Executive MPH Attracts Health Professionals Back to School

By JEAN LLEWELLYN

“There is much opportunity for the give and take of the real world...they bring their own experience with them...and provocative and challenging issues to the table.”

Dr. James Cowan’s Executive M.P.H. degree helps him fulfill his main professional responsibility: translating ideals of quality care into day-to-day patient care.

In four consecutive days a month for two years, from as far as California, Texas and Vermont, 70 doctors, nurses and other administrators steep themselves in health policy and management at Columbia School of Public Health (CSPH). Since its launch nine years ago, more than 200 students from a wide-range of health careers have entered the Executive Master of Public Health (E.M.P.H.) program. Calling the course of study “an overwhelming success,” Founding Director Sheila Gorman, Ph.D., M.P.H.,’72, notes that more than half of each class consists of “physicians interested in the managerial side of medicine and the rapidly changing and complex policy environment of today’s health care professional.”

Undisputedly, the need for management training specific to health care has grown in this decade. Lawrence Brown, Ph.D., head of the Division of Health Policy and Management, underscores the reality that “enormous changes in the health care system make going to work a kind of on-the-job training these days, and therefore managers have a greater than ever need for the kind of education this program offers.”

for these mature students, the E.M.P.H. in Health Services Management is exactly what the doctor, nurse, financial analyst or lawyer ordered. “They are seasoned, sophisticated and extremely quick, eager to learn the concepts and apply practical knowledge of the subject matter,” says associate Dean Michael O’Connor, Ed.D., an assistant professor who teaches human resource management in the program.

“There is much opportunity for the give and take of the real world, as opposed to a traditional academic model. They bring their own experience with them...and provocative and challenging issues to the table,” O’Connor adds, leaving little doubt that these astute mid-career health care professionals recognize their need to understand the changing health care landscape and, more importantly, to have their say and influence.

Excellence and economy

Taking time to improve their health care management skills, Dr. Roger Lane (left) and Dr. B. Smith Hopkins, discuss an executive M.P.H. class assignment.

To be heard requires preparation and the E.M.P.H. meets that need better than a traditional business degree, according to students. James Cowan, M.D., M.P.H., ’97, director of clinical performance improvement and chief of the department of medicine at St. Luke’s, a 434-bed community hospital in Bethlehem, Pennsylvania, explains his needs this way: “How do you organize your physicians and hospitals to do the right thing for patient care while making it work in an environment where resources are constrained and expectations are very high? My core function is to try to translate ideals of quality care into day-to-day care of patients.” Moving from clinical practice to administrative medicine over the last ten years, Cowan says that previous M.B.A. courses made him realize that most of them were not applicable to health care. “Frankly,” he says, “reimbursement is unlike anything in the business world.”

Word gets around, and other Pennsylvanians who had attended the program encouraged Cowan to look into Columbia. He found the 16-course, 45-credit E.M.P.H. “clearly focused at health care executives. It is well pitched to my needs.” His classmates concur, underscoring that they are not solely interested in business concepts that are unrelated to what they do. “My building is filled with M.B.A.s,” said one pharmaceutical executive. “I was looking for a new skill set.”

Students don’t have long to wait to apply their lessons. Cowan relates that when his chief operating officer reorganized, abandoning the traditional department structure in favor of service lines such as cancer or cardiovascular disease, they went through a planning process that utilized the strategic planning insights of Professor tom Ference, Ph.D., and that paralleled Professor Sam Davis’ model of analysis. Davis, M.S., ’57, senior director of Delta Consulting Group, is among the practitioners who have teamed up with Columbia full-time faculty to relate classroom theory to the realities of the workplace, a major goal of the curriculum.

International Pharmaceutical Perspective

Pfizer inc.’s British-born Senior associate Medical Director Roger Lane, M.D., M.P.H., ’98, finds that case studies of health care industry enterprises help him and his classmates better understand the domestic and international markets.

“to understand change and not be afraid of change, you need to understand the forces behind those changes. I’m not in there to learn about administration, I’m not specifically focused on that. This Executive M.P.H. is far more useful than a business degree,” says Lane. “I’m a medical director with no ambition to be marketing director. I’m still vocational.” However, he adds, “as a member of the medical marketing team of a major drug company, I have input into the multi-disciplinary team. It is inappropriate for me to know only one thing. I need to get the marketing perspective.”

Lessons to Be Learned from Hospital Closing

for some students, lessons come late. Aloysius Cuyjet, M.D., ’98, board certified in multiple specialities, served as director of adult medicine at Newark, New Jersey’s now bankrupt United Health Care Systems from 1980 until its demise in February 1997. After dedicating his professional career to the urban environment, the New Jersey-born Cuyjet was displaced—along with 1200 others (a workforce already halved)—when United shut its doors, its collapse largely attributed to management’s failure to adapt to the rapidly changing health care environment.

Cuyjet is using methods of analysis from the E.M.P.H. to reconstruct what’s happened to United’s 8,000 annual admissions, 120,000 outpatient visits and 38,000 emergency room visits since the closure. Profitable until June, 1996, United lost $4 million a month before it was over. Charity care, Medicaid managed care enrollment and graduate medical education bore the brunt of the decline, leaving Cuyjet wondering: “Where have the services gone? What about access? Why isn’t there an uproar?”

Medicaid Managed Care

“What’s key,” says Sandra Comerie-Smith, M.D., ’97, “ is sensitivity to the needs around you. It has become necessary for a health care provider to be a good manager, leader, and a public health person. There is no way to take the program and not be changed in your sensitivity to people who have no access to health care and to people who have no health insurance.”

Juggling three jobs, children and family life, Comerie-Smith realized that the E.M.P.H. would not only help her understand the health care market but would help her decide if she would like health care management. Dividing her professional time among a largely uninsured immigrant population at the Mt. Vernon (New York) Neighborhood Health Center, a poor urban community at the Harlem Hospital Center, and as medical director for Community Choice Health Plan, a Medicaid managed care plan in Westchester County and the Bronx, Comerie-Smith is immersed in Medicaid managed care, viewing it administratively as “the best thing that ever happened to Medicaid in terms of access to specialists, quality care and preventive care.” Nevertheless, she hastens to add that, “as a provider, I hate the thing.”

Many courses have been relevant to her work, says Comerie-Smith. She cites an outcomes research paper based on surveys of patients satisfaction; health policy courses that helped her understand how Medicaid policies are formulated; and guidelines for setting up benchmarks for length of stay, admission days and utilization. and she confesses that she has a better handle on managed care: “When I go to meetings, I’m intelligent: I can read a new report and critique it.”

Health Care Reform’s Effect on Pharmaceutical Products

as assistant general counsel at Berlex Laboratories inc., in Wayne, New Jersey, Jane Gilligan, J.D., ’97, became interested in the E.M.P.H. because her work relates to sales and marketing, “tracking health care reform to find out how it might affect pharmaceutical products.” Half of her time is spent on contracts with managed care companies or with hospitals, which often involves getting pharmaceutical products on formulary.

“After the Clinton health care reform effort, I learned a bit about the program reading a New York Times retrospective quoting Dr. Larry Brown. I didn’t know Columbia had a school of public health. When I learned more about the program, I thought it was divine intervention. It’s a particularly good school, at the edge of it all... and close to New Jersey.” CSPH’s Health Policy and Management Division ranked sixth in the nation according to the 1998 U.S. News and World Report “Best Graduate Schools” publication.

From health care proxies to pricing in a competitive market, eyeopening ethics and economics classes speak to an expansive program. “The health market differs from other markets,” points out Gilligan. “Professor Sherry Glied’s health economics class provides good insight into how traditional approaches from economics wouldn’t work in health care.” Traditional approaches don’t work, Gilligan says, because the government has an indirect price control policy for Medicaid, the largest single purchaser of pharmaceutical products in the United States.

A Doable Program

Widowed four and a half years ago, Elizabeth Reardon,’97, the mother of two and now managed care director for the office of Vermont Health Access, began a new chapter in her life by turning a life insurance policy into a forward-looking investment—an E.M.P.H. degree from CSPH.

Dr. Aloysius Cuyjet has used methods of analysis learned in the program to examine the community impact of a recent New Jersey hospital closing.

“Among the schools with the highest caliber programs, Columbia was the only place that admitted that people worked for a living. I also needed a concentrated experience not provided by classes that met three nights a week. Columbia’s four day a month combination of public health, business management and clinical focus works,” according to Reardon. “It’s like an all day management retreat four days a month.”

She says, “We have management meetings on Monday morning and I’ve driven people crazy with what I learned over the weekend. It goes both ways: work to school and school to work.”

“It isn’t just the dynamic course work that makes this program so remarkable but the colleagues and contacts, the faculty respect, collegiality and mutuality—that is not seen in classic grad school situations,” Reardon says. But make no mistake, the curriculum is demanding. Most students agree with E.M.P.H. associate Director Alicia Benjamin Stennet’s estimate of 15 to 20 hours of preparation time each week.

Alliance-Building

From the first day of school, the group process of getting acquainted really worked for Lisa Mollicone, ’97, and Nick Macchione, ’97. as a result, both landed new jobs in California, she in the general counsel’s office in San Diego County and he as the county’s assistant commissioner of health. Both acknowledge the direct relevance of the E.M.P.H. program on their careers and certainly on their futures: the discreet twosome rocked their unsuspecting class last semester when they announced their wedding plans.

WHY A COLUMBIA EXECUTIVE M.P.H.? (We asked random representatives of the class of ’99.) “As a non-clinical person, I find that health care is changing rapidly. in order to keep up and to run my business, I felt that the E.M.P.H. was the necessary path to take. I looked at M.B.A. programs but they weren’t relevant to what I do, they were geared toward businesses other than health care.” Susan Lazar Director of Women’s Health Marketing, CIRCON Santa Barbara, California “Columbia had the best blend of the business of medicine and health policy topics. I explored M.B.A. programs, but they didn’t include enough about health; and other M.P.H. programs were light on management.” Joseph Merola, M.D. Chairman of OB/GYN for Health Network, St. Lukes Eastern Pennsylvania Region “I looked around for a number of years, considering what kind of graduate degree and where. When I saw the program description here, it just fit. It really touches on a lot of issues that I struggle with every day. for those of us who begin as clinicians, it really teaches us the tools we need everyday. and the schedule renders it doable for hectic lifestyles.” Carole Treston, R.N. HIV Program Director St. Christopher’s Hospital for Children, Philadelphia, PA “I’m in the Columbia Executive M.P.H. program for three reasons: The reputation of the program, the balance of management and health topics, and the schedule that allows me to work and go to school.” Albert Yee, M.D., Associate Medical Director, Harvard Pilgrim Health Care

Responses to a recent survey of EMPH alumni (Class of 1994, 1995 and 1996) highlight the program’s continuing success in recruiting a diverse group of students with proven records of achievement, meeting student expectations and preparing graduates to be more effective managers in the rapidly changing and complex policy environment of today’s health care system.

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CALLING EMPH ALUM! It may be rushing it to get a Year 2000 calendar—but it is not too soon to make plans for the 10th Anniversary of the Executive MPH program coming up in’00. VOLUNTEERS are needed to serve on the planning committee for an Alumni Conference to mark the event. Contact Dr. Sheila Gorman at (212) 305-3724 or e-mail sag2@columbia.edu with your name, year of graduation, home address, phone, fax, beeper and e-mail.