Business school was far from Jim Jirjis' mind when he began his internship in primary care at Vanderbilt University Medical Center back in 1993. He took on a fellowship and taught, completed specialty training in infectious disease, and had practiced there for several years when he was offered their director's position in adult primary care.

"Suddenly I was forced to look at things like accounting and efficiency, and that's when I came to the realization that I had a lot to learn about the process of what we do here," says Jirjis, who is now halfway through an Executive MBA program at Vanderbilt's Owen Graduate School of Management. "Physicians in academic medical centers like this one are excellent teachers or researchers, but that doesn't necessarily translate into good management or an understanding of how money works or how to manage even non-profit institutions."

While physicians at for-profit hospitals and private practices have been heading to business schools in great numbers over recent years, M.D.'s at academic medical centers have been slower to react to the trend, experts say. According to the American College of Physician Executives (ACPE), some 2,040 of their 10,000 physician members have already received MBAs or other advanced management degrees like MMM, MPH or MHA. Of those 2,040, however, only 117 work in an academic setting.

"The trend hasn't really caught on for academic physicians, even though it should," says Frederick Sherman, M.D., M.B.A., a professor of Pediatrics, Obstetrics, and Gynecology at the University of Pittsburgh School of Medicine who has written about the shortage of management training among academic physicians. "I think we tend to look down on the business types; I know I used to," confesses Sherman, who received his MBA from the University of Pittsburgh's Katz Graduate School of Business in 2002.

Sherman, now the director of perinatal cardiology at the University of Pittsburgh's Magee Women's Hospital, says he was spurred to get an MBA by feeling fed up with non-physician administrators who had little understanding of what doctors do and were prone to making unrealistic demands as a result. "What I found out in business school is that yes, administrators can be a little clueless about medical issues, but it's really the doctors in academic medicine who are completely in the dark about even very simple management issues," says Sherman.

Vanderbilt, for it's part, is joining the ranks this fall [2005] of universities that are creating special health care MBA programs. James Bradford, the new Dean of Vanderbilt's Owen Graduate School of Management who has spearheaded the new program, says it will draw on cross-university strengths with the Medical School to create a cutting-edge program. "[Health care] is a natural for Owen, given our location," Bradford says. "For a business school to be in Nashville and not create a focus on health care is like sitting in Silicon Valley and deciding you don't want to be in technology."

Since academic hospitals and research centers are largely funded by public and private foundations and companies, Bradford says, the same rules apply to them as apply to for-profit hospitals and private practices if they want to continue to be funded. "I think the boundaries between academic physicians and medical executives will change dramatically over the next several years," says Bradford. "They're realizing that they are subject to the same standards of efficiency and productivity that we find in the for-profit world."

The number of U.S. medical schools offering joint M.D. /MBA programs has soared 61 percent, from 28 in 1997 to 45 today, according to the American Association of Medical Colleges. Clearly, in today's world of HMOs and slashes in government healthcare payouts, more and more doctors have accepted that knowing the exact anatomy of the human body may not insure their success: they may need to know the complex anatomy of the system under which health care is provided in this country as well.

Jim Jirjis, for one, is sold on the idea of mixing business, research, and patient care at academic medical centers. Standard business principles, Jirjis says, can be applied to medicine and not only save money but save people's lives. In fact, he's already proven it.

Jirjis, who is also chair of Vanderbilt's Medical Records Committee, recently finished an experiment in which doctors were offered a financial incentive to improve their treatment of diabetes patients. Nationally, Jirjis says, only about 45 percent of diabetes patients get the two blood tests per year they should have. At Vanderbilt, the figure was slightly better at 55 percent, but still far below where it should be. "We applied a standard business model, used modern medical records technology, and partnered with Blue Cross/Blue Shield to help us contact all of our diabetes patient," Jirjis. At one year, 90 percent of Vanderbilt's diabetes patients were up to date on their blood tests.

"Standard business practices can improve quality of care. We showed it in spades," Jirjis says. "In the past, physicians have held business ideas at arm's length, but we just can't afford to do that anymore."