The Anxiety of Leaving Practice


As someone who makes his living helping physicians create jobs and business opportunities outside clinical practice, you may think this is a surprising article for me to write. It may sound like I’m trying to talk you out of a nonclinical career. That’s for you to decide, therefore not my intention. I am writing this to simply tell you the truth. I’ve worked with physicians for more than 30 years… listened to their stories, helped them establish practices, businesses, bought and sold medical practices, and helped them start new lives. Following the old adage that forewarned is forearmed; these are some of my observations.

Don’t ever let anyone say you’re not a doctor anymore just because you stopped seeing patients. The stories I’ve heard sometimes go beyond belief… the emotional punishment I see physicians endure when they say to friends and colleagues, “I think I want to find a nonclinical career.” First, you have to read my list of the Top Ten Truths Every Doctor Needs to Know When it’s Time to Leave Practice.

Facts aside, what should you expect as you begin to explore nonclinical careers and departing from clinical practice?

1.     Very often the first anxiety is internal. It’s a sense of betrayal to your education, your training, and your practice. Most physicians I speak with, and realize that number is in the thousands, entered medical practice with the belief and expectation that it would be the only job they would ever have and they would likely practice until a late, sometimes very late, retirement. Most.

If that was your expectation, and you’ve been in practice any period of time, then career change represents a real shock to your psyche.

2.     Next is the external pressure. I once had a client whose spouse was so upset about his desire to leave practice he had to leave the house for our weekly phone meetings. Let’s just say, it didn’t end well. Family, other physicians, mentors; all can see your decision as letting both you and them down. Realize, even your children can have a significant portion of their identities tied to your being a doctor. 

Colleagues can be an interesting group. You’ll have some who disparage your decision, some who cheer and some who are so envious they are unbearable. I had one client who after making his new career decision was so happy he called his residency mentor to tell him what he was doing. Expecting that same mentoring encouragement, he was completely devastated when the mentor turned on him, accusing him of wasting his education, the mentor’s time and every resource that went into his medical education and training. 

Therein lies the very interesting medical education, training, practice paradigm – a professional paradigm unlike any other.

1.     No other profession trains individuals to believe they are qualified to perform only one task.

2.     No other profession starts “new grads” at a salary level equal to the highest income they will ever make in their lives – some surgical specialties excepted.

3.     Medicine does, and it has to do this, because no other profession levies such high levels of educational debt on its students. In short, the paradigm is rigged to force physicians to practice medicine.

4.     Why, because the number of physicians is strictly manipulated to insure a constant shortage – thereby a constant demand that insures financial stability and success. 

Physicians area treated as commodities from the day they enter medical school, their numbers controlled by actuarial calculations based on so many in and so many out and within each specialty. 

Next, consider education.

1.     Every physician believes every other physician should experience the same pain he or she experienced to make a career transition. If one physician got an MBA, every physician has to get an MBA. Trust me, you don’t need an MBA. But if you want one, let the company that hires you pay for it. It will actually have some meaning then as you apply your learning to your day-to-day responsibilities.

2.     Further, education does not have to mean a degree. You may want or need some additional education. There are many ways to become educated without adding the time, expense and frustration that comes with another two to three years for your next degree. Quick, who can tell me the highest degree earned and from where of John Thain? How about Douglas R Oberhelman - C. Douglas Mcmillon? If you have to look it up, it doesn’t count.

3.     You’re accustomed to your career being controlled by your educational credentials. Get used to your career being controlled by your accomplishments. You’ve accomplished quite a bit, you just need to know how to express those accomplishments in a way non-physicians can understand, appreciate and value.

Let’s talk more about physicians punishing physicians. More physicians than you could imagine say the same thing to me…. “We’re the only profession that eats it own.”

1.     A physician once told me he’d had a successful decade-long career working locums, but decided to open a practice and stay in one place since he was getting married. His medical license was denied because, in the words of the Medical Review Board (all physicians), there must be something wrong with him since he couldn’t get a practice before and had to practice locums. He could have had a traditional practice, locums was purely a lifestyle choice.

2.     A physician told me she was fired from her ER job – by her medical group, because she was diagnosed with MS and asked for a reduced schedule.

3.     A physician told me a recruiter told her she was “un-hirable” when after needing an extended period for recuperation from surgery, her health systems “terminated” here contract but offered reinstatement once she recovered. She was un-hirable because the word “terminated” was used in her letter from her employer.

4.     A physician’s license was placed on probation because a marital argument in a foreign country resulted in a police visit. That visit was conveyed to his State licensing board that believed it was grounds for probation.

5.     What’s your story?

An exercise I suggest to many clients is to stop three or four people randomly on the street and tell them you just finished your education and/or training in …. You pick the profession, law, architecture, accounting, etc… and ask them what kind of jobs they think you could get. From experience, I can tell you, those people will offer a wide variety of career outcomes. Next, stop four or five people and tell them you just finished your medical education/training, and ask they same question. I can promise the response. “Wait, you just said you’re a doctor? Then you’re a doctor. Doctor means training, education, and career. It’s both a means and an end.

So, where does this lead? You must create your own path, your own roadmap to your next career. Every physician asks me, “What’s out there,” and the answer is anything you want to do. There is not “must do” next step when you leave clinical practice. There are obvious ones, but that’s all. They are obvious, not necessarily easy to access or desirable or appropriate for “you.” You may endeavor on this process by yourself, you may work with a consultant or advisor, you may even choose to work with me. But ultimately, the path you follow will be unique to you.  If you dedicate yourself as much to that new path as you have up to this point to medicine, it will be an enormously rewarding path indeed.  Good Luck.