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Dartmouth's MD-MBA Program: Training Change Agents in Health Care

Alicia Dagrosa, MD-MBA'17 (left), and program coordinator Merilee Perkins meet with students interested in the MD-MBA program at Dartmouth.

Not long after beginning his first year at the Geisel School of Medicine in 2012, Colin Tasi, MD-MBA'18, enrolled in "Medical Care and the Corporation" at Dartmouth's Tuck School of Business—an elective class popular among medical students that examines the significant role employer-sponsored health care plays in the U.S. health-care system.

By Tim Dean

"At the time, there were a lot of changes going on with the Affordable Care Act and in health care in general, and I thought the course would give me a broader view of what health care looked like outside of clinical medicine," recalls Tasi, who majored in biochemistry in college. "I ended up loving it and discovering I had a passion for the business side, as well as the clinical side, of medicine."

To get advice on how he might best pursue his dual interests, Tasi met with Mike Zubkoff, a professor of health economics and management at Tuck and then chair of community and family medicine at Geisel, who directs Dartmouth's MD-MBA program. "Mike put me in touch with several program grads, so I could get their perspectives, and suggested I get some management experience before applying to the MD-MBA program."

Having the opportunity to gain practical, tangible experience in a variety of real-world projects has given me the foundation, and also the confidence, to address whatever challenges I'll want to tackle in my future career.

- Alicia Dagrosa, MD-MBA'17

He spent that summer optimizing staffing patterns for the department of strategic planning at Montefiore Medical Center in New York City. "It was a great experience and it really confirmed for me what I wanted to do," says Tasi, who after graduating next year plans on specializing in emergency medicine and working in health-care delivery management and quality improvement.

Tasi is one of a growing number of medical students in recent years to take advantage of an increasing number of joint MD-MBA programs across the country. According to the Association of American Medical Colleges, there were about 150 MD-MBA graduates in 2016 compared to about 60 in 2003, and more than half of the 70 MD-MBA programs now available started after the year 2000.

But even back in 1991, when Zubkoff and his colleagues first proposed an MD-MBA program at Dartmouth, the advantages held by people who could "cross-walk" between the clinical and business communities were evident.

"There was a lot of consolidation of health-care delivery during that time and managed care was developing to moderate rising costs," recalls Zubkoff. "I knew a lot of physicians who didn't start out with any management training but who were taking on leadership roles with organizations in an effort to improve the health-care system—people like Norm Payson, who had to learn it on their own. We thought, 'Gee, wouldn't it be nice if we could help more physicians get those skillsets up front.'"

Payson (Med'73), who has maintained close ties with Dartmouth throughout a highly impactful career—first as a practicing physician, then as a business leader in the managed health-care industry, and most recently as a philanthropist and investor/consultant to private equity companies—was very supportive of the idea and wanted to do more.

In 2004, he and his wife Melinda established a generous $1.5-million endowment to support MD-MBA student scholarships at Dartmouth. The Paysons' gift, along with an earlier $600,000 start-up gift from Dr. Constantine Hampers and an additional gift by the Don Wilson Family Foundation ($426,000), has provided the vital financial support needed to help the program grow and thrive.

Colin Tasi

"Even more impressive than Norm's financial support, which we greatly appreciate, is the amount of time he continues to give to students of the program," says Zubkoff. "He comes back to Dartmouth at least two or three times a year to meet with them, to have them for dinner, to be here for their graduation, and he stays in touch with them as a mentor as they go off into their careers."

"I look back on my experiences at Dartmouth with tremendous fondness and gratitude—it's a very special place, and I've really enjoyed being able to help others in the same way I was helped," says Payson, who came to Dartmouth Medical School on scholarship after completing an undergraduate degree at Massachusetts Institute of Technology. "It's wonderful to interact with the students. Seeing their enthusiasm, intelligence, and creativity makes you feel very optimistic about the future."

At Tuck, we develop skills in communication and leadership that really complement our clinical training at Geisel. I now feel thoroughly equipped to pursue my passions in both patient care and the businessside of health care.

- Colin Tasi, MD-MBA'18

Today, this support combined with top-notch cadres of faculty and students, makes Dartmouth's MD-MBA program one of the premiere combined academic offerings in the country. The program currently graduates six to eight MD-MBAs per year, who are actively sought after by many of the most competitive residencies in the country.

Dartmouth MD-MBA students can choose either a compressed five-year program or a more flexible six-year track, says Zubkoff. "In their first two years, they receive a thorough grounding in the basic sciences in classroom and lab settings at Geisel, and then acquire a year of clinical training at Dartmouth-Hitchcock that we believe is important for context and reference, before shifting their attention to Tuck in year four," he says.

At Tuck, MD-MBA students go through a rigorous and innovative core curriculum that emphasizes teamwork, communication skills, and leadership development. Most students complete their medical clerkships and required courses at both schools in year five, having mixed in electives in areas of special interest along the way. Those who opt for the six-year track, divide years five and six between Geisel and Tuck, which allows them to take part in Tuck summer internships and spread their elective classes out between both schools.

While many graduates choose to apply their management skills in clinical medicine, the dual training opens up a diversity of career opportunities for doctors in areas like: hospital administration, health insurance, financing systems, government agencies, biotechnology, pharmaceutical and medical device companies, and health services delivery start-ups.

No matter where they decide to focus their energies in health care, MD-MBA graduates and students find great value in the knowledge, skills, and experiences they gainat Dartmouth.

"I'm extremely grateful for the program—it opened up opportunities I never knew existed and prepared me for a career as a mission-focused physician entrepreneur," says Si France, MD, MBA'07, whose highly successful endeavors have included founding a national urgent care chain focused on joint ventures with hospital systems, helping lead a venture-backed addiction company that serves rural areas, and co-founding a program that provides value-based care for frail seniors in their communities.

Mike Zubkoff, a professor of health economics and management at Tuck and director of Dartmouth's MD-MBA program

"Medical school, and at Dartmouth in particular, instilled in me a certain values system for either being a patient-centered physician or an agent of positive social change," says France.

"Whether in anatomy or pharmacology, my professors never wavered in teaching us to do the right thing, and in gray areas, how to discern what the right thing was," he recalls. "By combining that with a Tuck education and network, I was both inspired and prepared to launch companies and build teams that are all about making a positive difference and improving health-care delivery in some way."

For Alicia Dagrosa, MD-MBA'17, who will soon begin a residency in dermatology at Dartmouth-Hitchcock, the strongest aspects of the program have been its people and its opportunities. "The mentorship and support I received from faculty members and alumni, together with being able to learn from and with colleagues who are going to be doing some really great, innovative things in health care, has been outstanding," says Dagrosa, whose goal is to help improve health-care value for patients during her career as a physician.

"And having the opportunity to gain practical, tangible experience in a variety of real-world projects has given me the foundation, and also the confidence, to address whatever challenges I'll want to tackle in my future career," says Dagrosa. Her projects included creating a treatment decision aid for patients with coronary artery disease, conducting research at The Dartmouth Institute on unwarranted variation in health-care delivery across the U.S., and founding, together with Ayo Olufadeji, MD, MBA'16, WeBelieve—a Nigerian-based startup whose goal is to provide primary care and urgent care for citizens of Nigeria.

One of the attributes that Jessica Cronin, MD, MBA'10, found most beneficial about the MD-MBA program is the way that faculty and leadership work closely with students to improve their learning experiences. "While I was there, I was able to work with Drs. Hansen and Slaughter, to get a course about health economics incorporated into the curriculum, which was very well received," recalls Cronin, who'd worked as an investment banking analyst at Goldman Sachs before starting medical school. "There's a lot of flexibility, openness, and enthusiasm for health care at Tuck—it makes you feel like the sky is the limit."

She is now a pediatric anesthesiologist at Children's National Medical Center in Washington, DC, applying her dual skills to improve care processes for patients in the perioperative period.

"It's been challenging but really fun," says Cronin, who also serves as a member of Dartmouth's Joint Degrees Advisory Committee, and enjoys staying in touch with the program and sharing her perspective with students and colleagues alike. "It's allowed me to contribute in my small way to what's given so much to me," she says.

Tim Dean is a senior writer for Dartmouth Medicine.

One common conclusion shared by graduates of the program, adds Payson, "is their gratitude and affection for Dr. Mike Zubkoff, who's done so much for the MD-MBA program's success and been so supportive of them."

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