Options for Those Without Postgraduate Medical Training 

Today we revisit six jobs in which no residency is no problem. With the right experience and preparation, physicians have successfully landed all of these jobs. And for many, residency and not board certification are not required.

This discussion was first presented in June of 2019. It was in response to one of the most common questions in the Physician Nonclinical Career Hunters Facebook Group.

If you’re in medical school and ambivalent about pursuing a residency, or if you did not match, today’s episode is made for you. 

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Why No Residency Is No Problem for These Jobs

Your MD or DO degree is valuable. It enables you to compete for jobs with PhDs and PharmDs. Remember, too, that these jobs are open to residency-trained physicians, often at slightly higher salary levels to start.

1. Medical Writing

For physicians looking for flexibility and home-based work, medical writing is one option. With a range of writing types, from blog articles to technical writing, doctors are sure to find something that fits their needs.

Travel requirements are minimal. But this job requires self-discipline. And, unless your writing is based on interviews, interacting with others is limited. As a result, this may not be the career for the gregarious extrovert.

2. Clinical Documentation Improvement

Medicare regulations have caused an explosion of companies focused on Clinical Documentation Improvement (CDI). As a CDI professional, you will be trained in the intricacies of translating chart information to billing codes. This work is extremely important to hospitals. It determines whether appropriate payments are received and how quality measures are reported.

You can find these jobs in several situations. These include hospitals, large consulting firms, and as independent contractors. For the last one, working on-site or from home is possible. The job requires working on CDI teams, interacting with physicians, and teaching groups of physicians how to document properly. 

3. Medical Communications

Generally, you’ll be working in marketing agencies that serve pharma and device companies. It’s a great role if you enjoy working in a conventional office with a regular schedule. Teamwork and communication skills are important. These ad agencies are found in most large cities in the U.S.

4. Consulting

Consulting is an excellent career choice for physicians without postgraduate training. Firms sometimes prefer doctors without experience. They can train them to their way of doing things, without the need to break old habits. Depending on the position, it may require significant amounts of travel. It can be very lucrative, though, with opportunities for advancement.

There are many companies to consider if you are interested. Here are some of the largest ones:

  • McKinsey and Co.
  • Boston Consulting Group
  • Deloitte
  • Bain and Co.
  • Huron Consulting Group

5. Medical Monitor

Doctors with experience in research or on pharmacy committees are suited to a career as a  medical monitor. Medical monitors support research studies and ensure that they are medically sound. They track adverse drug reactions. And they serve as liaisons between investigators and the Contract Research Organization or pharmaceutical company.

The job may involve some travel. However, it is usually less than consulting or medical science liaison (MSL) positions. There are hundreds of companies that employ medical monitors. Here are some of the biggest ones:

  • Parexel
  • Syneos Health
  • Covance
  • Icon
  • PRA Health Sciences
  • PPD
  • Medpace

6. Medical Science Liaison

An MSL is a good entry-level job in the pharmaceutical space. Ideal candidates must be familiar with the regulatory landscape. This career involves travel up to three out of five days each week. The MSL Society and MSL Institute are great resources. And the course Introduction to 6 Nonclinical Careers Any Physician Can Pursue will walk you through the process of finding your first MSL position.

Summary of No Residency Is No Problem

There are many jobs in the healthcare industry in which no residency is no problem. Since the original episode aired, additional jobs have been presented on the podcast. In Pharma, there are jobs beyond MSL and medical monitor positions, such as clinical scientist, clinical research associate, or technical medical writer for a CRO.  In Episode 209, Dr. Marsha Caton described the tactics for landing those jobs. And there will be more on that subject in Episode 214 with Dr. Laura McKain.

NOTE: Look below for a transcript of today's episode.

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Transcription PNC Podcast Episode 211

PNC Podcast Blast from the Past: No Residency No Problem

As I mentioned a few weeks ago, I decided to bring back some of the classic podcast episodes during this summer of 2021. They are the most popular episodes aired during the first two years of the podcast. And they are inspiring and informative today as they were when I first posted them.

Today, I'm revisiting my solo presentation of six jobs that any physician can pursue, even if you don't have a residency under your belt, or are not board certified. This discussion was first presented in June of 2019, and it was done in response to one of the most common requests I receive via email and in The Physician Nonclinical Career Hunters Facebook group. And that's "How do I get that job if I haven't completed a residency?"

If you're in medical school and you're ambivalent about pursuing a residency, or if you did not match and you want to expand your options, today's episode will be very useful. One of the things you must realize is that your MD or DO degree is very valuable and enables you to compete for jobs with PhDs and Pharm.Ds in many cases.

Here's today's presentation.

Let's get right into the six nonclinical careers that will save discouraged doctors. What do I mean by discouraged doctors? Well, I mean physicians like some of you who are discouraged because you have a medical degree, but you're underemployed because you didn't complete a residency or maybe you're discouraged because you're overworked and burned out.

There are at least six careers that I've found in doing the podcast and working with physicians through career change that are open to just about any physician with pretty much any background, because they depend more on the medical degree than on residency training or clinical experience. But don't get me wrong. These are careers that any physician can pursue. And for some, the clinical experience may provide a competitive advantage, but there are a few examples where actually not having the clinical experience may help. And I'll discuss that later, as I'm talking about particular careers.

Now I'm excluding some of the careers such as doing entrepreneurship or starting your own business. They're kind of a calling, they're not really a career per se, and that can go in hundreds of different directions. So, what I'm talking about is more of a formal career, generally working for an organization that builds upon the medical degree. There are situations where the company needs someone with that medical degree and with or without the additional clinical experience. They're really open to physicians in both categories. Because many of you tell me that you'd like to know what are the options out there for me, if I have limited clinical experience, or maybe I did a partial residency or something like that. So that's why I'm focusing on this group of six careers.

Now I want to keep this to a reasonable length today. So, I'm not going to get into the very nitty gritty details, but I'll describe each of these six careers enough to give you a sense of the pros and cons and the personality you might need to go into that. And also, some of the resources you can pursue. I'll describe each of them and provide the tactics and resources and also be giving you a lot of links. And some of those links are to previous podcast episodes, which address some of these careers.

And one more thing before I do that. Instead of going into the specific tactics that are common to all six of these careers, just let me mention, that you should do the following. The first is to have your LinkedIn profile to be complete. We've talked about that before and LinkedIn is a really vital tool as you're looking at pivoting to a new career. So, make sure you've done that. You must begin to network if you haven't already. And you can use LinkedIn, but you should network with med school classmates and others that you may know in and out of the field. So, keep that in mind. Most of these fields that I'm going to talk about have professional organizations, so you should surely take advantage of those.

And speaking of LinkedIn and networking and so forth, there are many of these that have groups on LinkedIn. They may be groups affiliated with professional organizations, or they may be free-standing groups. So be sure to look at that. And you, of course, need to find a mentor, if at all possible, maybe one or two, and follow the guidelines I've given to that before, which is to keep that a relatively informal relationship and don't put a lot of burden on the mentor. But simply tap into them from time to time to help you not make big mistakes as you're pursuing your career. I'm not going to mention each of those, particularly as we're going through the six careers.

Okay. So here we go. The first career is that of a medical writer. Now, this is actually a vast field in the sense that there's everything in there from writing technical papers and white papers or technical jargon for the FDA and for pharmaceutical companies to writing a book for the lay press and everything in between.

Most of the physician writers I've spoken to have done things like writing articles for online medical journals, write articles or content for CME and or be like a medical journalist, where you're writing for an actual published magazine, something like that. But there's a lot of different types of medical writing. And the ones I would focus on personally, would be the medical writing that you can do where you can get started gradually and work your way into it. You want to find out if you really like medical writing. So, most of us know what it is.

For the type of writing I'm talking about, you'd be pretty self-disciplined because you're either going to be freelancing or are going to be working for a company. But the companies on the plus side allow you to do a lot of the work from home because you don't really need to be in an office to write an article or to write a chapter of a book or something like that, or even to write material for the public. But you certainly have to be able to meet a deadline, which means you have to be consistent in your writing. And this issue of having writer's block really is not anything that you can fall back on because just like a ditch digger, digs a ditch, a writer writes. You need to get up every day and write or whenever you're going to be writing.

That's the type of personality. You can be a bit of an introvert unless you're doing the type of writing that involves doing interviews. You are kind of self-sufficient. You're going to be self-disciplined and you are going to stay on deadlines. There's going to be probably little or no travel unless again, you're going to some kind of conference and doing a summary of the conference. That kind of covers the pros and cons and so forth.

The question is "How do you get started?" There are a lot of tactics you can use to get started. I mean, the thing about writing is, and in anything really to get better at it is to do more of it. If you are practicing, then you can do some writing on the side for a variety of different publications. You can have articles published. Of course, they're not going to necessarily always pay you at first. Kevin MD and Medium and Doximity and others will publish your articles. If you look, you can find many of them at other outlets.

But then at some point you're going to have to try to get paid to do that so that you can phase out a clinical practice or leave the nonclinical job you're already doing. Let's say, if you're doing more of a paramedical job because you don't have board certification or a license.

You can learn more about this by listening to some of the previous podcast episodes. And those include my interview with Mandy Armitage, which is episode 22, my interview with Emma Nichols, that's 56. My conversation with Heidi Moawad, episode 63. And then two episodes with part one and part two with Andrew Wilner. Mostly we talked about his writing in the first part of the interview, which is episode 75.

Now the thing is, if you question how good your writing is, you should sign up for a writing course, perhaps through a local community college or something like that. There is a place where you can get some specific instruction on how to not only write better but do medical writing better and even create a business. And that's through Emma Nichols, again, who I interviewed in episode 56, because she has a course. She usually introduces a course through a free webinar, which can generally be found at sixweekcourse.com. And by the way, I don't have an affiliate relationship with her. I just have talked to multiple physicians that have gone through the course and they really enjoyed it. It teaches you how to do the business side of it, as well as the writing side to some extent. And she even has the ability to hire you for some of her business if you're a good writer. So, I would definitely check that out at sixweekcourse.com or just look her up by going to the podcast episode I mentioned.

The other resource I would provide for that in addition to her course is the American Medical Writers Association, which can be found at amwa.org. And as it sounds, there's a lot of resources there for medical writers. So, that would be something to check out. I guess that's what I'll say about medical writing at this point. You can look at those resources and get more into it if it's something that you think you might do. If you're really thinking of doing it, you might want to actually sit down over a period of a week or so, and write three or four articles. The same advice I give to bloggers and podcasters is to create some content before you decide that that's what you want to do and see how difficult it is. And if you enjoy it and if you love it, and if you get motivated by it, then you know you're on the right track.

Okay, let's go to career number two, a career in clinical documentation improvement. I love CDI - Clinical Documentation Improvement. It's something I enjoy digging into. I like learning the rules of the game and sticking to the rules and using the rules to help improve an outcome in a game. So that's kind of what it is. I've always found it interesting that we've had these industries grow out of nowhere in the last 10, 20, 30 years because of the regulations that Medicare and CMS have created.

Clinical documentation has never been a big deal until it was tied very closely to how the hospital or a medical group gets paid. And when I was working as a CMO, I was just intrigued by it because the outcomes that are now publicly published for hospitals and health systems and nursing homes and hospices now all depends how things are coded, because we don't have a great way for actually measuring quality without going into the medical record and the billing record as a primary source of the information. So, these arbitrary rules were created and we found that we needed experts to figure them out. And the CDI world has grown enormously.

It's a world where a physician becomes trained in the intricacies of translating the documentation, let's say in a hospital chart to the actual coding, such as the coding reflects the risk adjustment as needed to get paid properly or not to be dinged or when you're measured on your quality outcomes. Your risk-adjusted mortality and morbidity and things like length of stay and readmission rates, it all depends on coding. So, you have this huge business that's developed and you need someone to talk to the physicians and explain things. And there's a certain subset of those that need to be physicians themselves. It's the kind of job that involves working with others, talking with others. But you have to dig in and understand the rules of CDIs. There is some learning, but there's nowhere to get this kind of training except by doing it.

And so, this is a career that's grown up for a lot of physicians. The opportunities are to be employed by the hospital you're working at as a CDI, but you can also work for a company that does offsite reviews and helps interact with physicians or a company that places you into a hospital. So, there are different options here.

But it's something that can be quite interesting. And there's a great upside, because not only are you improving the apparent quality provided by the hospital that's using your services, but it also improves the bottom line most of the time, because the risk adjustment allows you to bill at a higher level of DRG. So, there's no real school you can go to learn this, but you can learn from an organization known as the Association for Clinical Documentation Improvements Specialists, ACDIS. So that would be a place to learn more, to sign up. It includes a lot of non-physicians in the group. And it also has courses that you can learn and you can become certified.

In terms of resources for my podcast, I had a couple of them. One of my early interviews was with Cesar Limjoco and that was episode number five. And by the way, he has a vast LinkedIn following. He has more than, I don't know, 10,000 - 20,000 followers on LinkedIn. It's crazy. You can find him there, but also you can listen to that podcast episode.

And then a more recent one with Christian Zouain who is someone who has the medical degree, but not board certification. He definitely has successfully transitioned into the CDI role and that's episode number 77. That's what I would do. I would access those resources and look into it. It's one of those things that if you have any previous exposure to the hospital environment, it would be helpful. I think Christian kind of came in through the UM side. He was working as a UM specialist, not a physician, let's say medical director, but kind of similar to a nursing role. But by virtue of that, he was able to get into CDI and has been really able to develop a nice career.

Let's move to career number three, medical communications. Now, this is one where you can actually see that it's open to both types of physicians, whether just the medical degree or also the clinical experience. And it becomes apparent as you're looking for jobs where you'll see that associate medical director roles are given to those who simply have the MD or DO degree or equivalent. And the medical director role is for those that are board-certified and have some clinical experience. But what is it? The ones I'm talking about are related to pharmaceutical companies in the sense that you're working for an advertising agency, which does the promotional materials and the supporting materials and sometimes the educational materials for the drugs of a pharmaceutical company, probably also for a device company, a similar type of situation. It's just a totally different environment. In a way, it's kind of like medical writing, but this is a very specific and specialized area that is open again to both.

You're going to be working on teams here. You may want to be a little more extroverted. You're not going to be holed up at home and working on these things. You're going to work together. You're going to be in an office environment, but there's a great opportunity for advancement. Basically, that's the way it goes. It's kind of a 09:00 to 05:00 job more or less, although sometimes you have to go to different meetings or you might have to go onsite to a pharmaceutical company to pitch something, or to explain a whole marketing campaign. You may be working on materials that are audio-visual. It's really quite advanced these days. It's pretty exciting and fun.

And one of the resources you could look at would be my conversation with Dana Carpenter in episode number 61. Now she relayed that the way she got the job was she had left clinical medicine and had started doing some writing and some consulting, and she had a pretty heavy presence on LinkedIn and out of the blue, one of these companies found her and asked her if she might be interested in joining their team. So, it does get back to the issues I was discussing earlier.

You don't necessarily have to be super creative because they actually have people in these ad agencies that do that part, but you're there as a medical expert. And you should focus perhaps on one type of area that's related to a particular drug or therapeutic class. Your medical degree is there basically so that you can learn new medical areas to expand into. So, you don't have to be an expert, let's say in women's health. You might start out in another area and eventually get that under your wings, so to speak. But you just have to have that experience that you can read and understand and take the information from the pharmaceutical company on the drug and its complications and its indications and so forth and so on, its uses. And then translate that into a way that people can understand.

And then also you're there to make sure that the creative people don't overstep what they're saying about the drug. So that keeps it real, keeps it honest. Dana said it was really such a wonderful type of job. She really loved it. She enjoyed it. And it's one of those that I've found people typically don't leave.

There is a resource that I have, I'll put a link here. It's a visual that I included in the original podcast show notes. And it basically shows the relationships or the parent organizations and the offspring ad agencies that focus on different drugs, different therapeutic classes or different areas of the country. The graphic has over 100 companies.

So, I would recommend if you're interested in looking at medical communications, which combines this scientific background along with writing and creativity and working with a team, then grab that, print it up, look at it, start looking up some of the companies you might look at geographically with something that's within your reach. It is possible to work remotely, but it's not the majority of the way that this works. But it does provide that as an option in some cases.Let's see, resources. That really would be that download. And I would look at those companies. They almost all have job listings or career sections on their website. So, you can just start there and start looking. And again, don't forget about networking, LinkedIn and finding a mentor.

The fourth area I want to talk about is consulting. Now I'm not talking about consulting from the standpoint of starting your own consulting business. And I've talked to people that have done that very successfully, but I'm talking about consulting as a job for a big company. And this is the one area where a consultant, a physician consultant, told me that they sometimes are looking for someone without clinical experience. I think partly it's because they can pay you less perhaps, but they want somebody with that MD degree. Basically, you are kind of similar to the PhDs they would sign up. But also, because they want to brainwash you, I guess, in a positive way. They want to teach you their way of doing things. They don't want you to come in with a lot of preformed ideas and ways of doing things. You know how some of us physicians are when we were practicing for 20, 30 years, how we get. And we want somebody who's going to be a little more flexible. So that's the one place where there may be an advantage to having less experience.

This type of job requires more travel. It depends on the company and where you're located. A lot of these companies are international and in some of them, it might be international travel, but certainly, a lot of it will be domestic as long as you're signing up for a domestic position. But it can be very interesting, it can be extremely lucrative. Let me just give you a list of some of the companies that I'm aware of. And I think these are all referred to as healthcare consulting firms. They're usually more than healthcare consulting firms. So, they have healthcare divisions within them. At least the ones I'm going to describe now. And these are the big ones.

If I were me, I would focus on finding out as much as I could about the first one and finding out what I would need to do to apply for a job. And that would be with McKinsey & Company. It's really considered to be one of the best, and I have no direct relationship with them. I get no compensation for recruiting for them.

McKinsey is headquartered in New York, but it's really around the world and it's an accounting and management firm. It's got a diverse array of healthcare consulting types of subsidiaries and probably employees, hundreds, maybe thousands of doctors around the world, at least. So, I would definitely look them up. There'll be a link to McKinsey in the show notes.

The Boston Consulting Group is another one. It's been around a long time. And it has a healthcare section that does kind of the same thing. There's just so much consulting going on for things like the CDI that I mentioned earlier for utilization management, for bringing on new service lines in hospitals for population health.

The third is Deloitte. I've been aware of them for many, many years. We had many consultations at my hospital from Deloitte. And then Bain & Company is another one. And finally, Huron Consulting Group, which I think bought the Advisory Board and has a bunch of other subsections that address healthcare consulting. But that's just a sampling. I mean, there are literally hundreds. And you can get into little boutique consulting firms.

Again, I actually don't have a podcast episode on this. The resource would be to just look at those companies, look at the career boards, look at what they're looking for and see if it's something that would fit with your needs.

The fifth one would be a medical monitor. This is another one more direct in pharma. The last two involve working for a pharmaceutical company directly or indirectly. A medical monitor is a person that helps to monitor research studies, making sure that the protocols are followed, answering questions, keeping the researchers on track.

It involves some travel. You're probably stationed more at the business and maybe even working from home a little bit and less traveled than let's say a consultant or an MSL would do, which we're going to talk about in a minute.

Usually, the medical monitor has some kind of science background in addition to the MD. So, anything that you have undergrad, or if you have a master's degree in the scientific area, or if you've had any exposure to working with patients or even a committee like the formulary committee or the P&T committee (pharmacy and therapeutics committee) in a hospital. Anything that exposes you to medications and in working with patients and or research would help get a job in this setting.

Now, most medical monitors work for what's called a CRO, a Contract Research Organization, which are the organizations at the pharmaceutical companies. They outsource their medical monitoring too, generally. There are LinkedIn groups related to this. There's no organization that I could identify.

In terms of podcast episodes, there was a conversation with Christian Urrea in episode number 70. Unlike medical writing, you do have to get out there, work with people. You have to work one-on-one with the researchers and their teams. You have to take that information back, to answer questions, you have to be educational and you have to be attuned to regulatory requirements. Maybe if you know a little bit about IRBs or Institutional Review Boards and the strict guidelines they require, that would be very helpful.

Just as a way of providing some resources, there are basically 10 or 15 primary CROs, big ones that hire many of the medical monitors, but you might want to look at these and to get more information to understand what the job description would look like. And the list would include the following. There's one called IQVIA. And then there's one called Parexel, Syneos Health. Company called Covance is a CRO and it's actually owned by Labcorp. ICON PRA Health Sciences and PPD, which is Pharmaceutical Product Development. And Medpace. So, that's eight. I'll stop there. I'll put links to all of those. And like I said, they all should have links to career boards for them.

Again, it's something where if you are interested in research and have had exposure to it in the past, you like working with people, that would be a definite option.

The sixth career would be that of a medical science liaison. Another career in pharma, kind of an entry-level or an introduction to pharmaceutical careers. You can go elsewhere once you've done the MSL job, but the MSL job is open to both board certified and non-board certified physicians.

What is it? Basically, you're interacting with key opinion leaders and influencers. They go by different terms to help educate them and take back information from them to the company about drugs or a therapeutic class of drugs. You are strictly on the education side, you're not promotional, although your activities may result in increased utilization of the drug, but it's more from an educational standpoint.

You have to understand the regulatory requirements, some of the things from the pharma code and the FDA. Personality-wise, if you don't mind traveling if you like getting out and working with people and communicating with people if you can be a little bit extroverted that helps. You're going to be doing more travel than the average job. I would say probably at least 50%, maybe more. So, it wouldn't be common for an MSL to travel let's say three days a week, and spend a day a week at home working, maybe two. And occasionally traveling to the parent company for your employer.

Again, you may not work directly for the pharmaceutical company. You may be working for a third party, kind of like the CRO, but it's a company that would hire MSLs and use them with different pharmaceutical companies. But anyway, yeah, it can be up to two or three days of travel. Now, some of the travel could be local. If you're in a very dense area, you can travel by car. If you're not in such a dense area and you are covering multiple states, you're going to have to travel by air. So, keep that in mind.

I happened to have interviewed many MSLs, so you can hear more from my guest Savi Chadha, it was episode 50, Linda Ho in episode 51. A review of MSL jobs in episode 66 and in an interview with Swati Shah in episode 89. I think you'll find those interesting.

There definitely is a Medical Science Liaison Society, which would be worth looking up as well. And something called the MSL Institute, which is really an online resource. It has been out there for, I don't know, roughly 10 years. And it just has dozens and dozens of articles, many of which are addressing how to seek the MSL career.

I think I'm going to stop there. Those are six careers that are open to any physician really. I could go on, but that is a starting place for those of you who feel frustrated and don't know where you should go. You can start with those six.

As you can see, we've addressed these issues in prior interviews. I've tried to add some value here, so you can understand these six careers and that you have these options. And there's many more out there. I'm learning as we go just as you are.

I hope you enjoy today's episode. Since that one aired, I have had additional conversations with experts in pharma, and there are jobs to be had beyond the MSL and medical monitor positions. You can search for positions as a clinical scientist or clinical research associate or technical medical writer for a CRO using the tactics discussed in episode 209 with Dr. Marsha Caton. I'll have more on that subject coming up in episode 214 with Dr. Laura McCain.

You can find my show notes for today's episode at nonclinicalphysicians.com/noresidencynoproblem.


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