Career resources content posted on NEJM CareerCenter is produced by freelance health care writers as an advertising service of NEJM Group, a division of the Massachusetts Medical Society and should not be construed as coming from, or representing the views of, the New England Journal of Medicine, NEJM Group, or the Massachusetts Medical Society
By Bonnie Darves, a Seattle-based freelance health care writer
Most physicians go into medicine fully expecting to spend their careers in patient care, and the vast majority do just that for three decades or so. Some physicians, however, might decide that they want to expand or alter their horizons — or even leave clinical practice altogether — by pursuing other types of work. Twenty years ago, it might have been difficult to make a major transition from patient care to nonclinical work. That’s not the case anymore. Within the health care realm generally, there are many kinds of nonclinical work available, and much of that work can be done on either a part-time or full-time basis.
Residency-trained physicians, particularly those who have spent at least three to five years in patient care, find many nonclinical avenues where their skills and experience might yield gratifying work. Common areas where such jobs are plentiful include pharmaceutical drug development and consulting, medical technology and informatics, health insurance and utilization management, and within regulatory agencies. Public health, education, and hospital leadership also offer numerous nonclinical opportunities, as do nonprofit organizations. In addition, “side gigs” abound in chart review, expert witness work, and, of late, in biotechnology and the ever-growing health care business and technology startup sectors. Still others find gratifying, if not necessarily highly compensated, work in medical writing.
The reasons that physicians choose to explore nonclinical work are myriad, but the key ones are a desire to seek new challenges or the awakening that full-time patient care isn’t the best fit. In some cases, physicians pursue nonclinical work almost by happenstance, when they’re exposed to something in the course of their clinical practice or are trying to figure out their own next move.
That’s what happened for Heather Fork, MD, a dermatologist turned career coach. Although she liked dermatology, after a decade in the field she decided that she needed to find a different way to help people. That led her to become a master certified coach and start a coaching practice dedicated to physicians. Today, Dr. Fork operates The Doctor’s Crossing, a company that counsels physicians seeking to invigorate their careers or transition to nonclinical pursuits.
Dr. Fork encourages physicians to explore new career options if they’re feeling stuck or less than gratified with patient care, but she cautions them to ensure they’re not just running away from something. “Before making any changes, I always recommend doing everything you can at your current position to make things better. Part of this process involves gaining clarity on what is and isn’t working,” she said. For some physicians, she explained, that process leads them to the realization that if they can work fewer hours and have more flexibility, their current job is actually okay. For others, who might be in a toxic environment, the solution might be finding a better practice setting. “A thorough self-assessment might also reveal that medicine was never the right fit to begin with, and that a new path is in order. Taking on new challenges and interests, either in medicine or outside medicine as a sideline or hobby, can help feed the mind and spirit,” she said.
Following interests to find nonclinical opportunities
Yasmine S. Ali, MD, a cardiologist at Vanderbilt University in Tennessee, was struggling with her decade-old career when she decided to shake it up by parlaying two of her longtime interests — writing and preventive medicine — into two new ventures. Today, as president of LastSky Writing, LLC, Dr. Ali works with individuals and companies seeking medical consulting and writing services across a broad range of health and wellness areas. She also helps physicians launch their own writing careers, and now operates a preventive medicine practice. “In my cardiology practice, I felt like I was doing a lot of damage control, so I decided to pursue my interest in preventive medicine by starting my own practice and writing about health and wellness,” said Dr. Ali.
Today, Dr. Ali serves as chief editor of the atherosclerosis and congenital heart disease sections at Medscape. She also writes for pharmaceutical and nutrition companies, and she writes and speaks frequently on wellness and disease risk prevention. “It took me a long time to realize that I could help patients in other ways,” she said. “I’ve discovered the power of writing to expand my impact, and it’s been very gratifying.”
Nisha Mehta, MD, a radiologist in Charlotte, North Carolina, like Dr. Ali, turned the concept of exploring nonclinical opportunities into her own business. She founded and operates a Facebook forum called Physician Side Gigs, a three-year-old venture that now has 38,500 physician members.
“It’s a very active forum. It draws physicians who want to learn about business or finance or are looking to shift direction to pursue nonclinical opportunities or something they’re passionate about. Some simply want to supplement their income or pay off their loans faster,” said Dr. Mehta, by exploring opportunities in real estate or investing, for example. “What our group says, I think, is that it’s OK not to want to be a traditional doctor. We try to connect physicians to opportunities, regardless of whether they’re related to the physician market.” Overall, the forum has evolved as a vibrant networking forum, she adds, that connects physicians from across the specialties.
In Dr. Mehta’s case, Physician Side Gigs provides a revenue stream from public speaking and other activities associated with the forum. She practices full time at the VA. “For me personally, I think that my Sides Gigs venture is actually promoting my career longevity. It has enabled me to pursue something fulfilling in a different way,” she said.
Straddling clinical and nonclinical realms
Hodon Mohamed, MD, a Michigan obstetrician-gynecologist, also moves between clinical and nonclinical work. She still practices two shifts a week as an OB/GYN hospitalist but has pursued a handful of sidelines in recent years, as a medical director, in utilization management, and as a career coach for physicians. “I enjoy my specialty, but I was definitely feeling the burn from the system,” she says. “I wanted to try something new.”
Dr. Mohamed has enjoyed all her side gigs but finds the coaching — she focuses on physicians in transition — especially rewarding. “I have found that as physicians, we don’t really talk to each other about the issues we experience in our lives. That’s why I really enjoy helping physicians find their passions beyond medicine, whether they stay in clinical practice or not,” she said.
Some physicians decide to make the transition to nonclinical in a relatively rapid fashion. Ophthalmologist Frances Cosgrove, MD, did that when she moved from clinical practice to the pharmaceutical sector about a year ago. Today, she is a clinical case manager and medical reviewer in the Global Patient Safety division for Eli Lilly and Company in Indiana. As she tells it, she had reached a juncture in her medical career, after nearly a decade in practice, where she wasn’t sure she wanted to spend another 20 years doing essentially the same thing. She started out by doing contract work in the pharmaceutical field and found she liked it, then took the job at Eli Lilly.
The focus of her work now is looking at side effects and adverse events that might be associated with drugs that are either in development or already on the market, performing pharmacovigilance. It’s been a good move, even if it required substantial adjustment. “It’s been a while since I learned a whole new culture — one that’s very different than the one I knew. And I’ve enjoyed it,” she said. “I’ve been very impressed, too, by all the continuous learning opportunities in the industry.” She also appreciates the fact that it’s a Monday–Friday job. “No more nights and weekends,” she said.
Physicians who move into nonclinical work often do so for a combination or professional and personal reasons. Family medicine physician Lisa Ho, MD, was looking for more flexibility in her work life — she has four children — than a breakneck-paced practice would permit, without losing a connection to patients. She found it in a mixed portfolio of part-time jobs, as a Social Security disability consultant, nursing home reviewer, and Medicaid utilization management specialist. “I still get the chance to work as a doctor, but I’m not tied to an 8–5 — or sometimes 8–10! — job, and I get to work from home. The jobs are flexible, and I can choose my hours and the amount of work I do,” Dr. Ho said. “What I like best is that what I do is necessary, because I think we all realize that resource utilization is important.”
Gauging income potential in nonclinical work
Dr. Ho has also found that nonclinical work does not, as a rule, pay less than clinical work. “I think a lot of physicians think that they’ll take a pay cut, but that’s not necessarily the case,” she said. Other sources interviewed for this article concurred. What physicians will — or potentially can — earn in nonclinical work depends on several factors. These range from their time in practice, to their specialty, to their skills sets and their ability to wax entrepreneurial when the opportunity arises.
Some nonclinical jobs’ compensation is on par with a physician’s salary, Dr. Fork reported, while other jobs may be lower earning and still others, significantly higher. For example, entry-level jobs in health insurance, utilization management, the pharmaceutical industry, and physician-advising pay between $160,000 and $300,000, but there can be considerable upside income potential as physicians advance, Dr. Fork and other sources said.
Further, physicians who obtain business, health administration, or clinical informatics degrees are likely to find themselves in high demand and with the potential to command very good salaries. Those in highly compensated specialties such as surgery, however, might need to prepare for a drop in income, Dr. Fork said.
Testing the nonclinical waters, over time
Following personal and professional interests where they lead, in an incremental fashion, is a prudent way to find a new career path, some physicians contend. That’s how a long-term journey from patient care-focused practice to clinical informatics evolved for pediatrician Feliciano “Pele” Yu, MD, chief medical information officer at Arkansas Children’s Hospital in Little Rock. He began his transition nearly two decades ago, when he became interested in computers, learned to code, and developed a “miniature” electronic medical record (EMR) for his practice. Over the ensuing years, while still practicing pediatrics, he did a fellowship in health services research via a National Institutes of Health award and picked up degrees in public health and health informatics.
Today, Dr. Yu works in a full-time administrative role in which he focuses on the intersection of health informatics, outcomes research, and quality of care. Although he misses direct patient care, in his view he is still involved by extension. “I truly feel that I am still taking care of patients, but in a different way now,” he said, “and it’s an exciting time for clinical informatics.” From an informal sideline that once attracted a handful of “geeky” physicians, clinical informatics is now an American Board of Medical Examiners-designated specialty, and there are 33 ACGME-accredited programs.
For physicians who are interested in informatics but don’t want, or aren’t ready to leave their practice positions, there are avenues, paid and volunteer, to explore the field part time, Dr. Yu said. Health care organizations of all sizes are seeking physicians who can act as subject-matter experts (SMEs) to help them optimize their existing EMRs and information systems to improve quality and extract useful data. He also recommends attending informatics conferences (or devoted presentations or tracks at specialty conferences). In addition, medical software and information systems vendors are often looking for physicians to act as SMEs or consult on their products.
“There are plenty of opportunities for physicians to pursue their interests or check out the field,” Dr. Yu said. He added that physicians working in informatics full time are also happy to connect with young physicians.
Like Dr. Yu, Jeffrey Grice, MD, also took the long road to his nonclinical career. As medical director for member experience and branding for Kaiser Permanente in Washington, the Seattle-based obstetrician-gynecologist has held numerous leadership roles over the years. He helped build a women’s cancer department, served as department chair and later chief of medicine, and then, in 2015, took a senior role in corporate human resources and compliance in Kaiser’s California headquarters before taking his current position. He reluctantly stepped away from part-time clinical practice because it just wasn’t feasible to continue, but Dr. Grice finds that his current work still provides the satisfaction that he is helping patients.
“In a typical week, I’ll bounce from working with the marketing and branding team, to analyzing data on our performance, to spending time with a patient who experienced a complication of surgery and didn’t feel supported enough,” Dr. Grice said. He urges young physicians to try something new every seven to 10 years, to challenge themselves intellectually and keep their professional lives fresh. He also counsels physicians to rejuvenate themselves by looking first for opportunities around them, whether that is working on a committee that interests them, engaging in quality improvement, doing peer review, or taking leadership courses. “It’s helpful to start by looking for an unmet need that interests you and taking it from there,” he said.
Be prepared for pushback
One issue that physicians contemplating nonclinical work face is concern about what their colleagues — especially their mentors — will think. That’s a valid consideration, but it shouldn’t deter physicians from seeking another path. The thing to keep in mind, Drs. Ali and Mohamed said, is that being true to yourself is a lot more important than reacting to what others say or think. That response, in most cases, will be fleeting, as most physicians are more focused on their own careers than those of a former residency or clinical colleague.
“At first, there was a reaction of surprise to what I was doing, and then the conversation began to go in a different direction. People started asking questions,” Dr. Ali said. “The thing to remember is that when people appear to question what you’re doing, it’s really more about their perceptions and opinions than it is about you.”
“There will be some backlash — but you’ll get over it,” Dr. Hodon said. “I think that will change, though. The younger generation of physicians is saying ‘this is my life, and I should do what I find gratifying.’”
Physicians who enter leadership nonclinical roles, whether early or mid-career, might also face opposition from colleagues, whether that sentiment is uttered or not, Dr. Grice admitted. “Unfortunately, there’s still a bit of the us-versus-them mentality, that physicians who go into leadership in nonclinical roles have ‘gone to the dark side.’ You have to remember that the work you are doing still benefits patients, but in a different way,” he said.
Planning the transition
The physicians interviewed for this article offered a range of helpful tips for their colleagues who are considering moving into nonclinical work on a part-time or full-time basis. Here are a few:
Thoroughly explore your options — and your motivations. Dr. Fork recommends that physicians spend considerable time looking at what’s out there in the way of nonclinical work, by visiting social media sites (see Resources) and doing research. “It’s also very important to talk to someone who doesn’t have an agenda to help you sort out your thoughts and feelings,” Dr. Fork said. “A trusted colleague or mentor can be helpful. What’s not helpful is talking with physicians who are very negative about their situation but are unwilling to do anything about it.”
Start networking and keep doing it. Physicians tend to underestimate both the importance and value of networking when they’re considering any kind of shift, Dr. Cosgrove said, but it’s critically important. “I think many physicians are concerned about saying out loud that they want to make a change, but every time I reached out and heard someone’s story or sought their counsel, it made me feel a bit better about what I was considering,” she said.
Don’t quit your day job — yet — and don’t expect greener pastures. Physicians considering leaving clinical medicine altogether should plan on a minimum two-year transition timeframe, according to Dr. Hodon. They should also be prepared to invest in themselves by gaining skills during that period and finding people in the envisioned pursuit to guide them. Dr. Fork adds that physicians should really ensure that they’re not running away. “Doing an honest self-assessment about what you truly want [from a] job and what would be a good match for your personality, skills, and interests is a key part of avoiding career-change mistakes. You don’t want to end up in a remote nonclinical job that doesn’t interest you and where you’re tied to a computer,” she said.
Physician Side Gigs: www.facebook.com/groups/PhysicianSideGigs
The Doctor’s Crossing: https://doctorscrossing.com
Nonclinical Job Hunters: www.facebook.com/groups/NonclinicalJobHunters