Career opportunities for doctors extend far beyond the patient care setting.
When choosing to become a physician, most people expect to spend their entire working lives caring for patients. Most physicians do just that – completing extensive and expensive schooling, securing and completing residencies and fellowships, and then working for decades at the bedside, fulfilling a desire to help people directly. In recent years, though, in part driven by declining satisfaction with the state of clinical practice in the U.S., many doctors are exploring career opportunities outside of patient care.
Embarking on such a career transition may have been difficult for most physicians to imagine a couple decades ago, but today’s health care realm has expanded to include many types of nonclinical work appealing to a broader group of doctors. Nonclinical careers for MDs and DOs range from work in drug development, consulting, laboratory-based research, and biotechnology investment to hospital leadership, medical technology, and informatics.
“Physicians are needed in some capacity for essentially any organization that directly or indirectly touches the health care system or the health of either individuals or populations – whether that organization is offering a service, a product, or regulatory oversight,” said Sylvie Stacy, MD, MPH, owner of the coaching firm Look For Zebras. Dr. Stacy’s agency helps physicians pivot to nonclinical careers with services like job boards, checklists for contract negotiations, and resumé templates.
The COVID-19 pandemic – and the corresponding stress and increased responsibilities placed on physicians, many of whom were already struggling with growing administrative burdens and declining practice autonomy – has many in the industry thinking about a shift away from clinical practice.
Heather Fork, MD, a master certified coach with The Doctor’s Crossing, a consulting firm that helps doctors explore and transition to nonclinical careers, told ASH Clinical News that the growth of her practice has been “exponential” this year.
“I have been coaching for 10 years and since the pandemic started, my requests have gone through the roof,” she said. “I have a waiting list I can’t keep up with from physicians who want and need help.”
In the first of a two-part series, to be continued in early 2021, ASH Clinical News asks why physicians are leaving clinical practice and examines the plethora of career options available to those who have earned a medical degree – whether it’s medical writing, informatics, a post in a government-run science lab, or a career in medical education.
The Great Migration?
The COVID-19 pandemic may have many physicians feeling increased pressure on the job, but is doctor attrition truly another epidemic?
“The data in this area are not great,” Dr. Stacy said. “The main reason is that physicians transitioning to nonclinical jobs end up going so many different routes in multiple industries.”
There is no single source of data to trace physicians’ career paths; however, previous research does provide some insight into trends within the profession.
Dr. Stacy noted that surveys to gauge physicians’ career plans at the time of medical school graduation or at different career points may provide an idea of where physicians are headed, but cautioned that these figures may not represent what physicians eventually choose to follow through with. For example, a recent survey by the locum tenens industry website Locumstory found that, of nearly 1,000 respondents across multiple practice types and specialties, 55% said they had at least considered quitting or leaving the medical field in recent years.1 However, this finding may have been biased by the survey population, and the proportion inflated by a nebulous definition of “considered leaving.”
Another 2018 survey of more than 8,000 physicians conducted by the Physicians Foundation and health care recruiting firm Merritt Hawkins reported that 12.4% of those interviewed were planning to look for a nonclinical job within the next 3 years.2 Nearly half of those interviewed, 46%, said they plan to change career paths, while 49% said they wouldn’t recommend medicine as a career for their children.
A Nonclinical Calling
The reasons why physicians decide to leave clinical practice are varied, but there are consistent themes among those who decide to make the move.
“I’d say the overarching one is that they feel they are not able to practice medicine and have the relationship with patients that they ideally want to have,” Dr. Fork said.
For example, in the Locumstory survey, 58% of doctors reported spending less time with their patients now than they did at the start of their career, and nearly two-thirds, or 65%, reported feeling more overworked now than when their careers began. Of those who admitted to thinking about quitting medicine, the most common reasons were spending too much time entering data into electronic health records (EHRs; 68%), feeling overworked (62%), and spending too much time on “paperwork” (59%).
Dr. Fork said centers and hospitals are increasingly micromanaging doctors: dictating how physicians practice, how many patients they need to see in a day, and setting unrealistic productivity goals that may be adding extra stress to the workplace.
“In a nutshell, [physicians] feel that they don’t have a voice, they don’t have autonomy, and the actual work they are getting to do is not satisfying because it feels like a patient mill,” she said about some of the doctors she consults with as a career transition coach. “Yet, they still have all the responsibilities and liabilities of caring for patients.”
It is easy to assume that clinicians who are leaving clinical work are doing so to escape burnout or a negative workplace, but Dr. Stacy said that many are running toward rather than away from something. Her coaching firm Look for Zebras was established “to bring fulfillment to the lives of medical professionals. [It] is not about abandoning medicine, dealing with burnout, or commiserating with frustrated clinicians.”
Physicians may be looking for nonclinical opportunities in order to make larger systemic changes in improving population health, she offered as an example, or simply may want to pursue a passion outside of patient care.
“Other doctors enjoying leading, managing, and strategizing, but don’t have the time to do that in their clinical jobs, or it’s simply not a part of their responsibilities,” she said.
Some of the doctors whom ASH Clinical News spoke with said their decision to leave clinical practice was mostly unplanned; rather, it was a matter of being in the right place at the right time when compelling nonclinical career paths presented themselves.
What to Do With an MD Outside of Medicine?
According to Dr. Stacy, many physicians do not realize that their medical education and clinical practice experience have already equipped them with the skills they need in a large variety of other professions.
“First and foremost, physicians have expertise in medicine and science, in a direct care capacity,” Dr. Stacy said. “Most other scientists have never directly treated patients and most other clinicians don’t have the deep-seated scientific knowledge that physicians have.”
Physicians have other “soft skills,” as well, including an ability to ask the right questions to get necessary information, to self-teach, to stay apprised of changes in a given field, and to react quickly in a situation. Doctors also are often well-versed in pleasing multiple stakeholders, giving directions, delegating tasks, managing their own time effectively, and taking responsibility for their actions.
Dr. Fork noted that almost any job description includes requirements for good communication, problem-solving, and teamwork skills. Physicians use these transferrable skills every day while interacting with patients and working with their own staff, she said.
There are dozens of nonclinical job options available to physicians, but most fall into three categories:
- Health care utilization management, which includes careers in health insurance, life insurance, disability insurance and benefit management
- Pharmaceutical and biotechnology industries, which include positions as medical science liaisons, medical monitors, and in drug safety or pharmacovigilance
- Medical writing and communications, which include opportunities as textbook authors, editing articles for peer-reviewed journals, and technical writing for health regulators
Outside of these categories, physicians also can pursue careers as medical-legal experts, educators, administrators of large health systems, nonclinical researchers, regulators, financial analysts, and entrepreneurs. These careers may be exclusive, with the physician no longer performing any patient care, or may represent a substantial proportion of the physician’s work effort while still allowing some clinical work.
Writing the Next Chapter
Elaine Schattner, MD, is an accomplished physician who worked as an oncologist and ran an NIH-funded cancer immunology lab. In 2006, she was forced to put clinical medicine behind her after a series of health concerns, which she recounted in the policy journal Health Affairs.3
Dr. Schattner found a way to use her extensive medical background in this new chapter of her life as a medical writer, publishing journalistic pieces in outlets including The Atlantic, The Washington Post, NPR Health, Forbes, and Pacific Standard.
Drawing from her own medical knowledge, she found that she was able to develop unique, carefully researched pieces. “I tend to write things that other people don’t write,” she told ASH Clinical News.
She is currently under contract with the Columbia University Press to finish a book on attitudes toward cancer that presents a narrative “that has never been told,” she said.
Dr. Schattner noted that it may be difficult for physicians to piece together enough freelance work to equate a full-time position, but said that medical writing also can be a side gig for those looking to exercise their writing skills.
“Some of the most successful medical journalists are practicing physicians who like to write as a hobby,” she said. “Doing it that way is, first of all, less stressful because if an article doesn’t get accepted for publication, it’s just one article – it’s not your entire career at stake. Second, I think a lot of editors want and value the perspective of a practicing physician.”
Julie Cantor, MD, JD, is a medical writer with, as she calls it, a “Renaissance soul.” Writing is just one facet of her diverse career that also includes teaching, doing project-based work as counsel to a law firm, owning her own business, and public speaking.
Dr. Cantor received a law degree from Berkeley Law before going on to earn her MD from the Yale School of Medicine. While in medical school, she taught two classes for undergraduates – one on literature in medicine and the other on reproductive rights – and discovered a passion for education.
Dr. Cantor was intrigued by clinical practice, but was somewhat turned off by what she perceived as a toxic culture of training, including long work hours and difficult working conditions for trainees, and decided not to pursue her clinical medical training any further after medical school graduation. Instead, she opted for a job with a law firm.
Over the years, her legal and medical background have allowed her to customize a career path that draws on her knowledge from both worlds. As a writer, Dr. Cantor often works for medical journals. “I love writing just to stay current and curious about the medical world,” she said. “I especially love writing for medical journals because I enjoy being a part of that community. If I can add anything to the mix, I am happy to be part of it.”
In addition to her work in the medical and legal fields, Dr. Cantor also recently became an entrepreneur, launching her own line of Italian-made work bags through her company, Harlen. After having frustrating experiences hauling materials for presentations and speaking events, she was inspired to create new options for working women.
Dr. Cantor’s eclectic career suits her lifestyle, but she admitted it may not be the perfect fit for everyone.
“I enjoy having the flexibility and freedom to pick and choose projects,” she said. “It comes down to what fits your personality and the life you want to lead.”
The flexibility entrepreneurial ventures offer also means surrendering some stability, she added. “If you are looking for a job that exists, then you go to the job and negotiate your pay. If you are taking a more entrepreneurial bent, you can go virtually anywhere but, at least for a while, you wouldn’t have any kind of income you could count on,” Dr. Cantor said.
The Craft of Medical Education
Furman McDonald, MD, MPH, found his dream job not once, but twice.
For years, Dr. McDonald was Director of the Internal Medicine Residency Program at Mayo Clinic in Rochester, Minnesota, a position that stoked his love for graduate medical education.
“When people talk about educating doctors, almost everybody thinks of medical school, but I believe that residency is the formative period where people learn to become doctors – the details and the craft of their specific discipline,” he said.
He found himself first drawn to graduate medical education while working as a chief Internal Medicine resident at Mayo Clinic from 2000 to 2001. “It was an exceptionally educational role,” he recalled. “We were involved in designing and delivering conferences and evidence-based instruction in classrooms and on the wards.”
With the help of a mentor, Henry Schulz, MD, who Dr. McDonald credits with inspiring his interest in graduate medical education, he became an associate program director at Mayo before assuming the role of program director.
He saw the program director post as his dream job, but when his wife was offered an exciting new job in Pennsylvania, Dr. McDonald embarked on a new role at the American Board of Internal Medicine (ABIM), headquartered in Philadelphia.
Now, as the Senior Vice President for Academic and Medical Affairs at ABIM, he oversees ABIM’s certification programs, provides leadership for the ABIM Council and Specialty Boards and continues to provide leadership in the area of graduate medical education.
“This turned out to be a second dream job,” he said, adding that the position affords him an insider’s look at physician certification.
Dr. McDonald has helped coordinate specialty-specific governance during his time at ABIM, which he called “dynamic, fun, and intellectually stimulating.” He added, “it feels good to be part of something that makes an impact.”
He also continues to practice in the clinical setting part time, as patient interaction remains an important aspect of his career.
Dr. McDonald recommends those considering a transition to nonclinical work find something they are naturally curious about, then use that curiosity to make a meaningful contribution to the field.
Since his teenage years, Jonathan Lovins, MD, MMCi, has been drawn to technology and computers. But he also felt an early pull toward medical school.
He decided to pursue medicine and worked for a time as a hospitalist director before taking a clinical position at Duke University Health System in North Carolina. But he continued to find himself drawn to the problem of medication reconciliation and towards EHRs.
Now, in his position as Associate Chief Medical Informatics Officer and hospitalist at Duke Regional Hospital, he has combined his two passions.
He spends about half his time seeing patients in a clinical setting, and the other half doing medical informatics, he explained. “Medical informatics is an extremely broad field,” Dr. Lovins said. “It basically entails the use of computers and information technology in the medical setting. I tend to focus on the ways that physicians use the electronic medical record.” He enjoys this field, he added, because “it requires a different skill set and I get to use different parts of my brain to create things that other people eventually use.”
Medical informatics is often best suited to those with solid computer skills who thrive working on long-term projects that may not wrap up at the end of a workday, he noted.
“You have to be a little bit flexible in thinking about solutions and you have to be able to work with different people,” he said. “A big part of what I do is liaise between clinicians and analysts,” he explained, adding that his goal is to find solutions to improve physicians’ experiences with EHRs.
While Dr. Lovins enjoys the medical informatics side of his job, he also still finds fulfillment in clinical practice. “If my job was just straight informatics, I probably wouldn’t sign up for it and I wouldn’t enjoy it,” he said.
Cynthia Dunbar, MD, would have never predicted she would end up primarily as a laboratory scientist, but she has happily been part of the NIH Intramural Research Program (IRP) for more than three decades.
She landed at the NIH almost by accident. While applying for fellowships in hematology and oncology, Dr. Dunbar said she “checked a confusing box” on an NIH application and found herself in a group interview for an extra residency year at the agency’s National Heart, Lung, and Blood Institute (NHLBI).
She wasn’t interested in the position, but during the interview she happened to cross paths with Arthur Nienhuis, MD, who was then Chief of the Clinical Hematology Branch at NHLBI. He convinced her to come work in his lab as a post-doc for a few years.
“I came to his lab at a time of excitement surrounding new tools for developing vectors for gene transfer and gene therapy,” Dr. Dunbar recounted. “From the very beginning, I was interested in therapeutic applications, but I also was interested in using the technology to study hematopoiesis.”
After a year of clinical hematology training at the University of California, San Francisco, she returned to the NIH to become part of IRP as a physician-scientist, educator, and administrator.
Her role at NIH allows her to practice in a clinical setting as well, but the amount of clinical work varies day to day. It can be as little as 5% of her time, as she takes her turn supervising an inpatient ward and fellows, or up to 40% during an active clinical trial protocol.
“I think some people went into medicine because they absolutely want to do direct patient care all the time and they derive a lot of pleasure from that,” she said. “Personally, I don’t think I would be happy if I never got to see patients.”
Dr. Dunbar believes that, in some ways, seeing patients only part time has had a protective effect on her medical career. “I tend to get very involved with my patients on a personal and emotional level, and I think I would burn out if I was seeing patients with serious disorders all the time,” she said, adding that she’s always been driven to try to understand how to improve patient care in her laboratory work.
Within the IRP, Dr. Dunbar runs a large laboratory-based translational program studying hematopoiesis and varying aspects of stem cells in the production of blood cells. Much of her work is focused on using a nonhuman primate model system.
To be successful as a physician-scientist, she said, candidates typically need to be resilient and tolerant of failure.
“One thing I’ve noticed is you do have to be open to the serendipity of it,” Dr. Dunbar told ASH Clinical News. “My career has been pretty unplanned, and I am very glad it turned out the way it has.” —By Jill Sederstrom
- Locumstory. Physician Workload and Communication Survey Shows Physicians are Overworked and Want More Time with Patients. Accessed November 3, 2020, from https://locumstory.com/physicianworkload/.
- The Physician’s Foundation. 2018 Survey of America’s Physicians. Accessed November 3, 2020, from https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf
- Schattner E. The personal toll of practicing medicine. Health Aff (Millwood). 2017;36(2):371-375.