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Thinking about leaving medicine?

Medical Economics (Vol 20, No.5, May 2001, pp42-51)

Advice from career counselors and colleagues who have made a successful career switch.
The author, a freelance writer based in Ridgewood, NJ, writes frequently about health care topics.

Heard about the obstetrician-gynecologist who left practice to become a stockbroker? Would you believe a ballroom dancer? A screenwriter? A seminarian? To hear our readers tell these tales, you�d think they were speaking of medieval knights who chased and won the Holy Grail. Rather, they�re enviously recalling colleagues who traded their office duties for less traditional jobs. We�ve even heard about a former OB-GYN who�s now a deputy police officer, caring for her department�s SWAT team.

The public, too, is clearly intrigued by stories of physicians who cast off their stethoscopes. A local newspaper devoted much of a recent real estate section to Russian �migr� Galina Feit, a former gynecologic surgeon who now designs luxury homes in Westchester, NY.

In fact, thought, two out of three physicians who become disenchanted with their daily routines make what consultant Stephen Rosen calls �straight-ahead� alterations. That is, they take their knowledge and experience to a new clinical venue, such as academia, or simply modify the way they function in an established practice. �We receive about 250 to 300 inquiries a week�far more than five years ago, and perhaps even twice as much as a year ago,� says Rosen, chairman of Celia Paul Associates, a New York City firm specializing in career management for physicians. Clients who seek out Rosen�s services are also significantly younger than they once were. �I�ve seen the average age of physicians coming to us decline from the 50s to the 30s in the last five years,� Rosen says. �Something�s going on.�

Many are quick to blame managed care, claiming it has sharply increased the rate of physician burnout. But that�s oversimplifying, according to career counselor Gigi Hirsch, an internist and psychiatrist. As CEO of Boston-based MD IntelliNet, which provides career counseling and placement for physicians seeking positions outside of patient care, Hirsch has advised more than 2,500 physicians since 1992.

�Most physicians feel restless at some point in their careers,� she says. �That�s normal, particularly in the current state of health care.� Some handle their discontent by drawing satisfaction from areas outside the job, Hirsch notes. But if you�re one of those doctors who want to feel excited when they set off for work each day�and don�t�you have some important decisions to make.

Perhaps you made the wrong career choice or selected a specialty that doesn�t suit you. �I ask my clients when they decided to go into medicine, and one said it was decided for him in utero,� Hirsch says. �These days, you really need to love medicine to pursue it.� You also need to be comfortable in your professional environment. �In the last 10 years physicians� lives have become closely tied to organizations,� Hirsch says. �About 40 percent of physicians are now salaried employees. If you�re one of them, you have to figure out which type of organization is the best one for you.�

Barbara J. Linney, vice president of career development for the American College of Physician Executives (ACPE), helps guide physicians toward executive management positions. Many of her clients like clinical practice, but have grown to enjoy management activities associated with their group or hospital. �They talk about wanting to make a difference on a larger scale than they can in one-on-one patient care,� Linney says. �Sometimes it�s a desire to get out of something; sometimes it�s an itch to grow. It�s always better if the physician wants to grow.�

One new trend is physicians� increased willingness to discuss their discontent. �It�s easier to talk about this stuff now,� Rosen says. �Once it was considered disgraceful to even mention it.� Hirsch�s clients used to be so ashamed of needing career support that a few gave her a fake name out of fear they�d be labeled in some way.

The new Web-sters

With computer technology the latest big thing, it�s not surprising that many former OB-GYNs have found their way into the field. OB-GYN Jeffrey Levy, co-founder, chairman, and chief educational officer of MedCases, an Internet-based medical education company started in April 1999, is just one of them.

When Levy was director of residents at Albert Einstein Medical Center in Philadelphia, he developed a computer �lab� to give med students something productive to do while they waited for patients to deliver. It was a hit. �I almost couldn�t get them back to the labor room,� he remembers. Prompted by that success, Levy learned everything he could about high-tech ways to present medical subjects. He continued to develop educational tools, including informational CD-ROMs and the first virtual-reality hysteroscope, which allows physicians to view, diagnose, and treat abnormalities in the virtual uterus of a virtual patient.

Today, his company has 55 employees, 15 of them physicians. The company�s MedCases Interactive Case-Based Journal provides physicians with several interactive cases per month. �You can get all of your continuing medical education for the year,� Levy says. �We�ve launched products in OB-GYN, family practice, general surgery, and pediatrics.� MedCases plans to cover 30 specialties over the next three years.

Although an entrepreneur at heart, Levy isn�t keen on big financial risk. �I didn�t quit my job until I was sure the company could be successful,� he says. Even today, he maintains a tiny practice and is assistant professor of obstetrics and gynecology at Jefferson Medical College. His income has dropped only slightly, he notes, and he describes himself as �delighted� with what he�s doing. His advice for fledgling entrepreneurs: Thoroughly research a potential venture and surround yourself with people who are well-versed in the field.

OB-GYN David Toub is another doctor who�s found the good life in computers. He became hooked on them after his wife persuaded him to give up his manual typewriter. Ultimately, he learned enough to teach undergraduate computer science at a local college.

Toub left a busy practice in surgical gynecology at Pennsylvania Hospital when the facility was taken over by a larger health system. In 1997, he enrolled in an MBA program with a concentration in information systems, and took the first of two consulting jobs. Now, as medical director for Newton Interactive, a company that develops health-care-oriented digital media, including clinical Web sites for physicians, Toub manages the medical content team and works with programmers and graphic designers.

In his spare time, Toub serves as editorial adviser of this publication and moderates a women�s health forum (health.philly.com) on the Web site of The Philadelphia Inquirer. �I�m making less than half of what I made in practice, but you have to look at job satisfaction,� he says. �I indulge my clinical and technologic skills, and the combination is really nice.� Two years ago, OB-GYN Douglas M. Soderberg walked away, too. He left his 14-year partnership with a large group, bored and burned out. Today, as a consultant to cMore Medical Solutions in Minneapolis, Soderberg helps design and build procedure documentation systems. cMore�s technology allows surgeons to electronically document a case from diagnosis to post-op orders and discharge instructions. The software even suggests CPT and ICD-9-CM codes. �It�s constantly evolving,� Soderberg says.

Soderberg also provides content for the Web site of Midwest Medical Insurance, a physician-owned malpractice insurer, and does surgery as a clinical gynecology consultant to a 25-member family practice group. �After being out of practice for more than six months, I missed direct patient contact.�

Although he�s got three �jobs� now, Soderberg is making less money than he once did. �Luckily my wife is also an OB-GYN. We paid off our mortgage and other debts, which gives us great flexibility,� he says. A surprising number of physicians were envious when they heard he was leaving his practice, Soderberg remembers. �They said they wished they had other skills so they could do the same,� he notes, �but most physicians don�t realize how many other saleable skills they possess or could easily develop.�

Explore your heart�s desire

A career transition is more likely to succeed if you can separate the job aspects you cherish from those you could easily live without. Stephen Rosen has his clients take a battery of written tests to sort out their interests and needs. One such test helps tie proficiencies to preferences�you might find, perhaps, that you particularly enjoy management or research activities, or that you interact exceptionally well with colleagues, staff, or patients.

Physicians are also asked to rank their values. For example, when defining what�s most important, how does your earning potential stack up against tranquility in a job? How much do you treasure your ability to help others, your independence, your free time, or the potential for artistic creativity? Yet another exercise helps determine whether your attitudes can fortify�or impede�your capacity for change.

Of course, many physicians don�t need a battery of tests to show them a more satisfying path. OB-GYN Debra Gussman, for instance, works in the faculty practice at New York University Downtown Hospital, caring for indigent patients in Chinatown and the Lower East Side of New York. She also teaches residents.

The 46-year old Gussman left a stable, lucrative practice in Colorado when her marriage collapsed. �My first idea was to retire,� she says. �That lasted about four months.� She then spent two years doing locum tenens, caring for native women in Alaska and Colorado, then working in Pennsylvania. She also took time to travel and think. Three years ago she came to New York City, where the varied neighborhoods appealed to her sense of adventure. �Being in New York and working with immigrants is like traveling the world�only you don�t have to keep packing and unpacking.�

�I love it,� she says. �I�ve had long-term relationships with patients, and I�m willing to trade that for interesting cultural experiences. I�ve also had the big house, and I don�t want that anymore. There are all kinds of interesting things out there�new places and new people. There are jobs in industry, government, public health, administration, teaching. If you don�t like the job you�re in, go. Explore the options. Take a chance.�

Perinatologist Marc Lebed of Shell Beach, CA, would never have chosen to leave medicine, but a devastating sporting accident in 1995 when he was 45 years old robbed him of his fine motor skills and physical endurance. To fill the hours of forced retirement, he began law school. In his third year, finding law �too adversarial,� he turned to a graduate degree in dispute resolution. He has since formed a group called Dispute Resolution Professionals (DRP), which uses mediators to help broker agreements before a conflict gets to the courtroom.

Lebed is offering his services to medical malpractice insurance companies, as well as the risk management departments of hospitals to help resolve disputes. �It gives me the chance to do what I miss most about medicine, and that is to be needed by people,� he says. �If I were physically capable of working full time, I think it would be a very lucrative and satisfying field.�

Help for restless doctors

Traditional career counselors like Rosen and Hirsch can help pinpoint professional goals and formulate a strategy for attaining them. Rosen, for example, videotapes clients during mock job interviews and critiques their performance.

Todd Pearson, a pediatrician and director of the Center for Physician Renewal, takes a holistic approach to the worn-down physician. Unlike traditional career counselors, Pearson�himself working in an alternative career�delves into all aspects of his clients� lives. �For example, someone contemplating a career change will be asked to list the obstacles on a piece of paper,� Pearson says. �Some of those voices are yours, but many belong to society, the culture of medicine, family�you name it.� Physicians also record their reasons for taking action.

�When clients first contact me, they often say they�re thinking about getting out of practice,� Pearson says. �After puzzling through the pertinent issues, an estimated 90 percent find they really are called to medicine.�

Professional organizations can be helpful, too. The American College of Physician Executives offers a variety of services to physicians interested in management or administrative work in a range of settings, including government, group practice, hospitals, industry, managed care, the military, and universities. ACPR also sponsors a Master of Medical Management program (see �It�s academic: The route to an MBA,� page 00). Potential leaders need to understand issues such as finance, health law, negotiation, and quality assurance, says ACPE�s Barbara Linney, who predicts that in five years, physicians without a business-related masters degree won�t be considered for certain executive jobs.

Organizations also offer valuable networking opportunities. �Recruiters tell me that 70 to 90 percent of jobs materialize because the candidate knew someone,� Linney says. �You have to be around people who share your interests to make that happen.�

OB-GYN Toub agrees that it�s essential to make and nurture contacts. �I probably sent out 150 to 200 copies of my r�sum�,� he says, �and only 20 percent drew a response.� Before enrolling in his degree program, Toub went through every contact he had, as well as those of his wife, a health care administrator. �I contacted chief information officers from most major hospitals in Philadelphia to get their suggestions,� he recalls. �I wanted to know if it made sense to pursue an MBA with a concentration in information systems.�

Don�t leave family members out of the decision-making process. Not only are they a valuable source of support, Pearson says, but �you need to be sensitive to the fact that your transition will affect their lives as well.� Remember, too, that some families weather change better than others. �Recruiters think they�ve got it all worked out with a candidate, but suddenly the spouse won�t move,� Linney says. �I�ve seen that end the marriage.�

Expectations, great and modest

Be realistic. Recognize that more often than not, you�ll make less money. Of course, there are exceptions: Physicians have become successful stockbrokers or venture capitalists. Top management positions also pay well. But consider talking over your aspirations with a financial planner to see if you can truly afford to do something different.

How much change can you tolerate? If you go the management route, you�ll probably be changing jobs every three to five years. �That�s generally the lifespan of the job,� according to Linney. �Companies merge, they downsize, and they want new blood. There�s no job security, but there is career security. If you�ve done one medical management job, you can get another one.�

A successful career change takes an average of two to three years, Hirsch says, noting that a major cross-industry transition may not be feasible for the majority of OB-GYNs. �It�s not something that happens easily,� she notes. �It requires a tremendous amount of energy.� Consider an incremental process, instead.

For example, if you think you�re cut out for the pharmaceutical industry, see if you can sign on for a speaker�s bureau or participate in clinical studies. If management intrigues you, volunteer for committees in your hospital or professional group. Recruiters have baseline requirements, according to Linney, and these include board certification in a specialty, at least five years of clinical practice, good communication skills, and management experience.

�There is no single �medical career� anymore,� Hirsch concludes. But, while there are lots of options, it takes a great effort to find one that fits you well. �You always hear stories about the folks who go on to be a chef, a history professor, or play music professionally,� Pearson says. �The majority of physicians find ways to use their medical expertise in a new manner that holds special meaning for them.�

For more information

See �Where to go for help: Your career resource guide� on our Web site, www.memag.com. To get to it, click on �Your Career Guide� under the Medical Economics Library heading on the left side of the home page. For more on the organizations and options discussed in this article, check out the following resources.

Dr. Stephen Rosen,
Celia Paul Associates,
Premium Career Management for Physicians
1776 Broadway, Suite 1806 New York, NY 10019
212-397-1020
Fax: 212-397-1022
www.careerchangeability.com/doctors
StephenRosen@gmail.com

American College of Physician Executives
4890 West Kennedy Blvd., Suite 200 Tampa, FL 33609
800-562-8088
Fax: 813-287-8993
www.acpe.org
webmaster@acpe.or

Books

Leaving the Bedside: The Search for a Nonclinical Medical Career (American Medical Association,1996).
Career Renewal: Tools for Scientists and Technical Professionals, by Stephen Rosen and Celia Paul (Academic Press, 1997).
The Physician in Transition: Managing the Job Interview, by Donald L. Double (American Medical Association, 1997).
Strategic Career Management for the 21st Century Physician, by Gigi Hirsch, MD (American Medical Association, 1999).
Physician Executives: What, Why, How, by George E. Linney Jr., MD, CPE, FACPE, and Barbara J. Linney, MA (American College of Physician Executives, 2000).
Hope for the Future: A Career for Physician Executives, by Barbara J. Linney, MA (American College of Physician Executives, 1996).

It�s academic: The route to an MBA

Physicians interested in obtaining an advanced business degree can do so through traditional MBA programs or a variety of long-distance offerings. Whatever you choose, make sure it�s accredited. The American College of Physician Executives (ACPE) offers a Master of Medical Management in conjunction with Carnegie Mellon University, Tulane University, and the University of Southern California, says Barbara Linney, ACPE�s vice president of career development. Students combine long-distance course work with three one-week stays on the campus of the school they select. They can take up to seven years to finish. �You pick the time of year, location, and hours you want to study, and move at your own pace,� Linney adds.

The University of Tennessee�s Physician�s Executive MBA (PEMBA) program lasts 12 months. �About 50 percent of the contact hours are earned in four one-week residency periods on campus,� explains Michael J. Stahl, PEMBA�s director. �The rest is delivered over the Internet. Classes are held every Saturday morning from 9 to noon, Eastern Time. Participants and professor can interact during this period. If a student can�t be at the computer at the scheduled time, the audio component is stored digitally and the physician plays it back later. You have a question? Telephone the professor or send an e-mail. �We deliver high-quality learning without forcing students to travel,� Stahl says.

Enrollees in the Johns Hopkins Business of Medicine program commute to the Baltimore medical school campus one night a week for a three-hour class. The required 17 courses are completed in about four years, according to Douglas E. Hough, who directs the program. �We�ve tried weekend courses, but physicians tend not to want those,� he says. There are also nearly immediate payoffs: �A pediatrician in the program who practices with her husband has seen their revenues go up 30 percent over the past year and a half, in part because she now understands the mechanisms of billing and getting paid,� Hough relates. He expects that the school will offer a long-distance program once it �gets the technology down.� ####

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