What physicians gain and give up in non-clinical roles
Tradeoffs in the Era of the Portfolio Career
Despite the focus on medicine to the exclusion of all else during medical school and training, most physicians have a wide variety of talents outside medicine. There are the famous examples of Michael Crichton, Che Guevara, and Maria Montessori, but I’m guessing your medical school could have (or did) put together an impressive band, sports team, or art show in a matter of hours. Because I get to spend hours talking to other physicians in the operating room, I’ve gotten to learn surprising and fascinating facts about physicians’ lives. I’ve known physicians who were real estate moguls, stand up comedians, astrophysics bloggers, professional portraitists, and competitive athletes of every sport.
With so many talents and aspects to their lives, it’s not surprising that physicians want to use their brains differently than they do in their clinical work.
This pull between clinical and non-clinical work is a constant consideration for many physicians; how much time should they devote to each, and what are they gaining and losing with each? This exists on a spectrum, of course, from only clinical work to only non-clinical, with a varying amount of each between those extremes. The reality is that doing “just” clinical work as a physician is relatively rare, and also that most physicians I talk to want to keep doing some kind of clinical work.
The Portfolio Career
Sometimes these are called side gigs, but I prefer the term portfolio career, describing when people have more than one aspect to their careers at a time.
We’ve discussed that physicians bring a valuable knowledge base and skill set to both the AI lifecycle and the healthcare system overall.I believe encouraging practicing physicians to be involved in leadership holds enormous benefits for health systems and healthcare technology overall. This is an area where there’s a major divide in how the medical and nursing professions approach leadership: most physician leaders in a system still practice, and most (but not all!) nurse leaders don’t. I believe that being intimately involved in daily clinical activities gives physician leaders more insight and believability when they bring up issues, as well as in approaches to solving them. As an aside, many nurses have mentioned that they would like to continue to practice after taking on non-clinical or leadership roles, but that their employment contract wouldn’t allow them to.
What you’re gaining with non-clinical work:
More transferable skills
Physicians have an opportunity to become leaders and managers with basically no formal training in business. That’s sometimes a great chance to develop and hone skills that you might want to use in other areas of your professional life. If you’re interested in a CMO or CMIO role eventually, being a Service Line or Department Chair is a great way to get experience using soft influence, budgeting, presentations, and learning how the hospital Board works. Or if you move into an informatics role, you’ll gain technical skills and knowledge that could benefit you if you want to move into a more technical part of medicine. Negotiation is a key part of any business transaction and doing this in a non-clinical role and context may be beneficial. We’re used to negotiating with our patients about their care plans, but many physicians feel uncomfortable when the negotiation involves money or conflict.
Possibly more control over your time
One of the main issues I hear from physicians wanting to leave clinical medicine involves something about time. I think the desire for a different schedule can be broadly broken into:
Wanting more control and autonomy over how you spend your time, even if it’s not necessarily fewer total work hours. This category includes wanting to be able to be home at a certain time to pick kids up from school even if it means doing a few hours of work later in the day, for example.
Not wanting to work nights or weekends. (Almost) no one wants to do this, but for some people and at some points in their lives it gets harder.
Wanting to spend more time using your brain in a different way. It’s how you’re spending your time, not the time itself
Compassion fatigue and/or burnout. Seeing too many patients too quickly for too long, or neglecting other parts of your life that are important. Working less in the non-clinical world often seems like a possible path through this issue.
Knowing which of these buckets you fall into is helpful when evaluating new opportunities, because not all non-clinical options will involve a schedule that is “better” for everyone. And I say “possibly” because if you add non-clinical responsibilities without decreasing the clinical side, you will not have a better schedule.
A chance to solve problems on a bigger scale
How often have you had the same issue happen in your clinic or hospital and just wanted to fix it? Or felt like you enjoyed seeing patients but that you wanted to contribute to a healthcare change in a more big-picture way than is possible with one on one interactions? There are certainly a lot of ways that healthcare could be improved, and you probably went to medical school because you wanted to make a difference in the world.
A chance to learn/intellectual stimulation
At some point in most peoples’ careers, they hit a point at which the intellectual challenge may be markedly less than they’d like. This is great in the sense that it means they’re good at their jobs. They can recognize patterns quickly, are accustomed to reading the literature and can pull out insights from journal articles that they can apply to patients, and have seen enough to feel confident in their decisions. However, physicians’ natural curiosity and enjoyment of learning may make them want to be a learner instead of a the expert.
Public recognition
Part of the burnout issue with physicians is that many I talk to feel like a widget in a factory that can be replaced. This lack of distinguishing between the high and low quality doctors in medicine is unique. Almost every other field has some kind of acknowledgement, either via pay (think higher billable rates for attorneys with better reputations) or more attractive business terms (many businesses will pay a premium to work with partners they trust). In medicine, there’s no real difference in recognition or pay when you do a great job vs a mediocre job except for possibly your patients being appreciative. Being recognized for your talents can help affirm your contributions.
What you’re giving up with non-clinical work:
Focus
One of the great things about medicine is being able to sit with a patient, look in their eyes, and talk through their problem and how to help them. Though many of physicians feel pulled in many directions throughout the day, not having non-clinical responsibilities means that you can enjoy this focused time with fewer mental distractions. For some physicians, that can be incredibly meaningful. Additionally, context switching is very costly, as I recently discussed.
The ability to ignore problems
Most mid-career physicians have had the experience of realizing something needed to be changed at their hospital and clinic, quickly followed by the sinking realization that they were the one responsible for fixing th problem. When you’re exhausted from call and want to go home, meeting with nursing leadership about a systems issue is not how you want to spend your time. But once you take on a non-clinical role, you can’t ignore those kinds of problems anymore. The buck stops with you, whether you feel like dealing with it or not.
Immediate feedback
One of my favorite parts about being an anesthesiologist is that I usually know if I’ve done a good job that day. I give medicine and the patient’s physiology responds, or try a treatment for post-operative nausea and vomiting and the patient wakes up not vomiting for the first time in her life. Or I place an epidural in a laboring woman and she becomes comfortable. Those kinds of feedback are missing in many non-clinical jobs. What does success look like when your goal is to maximize your impact on the healthcare system? It will be different for everyone, of course, but our healthcare system will never look perfect.
Job security
Being a physician is a pretty secure job. Although the pace of private equity acquisitions and increased competition means physicians may feel less secure in their positions than they previously had, it’s very unlikely that a physician would not be able to get a job somewhere. It may involve moving or doing locums, but the chances that your income will dramatically decrease, or that you might not be able to find a job, are extraordinarily low compared to many other comparably paid professions. Being in a non-clinical role is unlikely to be as secure as a traditional doctor job. Entire units of companies can be shut down or the market can go downhill, for example. I still think non-clinical physician jobs are fairly secure, but it’s more likely to take a few months, rather than a few weeks, to find a new gig.
Decreased cognitive load
As I recently described, cognitive load is a major contributor to burnout, and increasing this - particularly if you continue clinical responsibilities and add on multiple additional non-clinical roles - could increase the already-high cognitive load most physicians experience.
Expanding your clinical skills
If your focus is on non-clinical activities, it’s likely that you’ll spend time learning more about that field rather than honing your clinical skills or trying the latest clinical innovation. You can still keep up, but it’s unlikely you’ll be at the forefront of clinical innovation.
Your contributions to the healthcare system are important and come in many forms. Whatever you decide to put in your portfolio career, I hope it’s as fun as learning a new language or practicing your favorite instrument. Capturing the fun and challenge of medicine or a hobby in an adjacent field is not just a nice benefit - it’s the point.
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