Wednesday, April 11, 2007

For Students: Don't Collect Degrees

It is Wednesday, so it is time to respond to a student, "college kid", who asks below:

As someone who is in on the business/medical/policy of today's health care system, what do you think about the career prospects of those pursuing a joint JD/MPH? Is it worth it?

On the JD (Juris Doctor), the answer is simple. Don't go to law school unless you plan to become a lawyer. Here comes my gross generalization: Law school is not a place to expand your horizons and become better educated. It is a place to learn the trade of law. The curriculum is focused on giving you the tools and techniques and resources to be a lawyer. (And then you have to study for the bar exam, anyway.) The course of study is not designed to teach you public policy, health care policy, public management, corporate management, empathy, or most other things that would be helpful to you in a corporate or non-profit setting. If you are lucky, there will be some good courses on negotiation, arbitration, mediation, and dispute resolution -- but on that front you would be better off just enrolling in a really good negotiation course somewhere.

Some people think it is handy to go to law school if you plan to run for legislative office, either state or federal. But if you are ambitious in that direction, spend the three years you would otherwise pay tuition working for a legislator or Congressman. Get the hands-on experience. Once you are elected, you can always hire a good lawyer to work on your staff.

On the MPH (Masters in Public Health), I am sorry to say this because I don't believe it ought to be the case, but the degree is sometimes not valued in hospital settings. I have tried to figure this out. I think it is because hospitals are dominated by doctors, who often view an MPH as a poor substitute for a medical degree and think people who get one were not smart enough to get into medical school. Also, people in hospitals do not view themselves as being in the public health business: They are in the acute care business.

Please don't blame me for being the messenger on this point. I personally do not agree with either characterization. In fact, I find that many MPH graduates have a breadth of interest and experience that is really attractive. If you want to get an MPH as a precursor to working in a hospital, use every possible opportunity to do internships in hospitals where you actually have responsibility for planning and completing specific projects, and use term paper assignments to write about hospital management issues. Then, send me your resume.

A final point. Life in college is really good. Ditto for life in graduate school. These are seductive and comfortable environments, and it is easy to persuade yourself that time is better spent there than being on the outside with a job. After all, too, your role models are professors who have chosen to live their entire lives in academia. So, some people have a tendency to collect degrees, moving directly from one program to the next.

Graduate school is usually a good idea, but many people find it more valuable after they have spent some time working. That serves to focus your interests, which will help you get more out of an advanced degree. So, get out and see the world and experience some of its discomfort and uncertainty. See what it is like to have to earn enough money to pay for food, rent, utilities, school loans, and insurance. You will meet a wider variety of wonderful, interesting, practical, and thoughtful people, including generous, intelligent, kind, and well-meaning folks with no degrees at all, and you will learn from them in a tuition-free setting.

[2014 add-on: And when it comes time to negotiate that new job offer, check out our new book on salary negotiation and more: How to Negotiate Your First Job!]


Anonymous said...

Thanks for your frank perspective on both degrees.

I can't help but respond on the MPH front. Let me preface my response with the fact that I have one. And I spent the first few years out of grad school working for a large powerful Hospital/Provider system.

I find truth in your comments on how this degree is regarded in comparison to a medical degree. However, I want to add that I really don't see an MPH as any kind of replacement for a medical degree. I have an undergraduate degree in English and I never planned (nor do I plan) on pursuing a medical degree.

Public Health is a vast and expanding field. I pursued the degree because I had worked in a hospital setting as well as in pharma (on the business end.) I wanted to change what I perceived to be a very complicated system that due to its own intricacies seemed to lose sight of the fact that the delivery of Healthcare is really about caring for people.

I realize that "fixing the system" is a tall order - but I also believe that the pursuit of a degree in public health is meant to facilitate this very ambition.

Anonymous said...

Years ago, I asked that question of many people, but the answer was different than Dr. Levy's answer- Don't get a MBA unless you want to work in finance; Don't get a MPA or MPH unless you want to work for the government; Do get a JD if you want to do both.

It is true that law school focuses on how to be a lawyer, but to meet the demands of the modern business world, law school also prepares future lawyers for careers in the private sector, and public sector, with concentrations in health policy, biotechnology, and public policy to name a few.

Being a lawyer today means you are the jack of all trades in all sectors. In a heavily regulated society, lawyers are valuable tools that are needed in the marketplace -whether a hospital, a government agency or a private sector corporation.

To use Dr. Levy's example - with high demand for the few spots in Congress, or the Massachusetts State House, you get your foot in the door by being a lawyer. You need to know the law to help make it and elected officials value that guidance. Then you get the door to stay open because of the respect for the degree. It is a doctorate and doctorate degrees still trump masters degrees.

However, the most valuable thing that you bring to your employer is the experiences you have and what you do with them. A degree is still just a part of the bag of tricks. Most employers don't value the list of letters after a name if there is no life experience to back it up.

I graduated from law school 7 years ago, and I appreciate the doors it has opened in my career in health policy. My law degree has surpassed other candidates with MBAs, MPAs, MPHs and even one with a MD/MPH. However, I went to school at night in order to concurrently build those life experiences, and I was responsible and professional in every opportunity I achieved.

So as you think about your future, think more than just letters. And more about how to get them, what should supplement them and what it is you want to do with your career - then let those decisions guide you. Best of luck and if you do decide to go the JD route, the Bar exam is not too bad.

Anonymous said...

Another perspective....

I, too, think that one should not got to law school unless one wants to practice law. After acquiring considerable education, I went to law school, only to find out after I graduates that I did not want to practice. Instead, I embarked on a health care consulting career. I found that legal education, especially the analytical training, was invaluable in figuring out solutions to myriad problems.

As far as an M.P.H. degree, there are two many out there who have them; many of them are underemployed or not employed at all.

Anonymous said...

"The course of study is not designed to teach you public policy, health care policy, public management, corporate management, empathy, or most other things that would be helpful to you in a corporate or non-profit setting."

I think this entirely depends on if the law school one attends has a health law program and how good it is. I recently had a law professor cancel a "Bioethics and the Law" class because she took a trip to Harvard to discuss the determination of death standard. The law school I attend also has classes in health care transactions and health care finance among others.

Anonymous said...

what about md/phd?

Adrienne said...

I just have to say that the real reason behind the comment that an MPH is a replacement degree for those who are not smart enough to get into medical school is money. Those who pursue an MPH are interested in the good of the population and not the bottom line. Most hospitals tout in their missions that their goal is to 'better the health of the population they serve'. What they often mean is that they want to 'better the health of the population they serve as long as it doesn't cost the hospital their profits'. Those of us who go into an MPH program truly want to help better the health of the population and believe that a hospital is in a unique and powerful position to do just that. Unfortunately, bettering the health of the population costs money up front and the hospitals aren't willing to take the risk that they will see the reward on the back end. Or, they are afraid that bettering the health of the population they serve will affect their bottom line in the long run because a healthier population means less visits to the hospital. I wanted to go into health care administration in the inception of my MPH. Now that I realize that most hospitals come from a place of greed and not altruistic caring I've changed my mind. JD/MPH here I come to help change make changes to policy that hopefully force the hospitals to think differently.

Anonymous said...

No one really mentioned an MPA. Currently I have a few years of experience after college and I work at the dtate house. I am debating between an MPA or law school. It seems like MPA arnt well respected but it also many times seems the most relevant to alot of jobs. An MPA is a policy degree.

Anonymous said...

There is some great advice here from the blogger.

However, it should be noted if you want to work in a hospital in management, you should pursue an MHA, not a JD, MBA, MPA or MPH.

Also, anyone who has an MPH knows that aren't a doctor! They are interested in population health issues.

Outside of a JD it may be best to get experience before studying for one of the "M" degrees. There is nothing worse than studying for a professional masters degree and not using the degree. I myself earned social science BA and MA degrees - and have now found myself working in the public health field in government for 5+ yrs. I'm thinking about studying towards an MPH part-time while working - and my MPH would definately be favored in my line of work over JDs or MBAs.

To the anyonmous responder thinking of an MPA - if you work in government, it is a respected degree.

Anonymous said...

I disagree with the notion that only a MHA is preferred for hospital management. MPHs with tracks in health policy and management provide tools for students to become excellent health care executives, in fact the MPH in management and the MHA are essentially identical degrees. Many of the same courses are taken and topics overlap. Typically, the MHAs separate themselves with their internships where MPHs intern in a broader scope of agencies/industry.

I on the other hand am pursuing a JD/MPH and hope to work in bigpharma, consulting, or actuarial industry. I want to work in the private industry I firmly think that my unique background and degrees will open many doors.

Anonymous said...

This in in response to the March 3 post...If you know you want to work in management or policy related to primary care, the MHA is the degree to pursue. On the other hand, if you want to work on population health issues the MPH the degree to obtain. That being said MHAs do work in pop health and MPHs work in primary health care settings.

For those who want the best of both worlds study at a school that allows you to study towards an MHA plus a graduate certificate in core public health concepts.

Anonymous said...

Health care industry turns to MBA's to run it like a business but everything fails because clinicians and MD's are not customer/patient focused. Worst is that they are not big on linking operations processes within cross functional departments.

Too many egos flying on the corridors of the building, especially the doctors.

Anonymous said...

"I agree about linking operations process with cross functional departments". Healthcare sites; hospitals, ambulatory surgery centers etc. are clueless to process and procedures and corrective action methods. they are against anything that is documenting order to prevent lawsuits.

Keep in mind there are more corporations, business than hospitals or clinics. Therefore, I will get the MBA to increase my chances of being employed on a luggish economy.

Also doctors need to be more humble. Once they learn the art of being humble they might find it easier to be patient/customer focused.

Ram said...

I disagree with the comparison of the MHA degree (specific skill set) versus the MPH (a variety of skill sets under one degree name). A MHA holder will definitely be better at running a hospital than someone with a MPH in biostatistics, or community Health, or environmental Health, etc. This is because a MPH has several areas of study. The Health Policy & Management (HP&M) area (with a management track) is equivalent to a MHA degree. In fact many old MPH HP&M programs changed their name to MHA in order to be more "popular" and less confusing. A good way to find programs is to search that are accredited by CAHME. There you will find programs with a variety of letters MHA, MBA, MPH, MPA, MHSA, MSHA, MS, etc, etc.

Anonymous said...

I just found this blog and I felt that I needed to say "Thank you". I was debating about going for my JD/MPH or MD but thanks to all of you I have made my decision. JD/MPH here I come!

Anonymous said...

I am completing a MPH presently to compliment a MED and HR coursework and experience. I am also working on the PHD in PH. As one person said experience goes along way in making degrees work for you. Having connections in places will also give you what you need to, no matter the degree. In other words, you must work what you have to its fullest potential.Sometimes having certificates in areas will add to job choices. Try certificates with your alphabet soup. It can add to the flavor of things!

Anonymous said...

I found this blog by searching for university degree options to persue after graduating with a BSHA in 2014. I have finally decided to headed for admissions to a JD/MHA program. Thanks a million for assisting in making a decisive decision.

May 20th, 2014 1:32PM

Anonymous said...

Paul Levy, I stumbled upon your blog. You are part of the older generation, business profesionals who have fallen out of touch with current directions in health care. With Obama and health reform, the entire US is going towards population health. Hospitals NEED people skilled in population management. No wonder you are no longer with the hospital systems.

Paul Levy said...

Dear Anonymous,

First of all, I wrote this post in 2007, three years before the federal legislation passed. So, on that ground alone, it is a bit unfair to criticize the views presented.

Second, my comments about the way people in hospitals view people with MPH degrees still is often the case. I know this from talking with people around the country. As I note in this post, that's a shame, but such prejudices still exist.

Third, the degree to which the "entire US is going towards population health" remains in question. I'd like to think it is, but I don't see a lot of evidence as yet for that.

Now, let's turn to the personal approach you used in your comment. You state that I am out of touch with current directions in health care, but you have never talked to me about that topic. You end by making an assertion as to why I am no longer in a hospital system.

If you believe that this kind of commentary is a way to be persuasive with people, I fear that you will not do very well in the world of hospitals OR population health. A bit of respect for people--even when you disagree with their opinions--is something of great value for people who want to make changes in the health care environment. My career advice to you would be to learn the phrase "disagree without being disagreeable." And then practice doing it.

Finally, if you have something nasty to say about someone, at least have the guts to publish your name beside your comment and not stand behind a veil of anonymity.

Anonymous said...

Hello Mr. Levy

I must say your response to the previous post was something.

But he or she did raise a point about the direction of Obamacare and how it affects MPH Programs and other programs that focus on "Population Health".

You did state:
"Third, the degree to which the "entire US is going towards population health" remains in question. I'd like to think it is, but I don't see a lot of evidence as yet for that."

But I would like to elaborate on that comment, and also provide information on what you might expect from Obamacare and MPH in the next 10 years or so. Just because I’ am in pursuit of an MPH degree and want to know what my outcomes might be since healthcare is rapidly changing.

Thank You.
(Hopefully I made some sense in my post)

Paul Levy said...

I guess I am not sure if health care is rapidly changing in the US. It would be great if there were of a focus on population health, such as exists in Sweden and elsewhere, but the political and cultural environmnt is very different. The "rugged individualism" that infuses American life tends to work against programmatic possibilities in the public health realm. I don't know if that will change.

I really admire the people I know who have gotten MPH degrees. They often have a broad and systemic view of the world that is quite useful. There will always be a place for you: I just don't know how much will be valued in the US versus elsewhere in the world.

Do you like to travel . . . ?

Anonymous said...

Thank you for responding so quickly.

In all honesty I do enjoy traveling, but I would not really consider a career that involves traveling as a requirement.

Anonymous said...

Interesting article as I'm considering the JD/MPH although already hold a BSc and MSc in molecular medicine from the UK.

I think with the progressive advance in the US of the affordable care act (which will be a success), the MPH would be very useful on top of a J.D., especially if you want to work in public health, or with the government. I think big pharma would also see this as a plus, although this is purely a guess.

Anonymous said...

I am sorry. but doctors don't "dominate" hospiials anymore. Indeed in most large academic institutions we are nothing but cogs in the wheel to serve at the whim of administration which is completely out of touch with our and our patients needs. I'm saying this as an academic doc who is about to leave academia due to my disgust with the present army of MBA's/MHA's andthe rest of the clipboard brigade who run the institution and have complete disconnect with the docs and nurses. Food for thought, patients don't go to hospital to see the adminstrator, they go for medical care. I have little hope the private practice is much better, but at least their will be no illusions as to why I am there and certainly no verbal bullshit as to "supporting" research and education all the while tightening the screws of seeing more patients and increasing the RVU's. I have rarely met an MHA/MBA in the hosptial setting who is little more than a clueless parasite sucking of the hospital teat.

Diane said...

BSN RN, Tulsa, OK
Stumbling upon this blog was wonderful. I enjoyed the comments, both positive and negative. I have been a nurse for 21 years and have worked in various settings. I am seriously considering pursuing the JD/MPH degrees. I have no desire to be a doctor. I have always found law to be intriguing and I enjoy rendering care to the sick and dying. I feel that the JD/MPH would be a great marriage to fulfill my passion.I see a disconnect between those who need health care and the lack of appropriate resources available to help them. In many cases resources are available but the patient and/or their loved ones do not know how to access it. I would appreciate your comment!