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Jumping to a nonclinical career

Experts advise physicians to look before they leap away from clinical practice to figure out if they're ready to leave -- and what they want to do if they go.

By — Posted Nov. 7, 2011

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For all kinds of reasons, some new -- like opportunities in the health information technology industry -- and some old -- like burnout -- occasionally physicians decide to leave clinical practice.

But how can doctors tell the difference between needing a vacation from clinical work or a permanent break from it? And how do those who don't have a plan B identify a fulfilling second career?

Career coaches and former physicians, who are sometimes one and the same, say there is no limit to the new careers physicians can take on. But they also advise careful planning before making the leap.

The transition to a new career isn't always quick. It's possible, and often wise, to wind down clinical work while ramping up a new career over months or years. Also, a career change needn't be permanent. Many physicians who decide not to work in hospitals or group practices maintain their licenses and medical education either as a backup or as part of a plan to return to clinical work eventually.

There are some signs that more physicians are leaving medicine, and more are yearning to do so. Among them: During the last three years, the percentage of medical residents in their final year who say they would choose a different profession if given the chance rose from 18% to 29%. That was according to an email survey of 302 residents conducted in May by health care staffing firm Merritt Hawkins.

Knowing when to go

Physicians pondering a move might wonder whether they need some time off or whether they should follow the urge to leave medicine.

Career coach Stephen Rosen, PhD, is chair of Scientific Career Transitions, a New York firm specializing in coaching physicians. He advised doctors unsure if they want to leave clinical practice to start with a short break. "You can take a vacation for a week or two. If that doesn't work and you feel the same way, that might be a clue. People who really love their work don't seem to want to take vacations," he said.

Other career coaches and physicians working in nonclinical careers had similar advice. Lissa Rankin, MD, quit her job as an ob-gyn at a group practice in 2007. She's now a successful author, speaker and blogger, presiding over a blogging community at owningpink.com.

She is happy with her decision, but advises burned-out physicians to examine their options before leaving medicine. "There are creative ways to deal with burnout and stay employed," she said. "Every doctor can't do what I've done, or we'd have no doctors."

Susan Biali, MD, left her residency in emergency medicine in Vancouver, British Columbia, to pursue a career in dance. She worked for a few years as a professional flamenco dancer but now spends most of her time speaking, writing and coaching others to pursue their calling. She said taking the first step toward a new career is energizing enough and can help ease burnout so that a gradual switch is tolerable.

"The great thing is when you develop a dream, even if you're not there right away, you have hope, and that changes everything."

Finding an open door

Once a physician has decided to leave practice to pursue another career, whether abruptly or gradually, there are big questions and small details that need attention. Rosen's firm divides the career change path into three parts: assessment, options exploration and implementation.

During the first stage, the physician identifies dreams, goals and skills to get an idea of what to look for in the next career. Second, the physician researches what careers might fulfill what medicine did not and would be reasonably attainable. Finally, the doctor applies for jobs, conducts informational interviews, networks or goes to school to land the ultimate job.

Sometimes the first part of the process of switching careers is the quickest, said Heather Fork, MD, a dermatologist who now works as a career coach in Austin, Texas. She specializes in helping other physicians searching for new careers.

She asks them what they would do if money was not an issue. "We can usually uncover what they want to do," she said. "The bigger barrier often is more a disbelief that they could do it."

Rosen and Dr. Fork said clients often ask them whether returning to school to earn another advanced degree is a good idea. Dr. Fork said whether or not a physician needs to obtain further training, such as an MBA or MPH, depends on his or her career goals. Rosen said there are alternatives to returning to school. He had one client who worked as an unpaid volunteer -- basically an intern -- at a private equity investment firm. He proved so valuable that they hired him full time.

Dr. Fork advised physicians to ask others in a new field if getting another degree is necessary or the best route to take. "It's not something to do lightly," she said.

Picking a landing spot

For some burned-out physicians, going back to school is appealing because their training was the last time they felt in touch with what they loved about medicine. The answer to career burnout could lie not in returning to school as a student but in returning to a university to teach.

Memoona Hasnain, MD, PhD, MHPE, trained as an obstetrician in her native Pakistan. She now works at the University of Illinois at Chicago as an associate professor and director of research at the Dept. of Family Medicine and is director of the department's Patient-Centered Medicine Scholars program.

She started her career in academic medicine with what was supposed to be a three-month program in medical education but ended up on a journey that wound up in Chicago, with two additional advanced degrees in public health.

"Teaching, research and service all go hand in hand," she said. She cautioned that the academic life may not be a good choice for a physician seeking a slower pace or less stress. "A person like me is thinking and working 24/7," she said. "The work is not even work anymore. It's your passion. You're not switching it off anytime."

Claus Hamann, MD, wasn't a disgruntled physician. On the contrary, the Boston internist and geriatrician said he felt as if he had done what he hoped to do as a physician and was ready to learn something new. He now has a new career as a consultant. He left for a position as senior manager for provider clinical solutions with consulting firm Accenture. He helps hospitals and physician groups find and implement new electronic medical records systems and improve their clinical processes.

"The tacit assumption is that doctors just keep doing it until they fade away, get an illness or can't practice anymore," Dr. Hamann said. "That doesn't have to be everybody's script."

A career in business doesn't have to mean leaving the hospital behind.

Michael Marks, MD, practiced for 12 years as an orthopedic surgeon in Norwalk, Conn., before he received a degree 10 years ago through the University of Tennessee's Physician Executive MBA program. He stopped seeing patients only recently, when he took a job as vice president for business development at Norwalk Community Hospital.

"I chose the path I chose because at the end of the day, the decisions I make impact the patient," he said. "Each step you take away from the hands-on patient care, you exponentially increase the number of lives you can touch."

Susanne White, MD, went through the same program in 2010 and is now chief medical officer at Detroit Medical Center. Trained as an emergency physician, she went to business school after taking on administrative duties and feeling she was at a disadvantage because of a lack of business training.

"To be able to make a difference in a health care system, you have to be able to speak the language, sit at the table and discuss finance with administrators at their level," she said.

Even if they're not dealing with major investments at a hospital that might require an MBA, physicians can't avoid making big decisions about technology in their practice. For some, making those decisions has revealed a passion for health information technology.

Opportunities in the field have grown with not only the boom in startup companies selling electronic medical record systems, but also the genesis of health IT certificate, undergraduate, master's and PhD programs at several universities.

Donald Burt, MD, an internist and geriatrician from Pittsfield, Mass., is chief medical officer at PatientKeeper, a firm that sells physician health care information systems. He left his job practicing and teaching internal medicine and geriatrics in 2007.

"It was apparent to my wife and my family I wasn't having as much fun as I'd been having or should have been having."

Working in health IT was a way to be part of a wave of change -- or to surf that wave -- rather than being swept away by it. He still feels he's making a difference by improving health care.

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ADDITIONAL INFORMATION

Questions to ask before making the leap

Thinking of a career away from medicine? Here are some questions to ponder if you are considering jumping to a nonclinical career but aren't sure what that career should be:

  • What would you do if money were no object?
  • What would you do if you knew your success was guaranteed?
  • What did you want to be when you were a child?
  • What did you want to be before you wanted to be a doctor?
  • What do you love to talk about?
  • Do you have a dream job?

Sources: Career coach Heather Fork, MD, Doctor's Crossing; Lissa Rankin, MD, founder, Owning Pink; Career coach Stephen Rosen, Scientific Career Transitions

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Always have a way to re-enter medicine

Not everyone who wants to leave clinical practice is ready to give it up forever. Doctors can keep up with licensure and continuing medical education. Here are tips to circle back to clinical practice.

  • Identify the rules for physician re-entry in your state. Would you be willing to go through the hoops if you did let your license lapse? The AMA maintains a list of such requirements on a members-only website (link).
  • Keep your license by participating in the required CME if there's a good chance you will want to treat patients again.
  • Consider the cost of the additional CME to maintain your board certification. Make sure you understand what it would take to get your board certification back if it lapses.
  • Consider volunteering or shadowing another physician to add experiential learning to your CME.
  • Maintain connections with professional societies to keep informed of CME opportunities and to maintain your professional network if you need to tap it again for a job treating patients.
  • Find another physician who has left practice and returned, and ask for advice.

Sources: Physician Workforce Re-entry Project (a service of the American Academy of Pediatrics), AMA on physician re-entry

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Time to hit the books again?

Some second careers require, or would be helped by, a second advanced degree. But physicians looking to return to school should be cautious, given the potential for more student debt and time away from training on the job. If a second degree does look like the best route, here are some options:

DegreeYears requiredPotential careers after completion
JD3 yearsMedical law, consulting, health policy
MBA1-2 yearsConsulting, medical device design or manufacture, investment analysis, physician leadership
Masters in health informatics18 months-3 yearsHealth information technology design and implementation
MPH1-2 years after an MD, or 4-5 years for an MD/MPH earned concurrently (See clarification)Public health, government, policy research, nonprofit and advocacy work
PharmD 4 years, either concurrent or after MDClinical trial design, pharmaceutical development
PhD7-8 years for a concurrent MD/PhD programResearch, teaching, engineering, health policy

Sources: American Assn. of Medical Colleges, University of Texas School of Biomedical Informatics, Assn. to Advance Collegiate Schools of Business, American Assn. of Colleges of Pharmacy, American Bar Assn., Assn. of Public Health Schools

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Clarification

The table in this article originally gave more general figures on how long it takes to earn a master of public health degree. Usually, MPH programs require only one or two years additional study for students who already have earned a medical degree. Concurrent MD/MPH programs take four or five years.

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