The day after we buried my mother, I turned 7 and my father insisted that I blow out a birthday candle, because he understood that someone had to define the new normal.
I have been defining new normals ever since: in 2001 as the first African American woman OB-GYN at the North Florida Women’s Care in Tallahassee. In 2016, I assumed the role of the chief medical officer at Tallahassee Memorial HealthCare; during which I led the hospital through a string of literal hurricanes, a global pandemic, a cybersecurity incident and multiple electronic medical record transitions. And now, a quarter-century into my career, I am starting my MBA.
Because, these days, physicians practice within a business model, whether we are trained for it or not. And being business savvy is no longer a hobby for a select few, but a core competency for all. However, this new business model within healthcare comes with the risk of challenging the ethics of physicians as individuals and medicine as a profession.
When I first joined North Florida Women’s Care, my job was to be a master of my craft – deliver babies, perform surgeries, and earn trust, one patient at a time. No one ever handed me an accounting textbook. Physicians practiced medicine, and administrators ran the business, and that’s how the show was run.
That line has since dissolved, yet unfortunately, our training hasn’t caught up. 89 percent of physicians in this survey agreed that “business principles are very important to being a doctor,” yet only 36% to 41% reported receiving any training. In another survey, I learned that 81% of physician-MBAs called the degree very useful or essential, and it deeply resonated with me. After all, I became CMO 15 years into my practice purely on instinct and with the trust of my peers. However, I was missing several pieces of the overall puzzle – in this case, the financial and strategic pieces.
When physicians lack this fluency, we don’t just leave money on the table. We cede decisions about staffing, service lines, and working conditions to those who are more business savvy. What adds more salt to the wound is the fact that women physicians face an adjusted pay gap of roughly $20,000 per year and trail men in 10-year earning potential in 43 of 45 subspecialties. I would not be honest if I didn’t say I have recognized implicit gender bias and racial disparities throughout my own career. Fluent business acumen is a tool for every physician, and a necessity for those the system was not built around.
However, it is not the whole answer. MBAs alone do not resolve systemic disadvantages. I don’t want the young physicians I mentor to hear, “Get an MBA,” as “This is yours to fix alone.”
Therefore, medical education should be reformed on two tracks at once:
First, build business and financial literacy into every residency as core competency courses alongside clinical judgment, not just as an elective. Contract review, compensation models, and payer basics belong in training, before a physician signs a first contract that sets the trajectory for decades.
Second, hold our institutions accountable. Practices, institutions and health systems should publish pay bands, formalize sponsorship and make promotion criteria transparent to every applicant.
My father taught me that you build the new normal with intention. For physicians – that means shifting our mindset and learning the language the room is already speaking and insisting that the room stops making us learn it alone.
Dr. Friall is a board-certified OB-GYN and chief medical officer of Tallahassee Memorial Healthcare. She is currently pursuing her MBA.
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