The utility and return on investment of dual degrees

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Horners

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For those of you out there who have your medical degree and have (or considering) a dual degree. What exactly do you do? And how do you think a dual degree has positively (or negatively) impacted your career?

Moreover, which degree do you think is the most useful? (MBA, MPH, JD, MHA, MMM etc...)

Seems that the majority of folks with them have some utility for them in hospital administration, however as a hypothetical would a psychiatrist-attorney make a better expert witness? Would a psychiatrist MBA/MHA be more suited to be in the executive suites of a hospital/school/industry?

Thanks!

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For the average psychiatrist, dual degrees are worthless. Most don’t use them at all. Those that do typically transition out of medicine.

I’ve seen some get MBA’s from top 15 programs and go on to run a business or venture capital firm. Some get a JD and either sue or protect doctors.

Physicians are already qualified for hospital admin jobs. I know many that have transitioned to admin without a masters quite easily. If you want to do forensics, a fellowship is 10000x more valuable than a JD.
 
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As in, you mean the fellowship would help you get more expert witness hours than having a MD JD?

A MD/JD is not a good forensic expert. An attorney wants a psychiatrist with excellent composure/communication skills and who is performing the related clinical job consistently. In essence, you want an expert in the field. A psychiatrist cutting clinical hours and spending time training/practicing law is no longer an expert psychiatrist to a jury. The opposing counsel would tear this apart.

A fellowship trained psychiatrist is 1st a psychiatrist and 2nd has experience on the stand. It’s only a 1 year fellowship, and you are taught related legal issues while practicing psychiatry still.
 
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An MD/JD who also practices psychiatry primarily I mean. Like run your own practice, coming in to give an expert opinion on a case while understanding both legal and medical simultaneously
 
An MD/JD who also practices psychiatry primarily I mean. Like run your own practice, coming in to give an expert opinion on a case while understanding both legal and medical simultaneously

This doesn’t make sense. A JD degree will take 3 years full-time, and you will focus on general legal issues in which most are worthless to psychiatry. To be good at healthcare law, you’ll want to practice at a top healthcare firm to strengthen your skills. JD degree will put you $150k+ in debt/expenses. Healthcare firms pay about $75-125k/year to gain experience. In the end, you’ve neglected psychiatry for 5+ years. You are clinically rusty, and you have no experience actually testifying as an expert witness. Opposing counsel will bring all of this up, and you won’t be trustworthy.

The alternative path is a 1 year fellowship in which you’ll still be treating patients. You’ll get practice testifying. You’ll be paid as a fellow and then $200k+ as an attending after 1 year. You’ll practice clinically non-stop and easily be considered an expert in the field.
 
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an MD/JD would be good for those who wish to be legal scholars in medicolegal or psycholegal issues. It might also be one way of become an expert in bioethics. I know of one MD/JD who specializes in helping physicians who are dealing with lawsuits (more so in coaching them through the process and providing emotional support rather than legal representation). All of the MD/JD forensic psychiatrists I know are fellowship trained in forensics. a law degree provides you with a legal education, it does not an expert witness make. You will not be any better prepared in report preparation, expert testimony or surviving depositions with a law degree. A law degree will not help you with evaluations of malingering, violence risk, sex offender recidivism, testamentary capacity, disability, psychic injury, criminal resposibility, fitness for duty etc. The only advantage a JD confers here is possibly a network of attorneys who might be able to refer you cases or be a way in to getting cases (as most starting out struggle to get their foot in the door). Some MD/JDs do work for the medical board. I know who JD/MD forensic psychiatrist (who was an attorney before med school) who makes over 1 million/yr as head of a major psychiatric health system. You must bear in mind legal work tends to pay much less than physician work particularly at the intersection of law and psychiatry. For all those attorneys billing $1000/hr+ (mainly in the corporate sector), there are tons of who are barely breaking even. The pedigree of the degree matters too.

MD/MPHs are ten a penny. Does not really confer any benefit unless you are using it in some way, e.g. health services research, epidemiology, health policy and management, doing public mental health work (which often pays less). Many programs are shams (many med schools allow you to complete a so-called MPH without any longer time than med schools). the better programs provide a strong network and may also afford opportunities for consulting, healthcare administration, policy, or working for governments internationally.

MBAs are becoming more common among MDs. again, pedigree matters. not sure how much these healthcare MBAs and diploma mills actually are. MBA is totally useless for those in private practice or wanting to start a small business. If you want to run a department (e.g. chair or chief of psychiatry) or climb up the greasy poll of healthcare administration, it can be helpful, but the degree alone is not enough. You need to get into positions of leadership at different levels too. If you go to a top program, that can be good segue into other industries such as consulting, finance, tech, as well as healthcare. entry level jobs for MBAs often work much harder, for less pay, and less job security than physicians. However there is more scope for growth and higher overall earnings. Many people who start off in consulting go on to leverage their connections and experience to set up their own companies, do venture capital or other unspeakable evils.

BTW, psychiatrists are often overrepresented in leadership positions in hospitals and medical schools. We also have our own (psychiatric) hospitals one can lead as well. an MBA is not necessary, but as the corporatization of medicine nears completion it is often desirable.

tl;dr I wouldn't put much stock in dual degrees unless you have a) have very specific career goals b) are wanting to have a possible exit strategy out of clinical medicine c) have a specific interest in doing the additional degree for its own sake d) are going to attend a top program with the network that brings and/or e) willing to put the additional work in building up your professional experience alongside the degree
 
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As in, you mean the fellowship would help you get more expert witness hours than having a MD JD?

You're retained by an attorney as an expert/consultant in psychiatry not forensic psychiatry. Leave the law to them. A JD could be an expensive way to get to know lawyers though.

Working in the field of FP, I've gotten the sense of a conservative and imperialistic approach that many FPs take. Some seem to go outside of their scope (i.e., how psychiatry applies to the law) to "ultimate issue" things that would be better off decided by the law. Others, like myself, see themselves as psychiatric consultants with opinions that are psychiatric not legal.
 
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an MD/JD would be good for those who wish to be legal scholars in medicolegal or psycholegal issues. It might also be one way of become an expert in bioethics. I know of one MD/JD who specializes in helping physicians who are dealing with lawsuits (more so in coaching them through the process and providing emotional support rather than legal representation). All of the MD/JD forensic psychiatrists I know are fellowship trained in forensics. a law degree provides you with a legal education, it does not an expert witness make. You will not be any better prepared in report preparation, expert testimony or surviving depositions with a law degree. A law degree will not help you with evaluations of malingering, violence risk, sex offender recidivism, testamentary capacity, disability, psychic injury, criminal resposibility, fitness for duty etc. The only advantage a JD confers here is possibly a network of attorneys who might be able to refer you cases or be a way in to getting cases (as most starting out struggle to get their foot in the door). Some MD/JDs do work for the medical board. I know who JD/MD forensic psychiatrist (who was an attorney before med school) who makes over 1 million/yr as head of a major psychiatric health system. You must bear in mind legal work tends to pay much less than physician work particularly at the intersection of law and psychiatry. For all those attorneys billing $1000/hr+ (mainly in the corporate sector), there are tons of who are barely breaking even. The pedigree of the degree matters too.

MD/MPHs are ten a penny. Does not really confer any benefit unless you are using it in some way, e.g. health services research, epidemiology, health policy and management, doing public mental health work (which often pays less). Many programs are shams (many med schools allow you to complete a so-called MPH without any longer time than med schools). the better programs provide a strong network and may also afford opportunities for consulting, healthcare administration, policy, or working for governments internationally.

MBAs are becoming more common among MDs. again, pedigree matters. not sure how much these healthcare MBAs and diploma mills actually are. MBA is totally useless for those in private practice or wanting to start a small business. If you want to run a department (e.g. chair or chief of psychiatry) or climb up the greasy poll of healthcare administration, it can be helpful, but the degree alone is not enough. You need to get into positions of leadership at different levels too. If you go to a top program, that can be good segue into other industries such as consulting, finance, tech, as well as healthcare. entry level jobs for MBAs often work much harder, for less pay, and less job security than physicians. However there is more scope for growth and higher overall earnings. Many people who start off in consulting go on to leverage their connections and experience to set up their own companies, do venture capital or other unspeakable evils.

BTW, psychiatrists are often overrepresented in leadership positions in hospitals and medical schools. We also have our own (psychiatric) hospitals one can lead as well. an MBA is not necessary, but as the corporatization of medicine nears completion it is often desirable.

tl;dr I wouldn't put much stock in dual degrees unless you have a) have very specific career goals b) are wanting to have a possible exit strategy out of clinical medicine c) have a specific interest in doing the additional degree for its own sake d) are going to attend a top program with the network that brings and/or e) willing to put the additional work in building up your professional experience alongside the degree

This is very insightful, especially re: MBA and starting a private practice. Thank you for the detailed post.
 
One could possibly do medicine for a few years, then completely jump ship and become a JD. And focus entirely on health care law. Get one heck of website with a good web presence. Bread butter is physician contract review. Open up shop in a state that has non-compete clauses, another bread an butter case. And emphasize your description as healthcare worker for healthcare workers. If the private practice starts to struggle could switch gears and become a general counsel for a hospital... Even just focusing on labor disputes for CNA, LPN, RN, etc could keep you busy, considering how hospitals can be the largest employers in many localities. And since hospitals (health systems) don't always value their human resource capital, they are a feeding ground for lawyers. Local lawyer here keeps telling me how shocked he is how often the local health system fuels potential lawsuits.

Pros: no call. Business hours. Truly get paid for time and not some arbitrary wRVU system.
Cons: Possibly less pay? and opportunity cost loss with mid career change, and debt incursion of another high cost degree, Need to communicate clearly, shorthand speak doesn't fly anymore (i.e. Denies N/V/F/C/HA/Bleeding/CP/SOB)
 
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MBAs are becoming more common among MDs. again, pedigree matters. not sure how much these healthcare MBAs and diploma mills actually are. MBA is totally useless for those in private practice or wanting to start a small business.

I think most of your posts are spot on, but I'm going to disagree with this point.

I audited an "MBA in Healthcare Management" program while I was in med school (our dual degree program let anyone take the first semester of classes for free) which was ~$24k for the whole program. A few of the classes were dedicated to understanding how to actually start a private practice including billing policies and models in various fields, understanding loan terms and contracts, managing cash flow and reimbursement, staffing, etc. (one class was purely dedicated to learning how to use excel for accounting in PPs). For someone with no business knowledge or experience who wants to run their own private practice, I think this would be an invaluable tool.

That being said, I realize that many programs are unlikely to cover the more concrete and practical points of private practice and are more likely geared towards corporate management and general administrative education. For such programs I agree with your assessment and say that outside of elite programs it's likely a waste. I'd just point out that this will be dependent on the curriculum of the program and there may be some that are actually worth it to gain the basic knowledge necessary to effectively and efficiently run a PP.
 
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Pros: no call. Business hours. Truly get paid for time and not some arbitrary wRVU system.

Those “pros” are inaccurate. You won’t come out of law school prepared to handle healthcare law. Like residency, you’ll want to do a few years at a top healthcare firm and learn from the best. Many expect you to handle “call” for weekend issues 48 weekends of the year. Deadlines exist, and you’ll be expected to work overtime to meet them. Salary is typically $75-125k with nothing for call/overtime. With experience and moving up the ladder, you’ll eventually get paid well, drop call, etc but it’s a cut-throat industry.
 
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I think most of your posts are spot on, but I'm going to disagree with this point.

I audited an "MBA in Healthcare Management" program while I was in med school (our dual degree program let anyone take the first semester of classes for free) which was ~$24k for the whole program. A few of the classes were dedicated to understanding how to actually start a private practice including billing policies and models in various fields, understanding loan terms and contracts, managing cash flow and reimbursement, staffing, etc. (one class was purely dedicated to learning how to use excel for accounting in PPs). For someone with no business knowledge or experience who wants to run their own private practice, I think this would be an invaluable tool.

That being said, I realize that many programs are unlikely to cover the more concrete and practical points of private practice and are more likely geared towards corporate management and general administrative education. For such programs I agree with your assessment and say that outside of elite programs it's likely a waste. I'd just point out that this will be dependent on the curriculum of the program and there may be some that are actually worth it to gain the basic knowledge necessary to effectively and efficiently run a PP.

A MBA is overkill for private practice. You’ll want to use an attorney, CPA, talk to a peer, and read 1 book or so about it maybe.

If you want to start and run your own hospital chain, MBA may be worth it.
 
A MBA is overkill for private practice. You’ll want to use an attorney, CPA, talk to a peer, and read 1 book or so about it maybe.

If you want to start and run your own hospital chain, MBA may be worth it.

I think it depends on the goals and size of the PP. Just you and maybe one other doc in an office with an administrative assistant? Not worth it. Goal to create a large practice or multiple locations which partners with multiple groups, provides wrap-around services, or utilizes various modalities like ECT or TMS? Probably much more relevant. I see your point, I just don't think it should be completely written off (depending on the actual curriuculum, time requirement, and cost).
 
Those “pros” are inaccurate. You won’t come out of law school prepared to handle healthcare law. Like residency, you’ll want to do a few years at a top healthcare firm and learn from the best. Many expect you to handle “call” for weekend issues 48 weekends of the year. Deadlines exist, and you’ll be expected to work overtime to meet them. Salary is typically $75-125k with nothing for call/overtime. With experience and moving up the ladder, you’ll eventually get paid well, drop call, etc but it’s a cut-throat industry.
Disagree. Working at a top law firm to "learn from the best" doesn't mean much. Why sign up to be abused as low man on totem pole to do the scut work and have profit skimmed off your labors? I've consulted with larger firms for various issues over the years and smaller firms, and even solo lawyers. Fees whether low or high, and size of firm doesn't correlate to quality of the lawyer. Similar to medicine, can they communicate with you in a way you understand? Have they had some cases similar to yours in the past they can speak to some experience? You put 10 lawyers in a room on 1 issue, you will get 10 opinions. Will they give you a deadline to resolve issue X and actually follow up on it? And something I specifically look for is do they present an itemized bill that matches their services and is something you can understand - or is it a large lump sum mystery bill.

One issue in the past, one lawyer said essentially a lawsuit should have been filed yesterday, another said you have no case, and another said not sure 50/50.
I've also found that even the higher paid, fancy law firm, and the lower rate small firm don't know everything, and pulling up case law articles that might be applicable, has actually been educational for them and become a discussion point for the issue at hand.
Law like medicine, hit pubmed (law library) and pull up possible similar case law, or even case studies published in state law journals. Extrapolate from there. Not rocket science, but a JD sets the foundations to process better.
 
Disagree. Working at a top law firm to "learn from the best" doesn't mean much. Why sign up to be abused as low man on totem pole to do the scut work and have profit skimmed off your labors? I've consulted with larger firms for various issues over the years and smaller firms, and even solo lawyers. Fees whether low or high, and size of firm doesn't correlate to quality of the lawyer. Similar to medicine, can they communicate with you in a way you understand? Have they had some cases similar to yours in the past they can speak to some experience? You put 10 lawyers in a room on 1 issue, you will get 10 opinions. Will they give you a deadline to resolve issue X and actually follow up on it? And something I specifically look for is do they present an itemized bill that matches their services and is something you can understand - or is it a large lump sum mystery bill.

One issue in the past, one lawyer said essentially a lawsuit should have been filed yesterday, another said you have no case, and another said not sure 50/50.
I've also found that even the higher paid, fancy law firm, and the lower rate small firm don't know everything, and pulling up case law articles that might be applicable, has actually been educational for them and become a discussion point for the issue at hand.
Law like medicine, hit pubmed (law library) and pull up possible similar case law, or even case studies published in state law journals. Extrapolate from there. Not rocket science, but a JD sets the foundations to process better.

Law school like medical school teaches you the basics. Coming out of med school, would you expect to know anything close to what a psychiatrist knows? Like a psychiatrist, you don’t just learn by reading random journal articles.

I’d rather consult an attorney at $600/hr that has done X 1000 times and can give me a good response immediately than base lawyer billing me $100/hr that’ll spend 15 hours searching westlaw and lexis/nexis for applicable cases.
 
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If the $100/hr can actually communicate, is reachable, and honestly bills, and the bills are itemized with ease of understanding, I'll take the $100/hr every time - even if they are billing for their extended time to learn so to speak.
 
If the $100/hr can actually communicate, is reachable, and honestly bills, and the bills are itemized with ease of understanding, I'll take the $100/hr every time - even if they are billing for their extended time to learn so to speak.

After you’ve tried both a few times, let me know which you prefer.
 
I have the cheaper one on retainer. Tired of the higher cost law firms. Too much punting, too much bureaucracy, in accessible, and quality of letters/interventions isn't worth the extra cost.
 
In a slightly different vein, what about something like an MD/MA in bioethics/medical humanities in the context of applying for residency? Given a history of humanities scholarship/publications in med school connecting the humanities and medicine.
 
I have the cheaper one on retainer. Tired of the higher cost law firms. Too much punting, too much bureaucracy, in accessible, and quality of letters/interventions isn't worth the extra cost.

I think we are arguing different things. I’m certainly not advocating for inaccessible, bureaucratic firms that don’t communicate. I want good, cost-effective legal help. This can happen at small or large firms.

My point is merely that law graduates should spend time learning from someone seasoned in their preferred specialty first. I can search a potential attorneys recent cases and whether the attorney often settles, goes to trial, and W/L record. A MD/JD shouldn’t expect to graduate and understand healthcare law. No legit hospital will sign a fresh MD/JD as lead counsel. No physician wants a MD/JD that hasn’t been to trial on their related issue. Attorneys need experience. A good, experienced attorney may be found at a large firm or a 1-man shop.

This isn’t special to law or medicine. PhD’s do post-doc years. We do residency. Law graduates work beneath other attorneys. Counselors do an internship after their masters.
 
A MBA is overkill for private practice. You’ll want to use an attorney, CPA, talk to a peer, and read 1 book or so about it maybe.

If you want to start and run your own hospital chain, MBA may be worth it.

Some local colleges also offer certificate-type programs in small business ownership. I don't work in PP and haven't attended any of those programs, but I imagine some of them might be helpful for starting a practice (and much, much less expensive and time-consuming than an MBA). Or, you know, if you end up wanting to open some other type of small business outside of medicine.

I asked a friend about it once after he'd recently finished his eMBA at Kellogg. He said his degree would basically be useless for me, and recommended the community college route as more directly applicable. He also recommended it over getting an MBA at a lower-tier, regional university.
 
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HBS Online offers a certificate course for $2000 that covers the essentials of an MBA. That’s it. All you need from an information standpoint. A Wharton/Stanford/Harvard MBA or Harvard MPP is always worth it.
 
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