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Making a Doctor Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Making a Doctor case study


At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Making a Doctor case study is a Harvard Business School (HBR) case study written by Steven J. Spear. The Making a Doctor (referred as “Doctor Tps” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, Career planning, Health.

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment






Case Description of Making a Doctor Case Study


Three doctors were interviewed to learn how they were trained to be a physicians. One was a family practice senior resident, one was a critical care pediatric chief resident, and one was an orthopedic staff surgeon 18 months out of residency. All three were interviewed one-on-one in an unstructured fashion and were asked the same questions: "What type of doctor are you, and how did you become that type of doctor?" The subjects, in recounting their experiences, established the content, sequence, chronology, and emphasis of their responses. When the subjects were done telling their stories, the interviewer posed follow-up questions, such as "What did you mean by 'X' that you mentioned?" or "Would you give me an example of 'Y' that you described?" All interviews ended with the same questions: "Are you a good doctor?" "What made you so?" All three interview sessions lasted approximately 90 minutes. The interviews are not a judgment on medical education or the practice of medicine, but a basis for an exercise in applying the Toyota Production System (TPS) Rules-in-Use framework to a process for which TPS has not been applied previously.


Case Authors : Steven J. Spear

Topic : Technology & Operations

Related Areas : Career planning, Health




Calculating Net Present Value (NPV) at 6% for Making a Doctor Case Study


Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 6 %
Discounted
Cash Flows
Year 0 (10016315) -10016315 - -
Year 1 3452855 -6563460 3452855 0.9434 3257410
Year 2 3961985 -2601475 7414840 0.89 3526153
Year 3 3950694 1349219 11365534 0.8396 3317079
Year 4 3234506 4583725 14600040 0.7921 2562032
TOTAL 14600040 12662673




The Net Present Value at 6% discount rate is 2646358

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting


What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.




Capital Budgeting Approaches

Methods of Capital Budgeting


There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Net Present Value
2. Payback Period
3. Internal Rate of Return
4. Profitability Index

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Doctor Tps shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.
2. Timing of the expected cash flows – stockholders of Doctor Tps have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.






Formula and Steps to Calculate Net Present Value (NPV) of Making a Doctor

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Technology & Operations Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Doctor Tps often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Doctor Tps needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.



Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 15 %
Discounted
Cash Flows
Year 0 (10016315) -10016315 - -
Year 1 3452855 -6563460 3452855 0.8696 3002483
Year 2 3961985 -2601475 7414840 0.7561 2995830
Year 3 3950694 1349219 11365534 0.6575 2597645
Year 4 3234506 4583725 14600040 0.5718 1849339
TOTAL 10445297


The Net NPV after 4 years is 428982

(10445297 - 10016315 )








Calculating Net Present Value (NPV) at 20%


If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years              Cash Flow     Net Cash Flow     Cumulative    
Cash Flow
Discount Rate
@ 20 %
Discounted
Cash Flows
Year 0 (10016315) -10016315 - -
Year 1 3452855 -6563460 3452855 0.8333 2877379
Year 2 3961985 -2601475 7414840 0.6944 2751378
Year 3 3950694 1349219 11365534 0.5787 2286281
Year 4 3234506 4583725 14600040 0.4823 1559851
TOTAL 9474889


The Net NPV after 4 years is -541426

At 20% discount rate the NPV is negative (9474889 - 10016315 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Doctor Tps to discount cash flow at lower discount rates such as 15%.





Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Doctor Tps has a NPV value higher than Zero then finance managers at Doctor Tps can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Doctor Tps, then the stock price of the Doctor Tps should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Doctor Tps should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What will be a multi year spillover effect of various taxation regulations.

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

Understanding of risks involved in the project.

What can impact the cash flow of the project.

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.






Negotiation Strategy of Making a Doctor

References & Further Readings

Steven J. Spear (2018), "Making a Doctor Harvard Business Review Case Study. Published by HBR Publications.


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