Saturday, April 10, 2010

MD/MBA Careers in Financial Services

After a nice break this morning at the Association of MD/MBA Programs (AMMP) 8th Annual Conference, Jonathan Gertler, MD, MBA (Managing Director of Leerink Swann Strategic Advisors) spoke about careers in financial services.

Memorable quote: "Never leave something because you're unhappy. Go to something that will make you happier."

Why did Dr. Gertler get an MBA?  In 1996, the MGH was crawling with consultants. Health care leaders need to understand business practices, so he wanted to get an MBA to become a better health care leader. And then, he got distracted by new technology development. He started his own company and he was "fusing clinical and scientific insights with the power of finance to catalyze projects and accelerate products to the bedside."

The Learning Curve
  • Doctor negatives
    • Medical omniscience for all technologies doesn't exist
    • Tech savvy does not equal business sense
    • Sesquipedalian pontificators (doctors who use big words) aren't necessarilty clear thinkers
    • Being expert in one area doesn't render you the smartest person in the room
    • Don't act like the smartest person in the room
    • There is no substitute for 10k hrs 
    • Listening is a huge skill.
    • Your hierarchial powers disappear at the door of your new office (so should your ego). You need to learn how to respect other people's opinions. 
  • Health care finance types negatives
    • Business sense without clear technology or systems understanding puts you at a huge disadvantage in creating asymmetric opportunities.
    • The game is not about returning capital in the absence of clinical utility and quality improvement
    • Capital return doesn't (shouldn't) occur in the absence of clinical utility and quality improvements
    • Leveraging other people's skill sets without cross functional learning ultimately hurts your business in the long run (don't pigeonhole clinicians/scientists)
    • Allowing for failure, allowing for risk need to be ingrained in the culture (you must tolerate a certain level of failure and risk)
    • Money is not the only reward people seek
    • Health care businesses require measurable outcomes in patient care to be justifiable and sustainable
Pitfalls for the MD in business
  • Paying too little attention to the nuts and bolts of finance and execution
  • Depnding on siloed intelligence to succeed
  • Allowing yourself o be pigeonholed into a clinical diligence corner
  • Over-relying on your medical degree as a diffentiator of expertise
  • Not learning how to apply expertise and experience over general principles and fields
  • Over-applying general approaches until one has become completely de-differentiated
  • Being a smart young person in a hurry
Value of the physician perspective
  • Avoidance of spin
  • Hard data analytics
  • Clear understanding of adoption criteria
  • Clear understanding of physician behavior and institutional barricades
  • Balance betweetn technology fervor and ability to reduce to practice
  • Correlation of these multiple factors into a cogent financial model and valuation metric
  • Correlation of numerous factors into a cohesive and flexible strategic plan
  • Ability to distinguish among biases in KOL and community opinions
  • Ability to discern where self promotion undermines credible opinions 
  • Recognition of the difference currencies in play among the drivers of life science businesses
It is the clinical and scientific years beyond the degree itself that enable these insights. Balancing time in grade in medicine against gaining primary business experience is a highly individual choice. 

The (non-economic) pleasures and metrics of success
  • Currencies differ: an issue often misunderstood in managing other physicians
    • Measuring economic success
    • Career advancement (new aptitudes, capabilities, progress, respect, network)
    • Contribution back to the health care system
    • Utilization of collective experience
    • Partnership based on trust
    • Life balance
    • Beware the investment banking culture!!! (our world is looking to trading/swapping to pursue economic gains and it's a short-sighted view)
The balance: Practical Idealism vs. Enlightened Self Interest

Is the MBA worthwhile?
  •  Depends where you are in your career and what you are heading toward:
    • Early on: provides a tool set that is complementary to your MD. Neither necessary nor sufficient, but it can accelerate the understanding of businesses of the life sciences
    • Mid career: focus on the skills that migrate you to the integrated level in your chosen area
    • Late career: leverages a wise and respected presence that can be highly useful to organizations as long as one has devoted complimentary and useful skills
Was the MBA helpful?
  • Company A: endovascular device company, directly related to clinical expertise. Multiple financing and business development activities.  (MD >>> MBA)
  • Company B: cardiac device company, sale with process that included all medical device giants and small companies. Ultimately sold to private equity group with vision for a consolidating CV company.  (MD >> MBA)
  • Company C: strategic transformation for a pharmaceutical company with applications in a particularly circumscribed and rapidly evolving field (MD = Getting Older)
  • Company D: strategic sale of a specialty pharma company in a difficult market with a difficult asset. Negotiations, positioning, tactics all critical to successful outcomes (Transactional experience >>> MD)
An MBA is only as good as the experiences it puts you in a position to obtain. There is no magical prescription. There is only the benefit of accumulated deal, strategy, and operational intelligence.

Paths and value:
  • immediate post MD entry: IB, VC, consulting, entry level industry
  • Training, delay the MBA, obtain MBA after defined career path
  • Entreprenuership (failure is valued)
  • Industry experience:regulatory, clinical development, CMO, Bus Dev, Corp Dev
  • Laterla move to mid/senior level financial services/consulting with grater running room from a position of prominence and expertise
  • Enjoying medicine and living fully within it while applying your skills across leveragable opportunities
Responsibilities of the physician business leader
  • Patient focus
  • Provider focus
  • Data focus
  • Ethical responsibilities/analysis of company attributes, strategies, and operational goals
  • Fluency in business capabilities
  • Reocognition of limits of direct knowledge of specific clinical fields, business issues associated and utilization of background to consolidate the best information and practices possible
Synthesizing the scientific, clinical, cultural, policy, and economic underpinnings of life science businesses is the critical contribution of the physician business leader and affords a rare opportunity to have broad impact while still staying close to the intellectual and social attributes that medicine provides. 

Questions from the audience:
  • How do you gain business experience during internship/residency? Don't divert your attention away from your clinical responsibilities. Use your off-hours to study, read, and network. Learn the business language.
  • Private practice vs. academic medicine before transition into industry? Both are valuable. Greater cache if you come out of academia. Community practice gives you the sensibility of the broader base of adoption.
Many medical students don't know very much about the venture capital and investment banking industries. Why? Because business courses are not required if you're a pre-med college student. As a result, many students focus on biological sciences and they may never take a single business course in college. Plus, they're often not reading business journals in their spare time (who has free time during medical school and residency?). The business world requires you to learn a new language.

Make sure to return in a few weeks to find a hyperlink to Dr.Gertler's slide presentation.

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