The MBA in Medical Education: Current MD/MBA Student Aspirations, Perceptions, and Motivations.

BACKGROUND: As combined Doctor of Medicine and Master of Business Administration (MD/MBA) programs gain popularity, it is critical to understand the motives, perceptions, and interests of MD/MBA students. The purpose of this study was to investigate career aspirations of MD/MBA students, skills they perceive to gain from the dual degree, and reasons why students enroll in MD/MBA programs. MATERIALS AND METHODS: All 73 MD/MBA programs in the United States were invited to participate in a twelve-question, online survey. Responses were collected between August 2019 and February 2020 from students enrolled during the 2019-2020 academic year. The questions were designed to examine career aspirations, program perceptions, and personal motivations. Data were aggregated into descriptive summary statistics and rank orders. RESULTS: A total of 18 MD/MBA programs agreed to participate in this study, of which 14 met criteria for final analysis. From these programs, 67 of 175 students responded (38%). Among respondents, 100% planned to pursue residency. The most common career interests included the following: clinical practice at an academic hospital (85%), executive leadership in a hospital network (76%), and clinical practice in a community hospital (65%). Students ranked "making a broader impact on health care" and "pursuing leadership in clinical practice" highest among reasons to pursue an MD/MBA. Students reported high rates of acquiring MBA-oriented skills. CONCLUSIONS: MD/MBA students in this study focused on pursuing clinical careers. Students appear satisfied with their education, reporting high rates of skill acquisition. Residency programs interested in MD/MBA students can incorporate leadership and entrepreneurial opportunities to foster students' broad interests.

Comparing the real and perceived cost of adenotonsillectomy using time-driven activity-based costing.

OBJECTIVE: This study aims to measure the costs of treating obstructive sleep apnea (OSA) in children with an adenotonsillectomy using time-driven activity-based costing (TDABC) and explore how this differs from cost estimates using traditional forms of hospital accounting. STUDY DESIGN: Prospective observational study. METHODS: A total of 53 pediatric patients with symptoms of OSA or sleep-related breathing disorder were followed from their initial appointment through surgery to their postoperative visit at an academic medical center. Personnel timing and overhead costs were calculated for TDABC analysis. RESULTS: Treating OSA with an adenotonsillectomy in a pediatric patient costs $1,192.61. On average, outpatient adenotonsillectomy costs $957.74 (80.31%); $412.18 of this cost ($4.89 per minute) was attributed to the overhead cost of the operating room. Traditional hospital accounting estimates outpatient adenotonsillectomy costs $2,987, with overhead attributing $11.27 per minute or $949.23 per case. 57% ($6.38 per minute) of the hospital's estimate for overhead was actually for equipment and implants used by different hospital services and not for equipment used in adenotonsillectomies. CONCLUSION: Through TDABC, we were able to highlight how traditional RVU-based hospital accounting systems apportion all overhead costs, including items such as orthopedic implants, evenly across specialties, thus increasing the perceived cost of equipment-light procedures such as adenotonsillectomies. We suspect that providers who perform a TDABC analysis at their home institution or practice will find their own unique insights, which will help them understand and control the different components of healthcare costs. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:1347-1353, 2019.