The Doctor Is Out

For doctors considering a career outside of patient care, experts offer advice for avoiding common pitfalls in the second of a two-part series

With the mounting stress of the coronavirus pandemic and growing job responsibilities, some physicians are considering a move away from clinical practice. Armed with expansive knowledge and a unique skill set, physicians are often well-suited for a variety of careers outside of clinical practice, whether in the legal field, pharmaceutical industry, nonprofit sector, government, or even finance.

But, before making the leap, experts warn of some common pitfalls to avoid in order to make the transition as seamless – and successful – as possible.

“Physicians disheartened by clinical medicine or who’ve grown bored in their jobs might be reinvigorated about their profession and the field of medicine by pivoting their careers,” Sylvie Stacy, MD, MPH, owner of the coaching firm Look for Zebras, told ASH Clinical News. “Many will find more schedule flexibility and better work-life balance without a drastic – or even any – decrease in compensation.”

But the key to finding success is not just finding a new job opportunity; it’s finding one that best suits the individual’s personality, goals, strengths, and comfort level with risk. Before making any sudden moves, physicians should honestly evaluate their motivation for making the switch, research the possibilities, and plan ahead.
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In December 2020, ASH Clinical News explored the plethora of career options available to those who have earned a medical degree.1 In this, the second of a two-part series, physicians who have left the bedside describe their nonclinical career paths and share advice for those considering a new venture.

Taking the Law Into His Own Hands

Michael Casner, MD, JD, had been an emergency room doctor for more than 10 years when he decided he needed a change. He had been feeling burnt out and, despite still loving medicine, he could not picture himself working in an ER for the rest of his life.

As he was considering his next step, a friend suggested he go to law school. It began as nothing more than a joke, but the idea stuck with Dr. Casner and he decided it might be the change he was seeking.

“Initially, it was a huge leap to wrap my head around the idea of deciding to leave medicine after having spent as much time and effort as I did getting into medical school, finishing medical school, completing residency, and becoming experienced as a physician,” he said.

Yet, it was also something that he felt compelled to do to find a new sense of fulfillment.

After finishing law school, Dr. Casner was able to combine his interests in medicine and law as an associate at a Chicago-based law firm specializing in product liability defense for pharmaceutical and medical device manufacturers.

As a physician attorney at the firm, he advises the best defense for a case by determining whether the science supports a plaintiff’s claims of harm caused by a drug or medical device, reviewing medical records to determine whether the plaintiff’s injury claim matches their allegations, and working with expert medical witnesses who agree to testify or assist in the case.

“What I enjoy most about my current job is that it uses my medical knowledge and experience in a completely different way than I had initially used it,” Dr. Casner said. “I am not looking at a patient trying to figure out what’s going on with the patient and trying to treat him. I am now retrospectively looking back at medical records and saying, ‘In a legal context, how can I fit the records that I am finding into the story that we would like to tell?’ It’s a different way of using my brain.”

He added that individuals with both an MD and JD remain in “high demand” in the industry because of the small percentage of the population that carries both credentials. For Dr. Casner, the transition paid off and he ended up with a challenging and fulfilling new career.

Taking Patient Care Public

Peter Marks, MD, PhD, serves as Director of the FDA’s Center for Biologics Evaluation and Research. The center is responsible for ensuring the safety and effectiveness of biologic products, including blood products, vaccines, gene therapies, and cellular and tissue therapies. It oversees drug applications, performs applied scientific research in its laboratories, enacts regulatory guidance for advances such as gene therapies, and manages the lot release of products, including vaccines and certain tests used for screening the blood supply.

“It’s a nice variety of different responsibilities,” Dr. Marks told ASH Clinical News. “As someone who came from a background of academic medicine and industry, it’s a wonderful mix of the two.”

Dr. Marks brings to the post his own previous experience as a clinical investigator within the Harvard medical system and experience developing hematology and oncology products in the pharmaceutical industry. Before joining the FDA, he also worked at Yale University, where he led the Adult Leukemia Service and served as chief clinical officer of Smilow Cancer Hospital.

Although Dr. Marks’ current position does not involve any direct patient care, he finds the work intellectually stimulating and important. “What we do affects quite a number of lives,” he said. “That never was so apparent to me as it was most recently with COVID-19.” In addition to working toward a successful COVID-19 vaccination plan, Dr. Marks said the center also evaluated the safety and efficacy of convalescent plasma.

According to Dr. Marks, a career in government often requires patience, but it also best serves those who enjoy taking a collaborative approach to problem-solving, have solid leadership skills, and are committed to making positive progress on a large scale. “We have a group of people working together who are absolutely devoted to the common cause,” he said. “The job has been incredibly rewarding.”

Big Pharma

Allen Yang, MD, PhD, had been working in academic medicine as an assistant professor in California when he began to think about other career options that might give him a better work-life balance.

When a friend called him out of the blue to ask whether he’d consider a position in the pharmaceutical industry, the timing was right and Dr. Yang decided to give industry a try. The job was an enticing new challenge that offered several advantages: it didn’t require him to relocate his family and gave him a better work-life balance that allowed him to be more present in his young children’s lives.

While industry offered its advantages, Dr. Yang said the transition has come with some trade-offs.

“In academia, you are your own boss, within the limits of the university system,” he told ASH Clinical News.2 “You can study graft-versus-host disease one day, then switch over to diffuse large B-cell lymphoma, and then coagulopathy. As long as you do the research well, get the right funding, and produce good scientific work, you can do that.” In the pharmaceutical industry, “the agenda is set by patient needs and business interests – those factors usually align pretty well.”

Dr. Yang, who currently serves as senior vice president and chief medical officer at Xencor, described work in the pharmaceutical industry as “dynamic.” Shifting between different products and projects – whether studying leukemia, lymphoma, or checkpoint inhibitors – has been a great fit for him.

“I do everything I did as an academic physician, except patient care and applying for research funding,” he wrote.3 “That time is now devoted to thinking about clinical trials, collaborating with colleagues on new investigative questions, reading medical literature, and digging deeper into scientific ideas that could eventually translate to improved treatment options.”

Working in the Nonprofit Sector

For Kathleen M. Grima, MD, the switch from a time-intensive hematology/oncology clinical practice to blood banking was motivated in part by the demands of having two young children at home.

Dr. Grima, who is board certified in internal medicine, was intrigued by the stem cell processing work being done in blood center laboratories. She decided to do a one-year blood banking fellowship at the New York Blood Center, then remained at the center to work in transfusion services. Later, she transitioned into clinical services, where she worked on stem cell processing, therapeutic apheresis, and stem cell collection.

In 2011, she accepted the role of executive medical officer at the American Red Cross. At the nonprofit, Dr. Grima works with the donor client support center, which regulates activities such as donor eligibility, product sustainability, donor complications, and recipient complications. She also works with other organizations including the FDA and AABB. Much of the work involves interpreting regulatory guidance and finding the right language to update the organization’s policies and procedures.

The shift to blood banking required Dr. Grima to secure the appropriate credentials and she is now boarded in blood bank transfusion medicine by the American Board of Pathology. Her position also brings her in contact with experts from other industries, such as donor recruitment, marketing, logistics, and manufacturing.

“These are highly skilled, brilliant people and it’s interesting and exciting to problem solve with them. [To enjoy this type of work,] you have to be the type of person who enjoys collaboration,” she advised.

The Doc of Wall Street

There are few things riskier than finance, but Robert Glassman, MD, decided to take a gamble and broaden his horizons by transitioning from a career as an accomplished academic clinician-scientist to one as an investment banker immersed in the world of business.

The move has allowed him to travel abroad and embrace problem-solving from a more global perspective – but the financial world is a risky one. Dr. Glassman said that a career as a physician can be stable and somewhat predictable, as physicians can continue to practice late into their lives. The financial world can be more volatile, as it is driven by the stock market, success of business deals, or external factors.

“If you are risk adverse, I think medicine is wonderful,” he commented. “You can work until you’re 90. In business, it’s not that easy.”

As an investor and investment banker, Dr. Glassman stayed close to his health care roots. His current work involves evaluating new drugs from biotechnology start-up companies, helping to develop innovative drugs while serving on boards of biopharmaceutical companies, and consulting with companies to identify how to best position drugs for the market.

The board-certified hematologist and oncologist made his first foray into the business world after happening on an advertisement in a medical journal from a management consulting firm seeking MDs and PhDs who liked to problem solve.4

Initially, he envisioned the position would help him develop business skills that he could later use in an administrative role at a hospital. When he discovered that the heads of most hospitals and medical institutions rose through the ranks internally, he sought more job possibilities on Wall Street.

Following his job at the consulting firm, he went into private equity and then investment banking, while continuing to publish academic articles on medical economics, trial design, and data interpretation.

While Dr. Glassman expressed a love for both medicine and finance, he said they each require a slightly different skillset. In finance, strong interpersonal, networking, communication, and problem solving skills are necessities. His medical background, he added, affords him the ability to think differently and ask questions others might not consider.

In 2015, Dr. Glassman joined Credit Suisse, serving as managing director and vice chairman of its global health care investment banking group. He left the position in late 2020 to explore new opportunities, including sitting on the boards of several pharmaceutical companies.

Ready for a Change?

In 2020, Medscape surveyed more than 15,000 physicians about the pressures they face in practice and discovered that 42% reported feeling burnout.5 When the results were analyzed based on specialty, the highest rates of burnout were seen in urology (54%), neurology (50%), nephrology (49%), and family medicine (46%).

The ongoing COVID-19 pandemic has made the workplace environment even more stressful for many physicians. Another physician burnout survey by Medical Economics found that 65% of physicians reported the COVID-19 pandemic had increased the feelings of burnout they had, primarily because of a lost sense of autonomy and a general feeling of helplessness as the pandemic rages on.6

Heather Fork, MD, a master certified coach with The Doctor’s Crossing, a consulting firm that helps doctors explore and transition to nonclinical careers, said that although many physicians feel overwhelmed in the current environment, burnout on its own isn’t a good reason to pursue a career change.

“If you are unhappy and burned out, you definitely want to be careful about making any decisions where you are just trying to escape your current situation,” she said. “You want to be moving toward rather than away from something and understand your reasons for wanting a new job or position versus wanting to get out of dodge as soon as possible.” Dr. Fork typically recommends that physicians first try to improve their current work environment – as long as it’s not a toxic one.

“Physicians often find that they are able to decrease their hours, change their schedule, or trade some clinical time for administrative time,” she said, of possible ways to reduce feelings of burnout.

Other strategies include changing the location where one is practicing or letting go of current responsibilities, such as serving on committees, that could be adding too much stress to the workday.

For physicians who conclude that they are ready for a move, Dr. Fork recommends spending time researching the various nonclinical job opportunities available to MDs and DOs.

“In general, I think giving yourself the time to go through a thoughtful process of analysis and soul-searching to understand fully what is not working for you, what needs to change, and what is going to align with your skills and the type of work environment you want, as well as the impact you’d like to make,” she said.

Look for Zebras owner Dr. Stacy added that a critical part of that research process is talking to other physicians who currently work outside of clinical medicine.

“Track down and talk to doctors in positions that seem interesting to you,” she said. “Don’t be influenced by only one factor, such as compensation, liability, or prestige. Look at the overall picture, including job responsibilities, expected work-life balance, room for advancement, and ability to return to clinical medicine down the road.”

Starting the job search without thinking through where one’s career is headed can be a mistake. “A medical director role with a health insurance company is much different than, say, a medical director role with a biotech startup, and leading a department of public health is much different than leading a health care communications firm,” Dr. Stacy explained. “It’s important to explore your options and provide at least some direction to your job search.”

“If you are unhappy and burned out, you definitely want to be careful about making any decisions where you are just trying to escape your current situation.”

—Heather Fork, MD

In her experience, she sees physicians making a few common mistakes when beginning their foray into a nonclinical career. For example, doctors may exclude themselves from viable job opportunities because their experience does not exactly match the requested qualifications.

“Almost all postings for positions in the pharmaceutical industry list a requirement for a certain number of years of experience in the pharmaceutical industry,” she said. “However, just because a physician hasn’t directly worked for the pharmaceutical industry doesn’t mean they don’t have relevant experience.” Experience can also be gained by serving on a hospital’s pharmacy and therapeutics committee, conducting clinical research, or publishing articles, she added.

Once a physician secures a job interview, Dr. Fork said another common pitfall is failing to adapt to the interview environment with hiring managers or recruiters. The nonclinical landscape is “a completely different animal” than the clinical world, she noted, meaning doctors need to prepare thoroughly for interviews by converting their curriculum vitae into a resume and anticipating possible interview questions.

A Helping Hand

For physicians accustomed to the structured medical world, the job search process may seem intimidating, but coaching and advising firms can help physicians navigate each step of the process.

Dr. Stacy aims to help clients clarify their goals and set a course for accomplishing them. In her practice, Dr. Fork believes that her clients value her ability to provide a “concrete process” and structure to a search that otherwise might feel overwhelming.

A career coach offers an unbiased outsider’s perspective, Dr. Fork continued. “I am able to express to them their unique gifts and also what I am hearing in terms of whether they are truly ready to leave or not,” she said.

To find nonclinical opportunities, experts recommend networking and relying on traditional word-of-mouth, but more high-tech strategies can also be valuable in identifying viable options. Dr. Stacy hosts a job board that focuses on nonclinical, remote, consulting, part-time, and other unconventional jobs for physicians on her website, Look for Zebras, but positions can also be found on common job search and networking websites.

Dr. Fork added that podcasts are another avenue for gaining information about nonclinical careers. She is starting her own podcast where she plans to interview clients, recruiters, and hiring managers about transitioning to new careers, but she also mentioned the “Physician NonClinical Careers” podcast from John Jurica, MD, who speaks with doctors who have left the bedside about how they found more fulfilling careers.

Look Before You Leap

While experts agree that physicians can find fulfilling and satisfying jobs outside of clinical medicine, making that leap can be difficult.

Dr. Stacy said one fear holding physicians back is the idea that they could be perceived as “selling out.” Others are concerned that, by leaving clinical medicine, they could be disappointing family members, mentors, colleagues, or others who supported them through their training.

“Some doctors fear that they’ll regret the decision,” she said. “A good way to avoid regret is to get a feel for what a nonclinical job will be like before you take the leap.”

For example, if a physician is considering a job in the health insurance industry doing utilization review, Dr. Stacy recommends they first add some chart review or physician advising work to their current job. Even if a physician does regret his or her new career choice, she noted, it’s never too late to return to clinical practice. “Leaving medicine is not a one-time decision that you’re stuck with for the rest of your career.” —By Jill Sederstrom

References

  1. ASH Clinical News. “Leaving the Bedside.” December 2020. Accessed January 11, 2021, from https://www.ashclinicalnews.org/spotlight/feature-articles/leaving-the-bedside/.
  2. ASH Clinical News. “Pulling Back the Curtain: Allen Yang, MD, PhD.” August 2020. Accessed November 26, 2020, from https://www.ashclinicalnews.org/spotlight/pulling-back-the-curtain/pulling-back-curtain-allen-yang-md-phd/.
  3. ASH Clinical News. “From the Ivory Tower to Corporate America.” March 2018. Accessed November 26, 2020, from https://www.ashclinicalnews.org/viewpoints/ivory-tower-corporate-america/.
  4. ASH Clinical News. “Pulling Back the Curtain: Robert Glassman, MD.” September 2018. Accessed November 26, 2020, from https://www.ashclinicalnews.org/spotlight/pulling-back-curtain-robert-glassman-md/.
  5. Medscape. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Accessed November 26, 2020, from https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460?faf=1#1.
  6. Shryock T. How the COVID-19 crisis is exacerbating physician burnout. Med Econ. 2020;97(13).