voices are left possibly unheard.

To evolve careers and become social catalysts, a physician must either have connections, a strong undergraduate or extracurricular background, or incredible talent and luck. Necessary soft and hard skills are left behind. Even basic knowhow can be left to the wild. How do you file taxes? Learn that yourself. What does PhilHealth mean for practice and for patients? I hope you have a good mentor to teach you instead, because that sure isn’t part of the module.

So the MBA comes to the table and says

Business acumen can make a difference. Strictly speaking, the world of MBA holders is a world where the only thing that matters is the bottomline. For most industries, that means profit. For a person, that can mean a promotion. For Atenean doctors, profit happens to mean improved quality of life for as many people as possible. Viewed like that, the dissonance isn’t difficult to reconcile. The bottomline can mean better health care, decreased mortality, or increased confidence in the health system.

To reach the bottomline is an exercise in operational efficiency. What are the inputs comprising the value chain, what are the outputs that define profit, what are the throughput processes that influence cost? These concepts are exclusive to an MBA (or maybe an MM); a public health curriculum might help medical students understand the WHO building blocks of health, but it won’t help doctors navigate how to cost strategize to strengthen them. Neither can an understanding of research or ethics adequately prepare a hospital manager, a municipality health officer, or a developer of telemedicine technology for the realities of human resource management.

And time-motion studies, and the queuing theory, and all the cute little things that make up operations management, also provide the framework for other kinds of efficiency research. It’s the backbone to speak the language of engineers and HR admins, to determine the best physical layout for triage and ED, to identify communication modes with the fastest response rates and utilization, or to design a cost-efficient distribution systems for feeding or immunization programs.

It’s marketing know-how (not just the clinical skills of infectious and epidemiology experts) that helps entire health departments stay afloat in the nightmares of a pandemic. It’s HR management that guides the culture of a hospital; whether the spirit of a place dissuades applicants and customers, or whether it nurtures them. It is, god willing, financial management that propels innovative health start-ups to life-changing outcomes. It’s ‘principles of management dynamics’, course 1, that reminds leaders to always be adaptive to the times.

And it is, finally, strategic management, that will remind you that the realization of all goals requires internal responsiveness to the external environment. It will hammer it into your head– that to remain competitive, even against yourself, the choice is either to ignore the tides or to rise with it.

Even if you’ll never have to edit another financial statement in your life, at least you will know: to consider always the political injustice, the economic disparity, the social inequality, the technological advancements, the legal, and the ecological.* Regardless of your bottomline, regardless of where your medical degree will take you, any issue will always be political, it will always be economic, it will always be social…

If you don’t consider the laws that govern your operations, or the pollution that shapes your environment, or the technology that empowers your goals…then you fail. You are left behind. Regardless of what you set out to achieve. Regardless of how small your vision is, feet firmly set inside a four-cornered clinic with sterile white walls.

So in the question of “why should medicine be political?”, the answer should be obvious. Everything in this world is political. We live in the decisions of society and state everyday. Medicine is not and never will be a magical exception to this reality.

*This is the PESTLE framework, by the way, which we all learn in like week 1, but only really protest in StraMa.

Necessary thought disclaimers

Is an MBA necessary to tackle these problems? Of course not. In fact, many pioneers and social catalysts have led changes in the Philippine health system without an MBA degree. I can name many doctors who trained in different institutions before ASMPH was even conceived as an idea, and most of them are our professors and hospital consultants.

And to avoid the mistake of creating messiahs out of doctors, physicians are not the only ones with the task of solving interdisciplinary problems. Doctors shouldn’t even take the lead in most public health efforts. But teamwork sidesteps the gap of what doctors can’t do, and an MBA makes the gap even smaller.

Motivation, innovation, and adaptability can address what lack of formal training cannot. But if the tools to fix the trade are already offered up in a platter** …why not?

**With a tuition fee within range of other medical schools, getting an MBA in ASMPH is literally a buy-one-take-one deal. You only need to pay for it with your blood, sweat, and tears.

And finally…

As this is still, technically, a celebratory post –thank you to our STRAMA professor, who is in the running for best adviser and lecturer of all time, Ma’am Roselle Azucena, RN, MAN, MBA; my partner company (especially my brother’s friend) for allowing me to learn from you; my sources of moral, financial and transportation support, my mother and sister (also for your marketing insights); my brother for connecting and inspiring me; my main reasons of not-screaming in despair, Ate Risa and Faye; and everyone else who has metaphorically held my hand along the way. I can never say it on social media but you’ll all be happy to note I’m one of the few that got a 4.0.

Finally. This document has over 1600 words. This is because I drank iced coffee this afternoon. I still need people to stop saying an MBA is just for hospital administrators. Have a good week.

Stay safe, stay indoors, and stay healthy!