As a career changer — a practicing emergency room and inpatient doctor and former government official seeking to transform into a business leader — I pursued a mid-career Sloan Fellows MBA. I chose MIT Sloan for its heavily data-driven, analytic, and STEM-focused culture and storied entrepreneurship ecosystem. The Sloan Fellows specifically are known to launch new companies with a higher success rate than average. I knew that it was a close-knit and robust alumni network that was much more supportive than other schools. I began to experience that community via LinkedIn before I even started, including being asked to advise or maybe even join as a co-founder with a program alumnus.
I applied pre-pandemic, another one of the more than 40% of physicians burnt out and fed up with system flaws, wanting to come at the problems in healthcare from the business angle now. I was looking to disrupt my own life or to create disruptive innovation. I never expected for that to coincide with the world itself being so disrupted by a pandemic, shut down, and transition from in-person to online learning. Many people advised me to defer. In fact, about half from my original cohort did decide to defer.
When the world is disrupted, where should one place oneself? As a public health expert, I knew that — despite the optimism from the program office — autumn or even spring could be online, which would inherently reduce the experience of the MBA. Elite business schools curate invite-only private events that lead to strategic relationships critical to future career success. While I already have a LinkedIn following of over 200,000, the purpose of doing an additional degree should be to expand into new networks.
To choose to do an MBA this year is to accept all the risks and losses inherent to multiple levels of disruption. Personally, as a woman who has many traits of ADHD, I rely heavily on systems for my best functioning. If you have ever been on a Slack channel with me, you know that I obsessively organize into threads, pin posts, and sync apps. But this year the very system I was in was chaotic; every school attempting a hybrid model seems to self-disrupt every few days following the newest public health data and policy guidance.
To be honest, I was repeatedly frustrated at all the uncertainty and sense of chaos compared to the usual elite executive education experience I knew was the norm from attending other executive education programs pre-pandemic. Having experienced the physician gender pay gap that is well documented, it was painful for me to accept that usual parts of the Sloan Fellows program — like access to in-person networking for budding entrepreneurs at the famed Martin Trust Center — simply were not available despite paying the same tuition. It feels selfish and entitled to state this, especially when universities are themselves suffering financially — though, arguably, not using my skills as a physician in a pandemic, to pursue self-improvement this year, was already being “selfish.”
OPPORTUNITIES & OPPORTUNITY COSTS
I reasoned that if I were working within healthcare I’d be dealing with the same system disruption. Daily I would be living the failure of many public safety and public health systems — failures that have resulted in more than 200,000 deaths and counting — while trying to save lives. When I accepted admission to the MIT Sloan Fellows program this year, I had turned down a chief medical officer job overseeing 10 centers in New York City. I know there is an inherent moral injury that comes with overseeing care when supply chain disruptions beyond my control would prevent me from providing adequate safety for my staff. Just recently the health commissioner in NYC resigned, which validated my concerns about serving within the NYC public health system this year.
Grad school could offer the opportunity to work with faculty who consult with hospitals, I reasoned, and I could be the thought partner outside the chaos to work on effective solutions. By enrolling in “Hacking the Fall of Covid” class I am doing exactly that, where I have been able to connect my medical director colleagues in small community health centers to top faculty at MIT for access to affordable testing options. Similarly, I recruited peers from the EMBA and two-year MBA program to create a diverse leadership team to design and run the next of the Covid-19 Challenge series, now focused on the “Future of Work and Systems.” I placed myself where I felt like I could be effective at solving problems at a system level.
RE-LEARNING HOW TO LEARN AMID PANDEMIC STRESSES
What concerned me most was my ability to learn online, as none of my usual study hacks applied to online learning. Going back to school after being in the C-suite is hard enough, having to wrestle with Excel Solver on analysis I will never have to do myself in real life. Additionally, I had to re-learn how to learn within a system that was itself learning how to teach via Zoom. Being part of a global program meant students were across all the globe’s time zones. Knowing how non-stop screen time affects the brain, how hard I find it to manage my concentration for online classes, and my tendency to suffer migraines, I considered deferral or leave of absence. Instead I muddled through. To study for my summer statistics final, I watched all the lectures on 2x speed while doing jumping jacks in an attempt to concentrate. In medical school and my MPH, I did all my studying in groups in the library, which is just not an option now.
When I was feeling consumed with guilt and sadness over not serving as a physician as deaths — including those of my peers — mounted, I simply could not get myself to concentrate. I can tell you, the stellar GPA I had in my MPH at the Harvard School of Public Health is not what I am achieving now. I’ve always been the one to rush into danger to help others, not to seek safety myself. On the day of the Boston Marathon Bombing, I was walking into the hospital to work in the Emergency Department as others were seeking shelter. This quality of rushing forward without thought to myself, though, has repeatedly put me in danger of imbalance, even burnout. The relentless physician leader personality, when confronted with feeling helpless against the onslaught of Covid-19 deaths, resulted in overwhelm and mental health tragedies at the frontlines.
Feeling distraught and wondering about my purpose, I strongly considered dropping out to go back into the workforce. I consulted with mentors, a few trusted classmates, and a therapist. Instead I reframed. I would utilize my year not as just “an MBA” but to build out what is needed for the “Future of Work” at a business school associated with labs at the cutting edge of analytics and artificial intelligence. I could apply my clinical experience to building out needed solutions while staying committed to mission on equity.
EXECUTIVE COACHING & STAYING REMOTE
As executive coaching is a $15 billion business, access to it is an important component of an executive leadership program. While women and minorities face many barriers and need coaching to help navigate above, around, and through them, executive coaching remains a non-diverse field. Additionally, coaches may be from acting or sports backgrounds, dabbling in psychology without formal certification in mental health. However, when one delves into issues of sexual assault, harassment, and discrimination, then these must be approached with trauma-informed approaches, awareness of unusually high pandemic-induced stresses, even Zoom-related fatigue and dehumanization.
Unfortunately, those in coaching are often out of touch with the realities of minorities, particularly the experiences of minority women. There are few coaches of color, contributing to documented differences for minorities. As Ruth Bader Ginsburg said regarding male justices assessing the case of a teen girl who had been strip-searched, “They have never been a 13-year-old girl. …It’s a very sensitive age for a girl. I didn’t think that my colleagues, some of them, quite understood.”
That landmark case of administration-student interfaces is newly relevant given risks of Covid-19 for the entire community. Per the CDC, the lowest risk is online only. To manage an ambitious higher-risk model of in-person indoor interactions, strict group adherence is required. From my own years in academia and education, I know it is not uncommon for school administrators, when laser focused on safety, to overstep boundaries of psychological safety for students. As a pediatrician, my professional role has been to remain alert to peer or administrator bullying within school settings. Add to that my starting at Sloan at the same time #BlackintheIvory was in the news amid widespread social justice race protests. All this added layers upon layers of stress and hypervigilance that distracts from learning.
Based on a cumulative assessment of physical, psychological, and social risks, compared to what I assessed to be better for my own learning and well-being, I stayed away from campus.
In Fall semester, more acclimated to virtual learning, I have found spaces to explore the interface of my personal identity, professional identity, social justice, and social enterprise through a range of courses at MIT Sloan, Harvard Kennedy School, and Harvard Business School. In fact, this ability to cross-register and “attend” classes without any travel time between campuses is the unique opportunity of this virtual year. It is one reason I have chosen to commit to online only and avoid the convoluted, changing daily operations of the hybrid model — I have one set up in my own apartment from which to jump between classrooms and campuses.
With lower enrollments this year, it is possible to get into almost any class in the Harvard ecosystem. I also enjoy the exposure to diversity of backgrounds, thoughts, and industries. I find more people from the education, social service, and political activism spaces at HKS. I get the more data-oriented approach at MIT Sloan and an opportunity to dive deep on business applications of artificial intelligence and machine learning. HBS offers the case method teaching.
Away from work accountability or deliverables defined by others, one of the opportunities this year affords me is the freedom and space to experiment. I have been coached by faculty that it is OK to fail as part of the processes of exploring and innovating. As compared to the risk, liability, and permanent legal record when I am a physician or public official, now I can play around with ideas, hunches, and proposals outside of rigid institutional processes.
I love being creative to try to solve points that I’ve experienced repeatedly in my career. That has been liberating and fueled rapid and measurable growth. Within months of my starting the Sloan Fellows program, I had submitted two Sandbox Innovation Fund submissions, launched hackathon planning, and gotten buy-in on a new podcast. What has been hard is making sustained progress on things that need disciplined and deep attention, like the academic manuscripts for peer-reviewed publication.
Whether to do a mid-career program, when to do it, and why to do it are all deeply personal considerations. I do anticipate many more physicians will seek career changes and apply for MBAs in the future, especially women. Given that a Covid-19 vaccine is unlikely to be available until late 2021, many schools are may remain hybrid or online next year as well. It’s important to think about your opportunity cost, the timing of this degree, the parts of the experience that you can still access, and what unique opportunities exist now. Even in a normal year there is an inability to avail every opportunity.
Personally, writing off certain parts of the usual experience reduced my FOMO. By identifying what really matters versus “everything else,” it is possible — as described in Bill Aulet’s Antifragile series — to find greater focus and effectiveness amid chaos and disruption.
Umbereen S. Nehal, MD, MPH is recognized thought leader on healthcare system redesign and value-based care. She is founder and president of Nehal Group LLC. Dr. Nehal has been named “LinkedIn Top Voice: Healthcare” as well as a “Top Female Voice” on International Women’s Day. As chief medical officer and vice president of medical affairs for Community Healthcare Network, Dr. Nehal led a $100 million, 14-site multi-specialty agency serving 85,000 New Yorkers through behavioral health integration, school-based clinics, and telehealth. Dr. Nehal served as associate medical director of MassHealth — a Medicaid program serving 1.6 million members and accounting for 40% of the state budget — providing leadership on program development and evaluation, cost-effectiveness evaluation, population health initiatives, and guideline development. Dr. Nehal served as clinical lead for the five-year restructuring of MassHealth to create new Accountable Care Organization models, a successful bid for $1.8 billion in new investment from Centers for Medicare and Medicaid Services, including new funding for social determinants of health. Co-chair of the Patient-Centered Outcomes Research Institute’s Advisory Panel on Healthcare Delivery and Disparities Research, she informed national funding priorities for a portfolio of over $300 million that includes community-based clinical effectiveness evaluations. A frequent invited stakeholder to the White House, CMS, HHS, and NIH, Dr. Nehal’s national leadership on community engagement won recognition from President Barack Obama.
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