How Should I Start My Search?

In today's podcast episode, John answers this question: How do I start my search? He describes his experiences moving from practicing family physician to hospital chief medical officer.

Based on his conversations with podcast guests, and his own transition, he outlines an approach that works for most clinicians.

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The Highlights of John's Stepwise Approach

Given that no two people are exactly alike, here are John's experiences and some of the first steps you might take.

  • Acknowledge something is wrong.
  • Commit to addressing the problem.
  • Look for a solution in your current world.
  • Look for a solution near your current world.
  • Look for a solution out there somewhere.
  • Then learn about what’s possible, what’s been done before, and how did it work out?

Before Transition Process

Spend at least three to six months exploring your options. Depending on your circumstances, you may want to check out jobs in the pharmaceutical industry, hospital management, medical writing, consulting, working for the government or public health, or starting a small business.

And after you have knowledge of 10 to 20 alternatives, you can limit your choices to two or three, and really do your research. Then narrow it down even more, and learn how to pursue the particular career that you are most interested in.


There are a few logical steps one should take when first trying to identify a nonclinical career to pursue. Devote time to learning about nonclinical options through reading books, journal articles, or blog entries, and listening to podcasts. Use your network and talk to others about their nonclinical jobs. 

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

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Transcription PNC Podcast Episode 285

How Do I Start My Search for a Great Nonclinical Job?

John: For today's presentation, it's just me. I got this idea for today's episode because I received a number of questions from listeners like you, plus email subscribers and mastermind members. Some of those questions come up time and again, so they're kind of repetitive because they're things that we commonly think about when we're frustrated or trying to start a new career. Today I'd like to spend 20 minutes or so addressing one of the questions that I've encountered recently, because I know that many of you have the same question.

All right, let's get going. The question being asked today is in the title of today's episode - "How do I start my search for a great nonclinical job?" I get the question "How do I get started? Where do I begin?" They don't always throw in "great." I'll tell you a little secret. The reason that I sometimes put words in my titles is because they're more easily found and searched on Google and other search engines, and they give me a little higher score. There are the scores that you can apply to how well titles are received. I started with "How do I start my search for a nonclinical job?" and I had to throw the word "great" in there because it gave me a higher score, a headline score, you might call it. Anyway, you know what we're talking about today.

Now the assumption is this, as I talk about this topic, is that I'm going to take it from the perspective of myself, where was I when I found my first major nonclinical job. Because I did a lot of nonclinical things before I started, one that I spent more than a few hours a weekend. The assumptions that I'm making today and that I think are belay or behind that question that comes to me is that I'm unhappy, unfulfilled, maybe bored, maybe burnt out, frustrated, unhappy, or depressed. And I'm thinking as a physician that this is coming because I'm feeling that way about my job, about my career. I've got long hours. It's hard work. I don't feel that I'm being appreciated. And in retrospect was this really the thing I wanted to do for the rest of my life?

Now, sometimes that can be just the situation you're in, the temporary situation, your current colleagues or the person you're reporting to, or maybe the organization and just switching to a different organization would solve the problem. But I'm talking about someone who's really kind of already gone through that thought process to some extent. And I'm feeling that changing my job or my career is really the only option, or at least maybe the best option.

So, how did I answer that question? That question of how do I start my search for a great nonclinical job? What did I do? Looking back, did I do it the best way? Did I do it the quickest way? And I'll answer that question right now by saying no. But I think there were things I learned along the way, and it goes into my helping people now move along in their journey.

How are we going to approach this? How did I approach it? And can we learn from what I did way back when at the very beginning of my career transition? The transition that I'm kind of focusing on is when I really started out full-time practice, did some part-time side gigs, and ended up going into really a two-thirds time position as a VP of medical affairs, and then ultimately a full-time chief medical officer.

That was where I went through the process. And if it's having those feelings, I think most of you are having in terms of you are being very frustrated, or you're starting to really not like clinical medicine, or you've been sued a couple times, and I had been and really didn't think "Why am I spending all this time working long hours only to get sued because some patient is unhappy or feels like they didn't have the perfect outcome?" That's what I'm going to focus on today.

Let me summarize now at the beginning, and then I'll do it again at the end, some of the steps in this early process that you may need to go through. Not everyone's exactly the same. These are the things then looking back that I went through. I'll get into a little more details specifically about how to approach them and what they mean but here are the steps that I'm talking about.

Acknowledging something is wrong, making a commitment to address the problem, looking for a solution in your current world, or I was looking for a solution in my world that I was in at the time that might be called some other things we'll talk about in a minute. If that doesn't work out or doesn't seem possible, then look for a solution near my current world or your current world, or look for a solution out there somewhere.

When you get to that point, if that's what it's going to take, and this is where I think some of the other people get these questions, is where do you start? They're asking, what are my options? So that's kind of a brief overview of the steps, but let me go through each of these and maybe use myself as an example.

I don't remember being burned out in residency. It was hard work, but even then, I volunteered for extra things. In fact, in our program during our third year, you had the option of being the chief resident if you were selected. And actually, we had an election, and the current residents all three years selected the chief resident for the coming year. And so, my good friend and I actually both threw our hats into the ring. It was kind of a friendly competition. I don't think either of us would've been really unhappy if we weren't selected. And I think we even had to give like a five-minute speech, so to speak, or suggest why we wanted to do it.

But anyway, I was selected as a chief resident, so clearly, I didn't feel overwhelmed if I was willing to take on those extra responsibilities. And I did that. And, again, I don't think I felt burnt out during residency. There were some rotations that were frustrating. There were some periods of time where sleep was difficult but I didn't leave residency, like not looking forward to practicing. In fact, I was looking forward to it.

But once I got into practice, the first part that kind of made me think about something being wrong is that I was a little bit bored. I spent the first year or two in residency, as many of us do, still learning how to practice and how to work with my partners. I was in a small group. There were two that hired me. So, there were three of us, and after two or three years, they made me a partner.

But even from the beginning, I was moonlighting a little bit and sometimes those moonlighting jobs were in nonclinical. So, I ended up moonlighting as a physician advisor for utilization management. I'd spent an hour or two in the mornings, a few days a week helping the hospital meet its utilization management requirements for Medicare patients, basically because that's how CMS works. It puts the onus on the institution to make sure that you're keeping those patients within a reasonable length of stay and not overdoing the testing and so forth so that you can actually break even or make a little money as a hospital. But I wasn't doing it because I was burnt out. I had some free time and I wanted to make some extra money.

But there came a point that, I'd say two or three years later where I just very gradually increasingly became more and more frustrated with my practice. I had two partners and we were all working harder, just three of us, and we were doing OB for the first eight years I was there. We had a lot going on, and we were doing a lot of different things. We did start to all get kind of fried after a while. And part of it was the payments were going down for Medicare. We had switched to a DRG system several years before that. And that took a while to get used to on the inpatient side. And as family physicians, we were doing nursing home rounds and nursery rounds and hospital rounds and outpatient, and working a clinic for a local college. So, we were keeping super busy.

But I just began to get frustrated with my patients because I felt like I was just spinning my wheels. They weren't listening to what I was doing. I don't know, it just was the constant increase from year over year to working harder and feeling like I wasn't making that much progress, and that my income wasn't really going up the way it should, which is partly why I was doing moonlighting, which I think probably aggravated the frustration and the burnout.

I reached a point, and I think I remember telling somebody this or thinking this, that I really reached a point where I hated my patients. And I've said that several times before, and I don't think I really hated them. I was doing the best I could and a lot of my patients really, really liked me, and that was part of the problem. I would never fire my patients no matter how ornery or uncooperative they were. And so, I just kept building this larger panel of needy patients. But I did start to feel that.

And so, the first step is acknowledging that something is wrong. A lot of us, we put that thought off. We're in denial, let's put it that way. Things can be really bad and we haven't told anyone, we haven't told ourselves that, we haven't discussed it with our spouse. We haven't really made any changes. We figure it's just going to get better later, or this is just the way it is. And so, really the first step in this whole process is acknowledging that something is wrong. And obviously when I get the question from you and others that I work with "How do I start?" they've gotten to that point. They know that something is wrong. And sometimes it's okay to put a word on it. You don't have to name that something, but it could be any of the things I mentioned before. Moral injury or you feel underappreciated but you know something is wrong and something has to change.

Now, that doesn't mean what has to change is your entire career, but once you acknowledge something is wrong, the very next step that should follow shortly thereafter is for you to make a commitment to addressing the problem. And sometimes that doesn't happen. That could go on for years, feeling something is wrong and not really say, "Well, wait a second, it doesn't have to be this way. And I'm going to make a commitment to myself that I'm going to fix this, I'm going to make it better. I'm going to find a solution to this, whether it's in clinical medicine or outside of clinical medicine, but I have a problem. It's not necessarily of my doing, but it is of my doing if I don't make changes. And so, I'm going to commit to myself maybe even this year." Give a timeline like "I'm going to solve this problem. I'm going to find out how to solve it, number one, and then I'm going to take steps to make a change. And if it has to be a big change to a new job or a new career, so be it."

Now, as I try to remind people too, remember that sometimes when you're unhappy in a job, it's either because the people you're working with, in general terms, it's usually your manager. That's the number one reason. A lot of physicians don't technically have a manager, but there's somebody you're reporting to, whether directly or indirectly part of the hierarchy, particularly if you're employed by a large hospital organization or hospital system.

But if you can sometimes switch different department, different location, if you're in a super big system, you might be able to move to a different part of the system. But let's say you've contemplated that and you say to yourself, "Well, it's not really that, I just need a new boss. The way I'm practicing, the way medicine is practiced in general in this country, for the most part is not compatible with me being happy." And I've come to that conclusion.

All right, that was the second thing. Now you have to start looking for a solution. And again, this is where the questions come up. "I don't know where to look. How do I start?" Okay, very logical. I know there's a problem. I know I'm going to fix this problem, but how do I fix it? Where do I look? Well, okay, the next step usually is to look for a solution in your current world.

As I mentioned earlier, I was doing moonlighting at my hospital and I didn't mind it. In fact, a lot of times I liked the moonlighting more so than I liked the clinical practice. As a medical director for a family planning clinic, it didn't take a lot of hours but I was responsible for protocols. I was responsible for interfacing with the medical staff at the two hospitals in our town when we had patients that we couldn't find a physician for. We were doing pap smears and really well woman care and pregnancy tests. And sometimes we'd have a pregnant woman who needed to get in and it was difficult. And we developed solutions to that problem.

I actually kind of enjoyed those things. I was helping people on the administrative side as well as the clinical side as I was providing care in there. But I was also supervising several physician assistants, probably mostly nurse practitioners. It was natural for me to look within my current world, say, "Well, maybe I can do more things like that." Somewhere in there I got a mentor and he told me some things that I might consider. And so, I enrolled to get a master's degree in public health, mainly because I was working as an occupational medicine physician part-time in addition to working in my practice.

This brings up another point I want to make here, and that is some people don't get to this step very quickly because they feel like, or they believe that their partners, their organization, their clinic, people around them are not going to understand. And this is one thing that I'd like you to remember early in the process is that if you approach almost anybody in your organization in a positive way, in a curious way, in an honest way, don't assume they're going to not react in a positive fashion. In other words, some people say, "Well, I can't talk to my partners. They're going to freak out when they find out I'm thinking of leaving. Or this practice is pretty traditional. We all take 100% call that we're responsible for. We rotate for every fourth, every fifth, whatever it might be. They're not going to let me pull back a little bit and try some other things."

Because that is part of the first step is to look around in your current world. And for me it was in the hospital. I was part of a practice, it was independent from the hospital, but I was doing these things like working for the hospital as a medical director and for the family planning clinic. And then I was volunteering for other things. And as I said, I had worked as a physician advisor for UM so the hospital saw me as someone who was willing to do some of the jobs that other physicians wouldn't do for them.

Now, the part where the conversation might become challenging was when I had to explain that to my partners, because here I am, I'm in a 33.33% of a three-person group obviously, and we shared everything equally. So how could I do the moonlighting and do the part-time medical directorships? And to be honest, none of that income ever went through the practice. It came to me as like moonlighting income.

And so, as long as I was covering call, as long as I was seeing about the same number of patients and bringing in about the same amount of revenue in the practice, I was able to do these other things and they didn't really put up much of a fuss. But that's part of the burnout there because when you're doing other things, nonclinical things, maybe you have hobbies and you have a family and all kinds of things going on, and you're still trying to maintain that facade of being a full partner. Most people that get into business need to focus on one business at a time if you're a consultant or a business owner. And to kind of fool yourself into thinking you can do three or four different things equally well it's not true.

So, there came a point when I did have to have those conversations and I was asked to be the VP for medical affairs of the hospital. And this is where we get into the second bullet. You look for a solution in your current world, and if not in your world, like my practice, then you look for a solution near your current world. And someone might call that your zone of influence. Zone of control is things around you, the things you're responsible for, my practice, my partners and all that. But then I was looking outside of that zone of control into the zone of influence where I was already putting my toe in the water.

Now, this might be a little bit too easy because the situation I was in at the time made it very easy to do this because the hospital needed people. There weren't others willing to step up. And so, I just stepped into that gap and it worked out well. But I did have to have some pretty good conversations, pretty honest and straightforward conversations with my partners. And I just explained to them that I would continue to do what I could to maintain my share of the burden.

We did have a setup where if we did produce less revenue and did see less patients, then our income would drop. And we had a formula for that. That kind of automatically took care of that. If you don't have that right now, then there's going to have to be that difficult conversation.

But as I've told others that have brought this question up along the way here, even if you're in a large organization, they see the writing of the wall, they see that people are burned out, they see that people are requiring more freedom and a little more control and are requiring maybe a little more maternity and paternity leave. And then you've got FMLA and they've got to be more flexible.

I think if you go to your superiors, if you go to the people you work with in your group, even if it's in a large system and you have a conversation that's not threatening, you say, "Look, I'm really starting to get burnt out. And plus, it's not only the burnout, but I really would like to try some other things. I'd like to carve out a little bit of time without burning myself out where I can try these other things and maybe I can help the organization."

Now, you may not want to work for the organization in those roles, and so you might just have to say, "I just want to be honest. If things keep going the way they're going, something's going to give because I just can't do this. I don't want to do this. I don't mind working, I don't mind doing the specialty I'm doing right now, but not the way I'm doing it now. So, I'd love to figure some way for this to work while I'm still working with you and for you."

Most of the time they will listen, they'll say, "Look, we're aware of these things. We're trying to become more flexible." I've talked to many physicians who are doing job sharing or taking sabbatical for two, three months at a time or working halftime and then doing some side gig the other half. So, it can work out and don't be afraid to have those conversations.

That's what I did with my partners and it worked out. And so, eventually then I had to have a really tough conversation. I did it a little bit differently. I ended up leaving my partnership and still maintained my practice. And I went through that conversation and I said "Because I'm going to really split my time 50-50 with the hospital and I understand that for you guys, it's not going to make sense because I can't work 1/6 time and you guys somehow carve up the other 5/6." It wasn't going to make any sense.

And so, my plan was to cut my practice way back and to about half time and run it myself. And that's what I did. That probably added to my burnout, but that's why I did it. And it took me a long time to take all these steps and I see a lot of people getting into their new careers a lot quicker than I did. And that's why I'm here is to try and help you figure out the shortcuts to do that.

But to get back to the list of steps here, if you can't find something in your current environment, maybe work within your practice and become the managing physician of the practice and then cut your hours way back and then end up doing almost all nonclinical or just leave. Yeah, that's where you got to look for a solution out there somewhere. So, if you can't find it in your current situation or outside of it, but nearby, then you just got to say, "Okay, then I'm going to keep doing this until I find the plan and make the plan and I find the solution, but I'm going to have to leave this job."

That brings us to the next step, which I think also is included in this question about "How do I start?" A lot of people ask that question when they want to know what their options are. So, what are my options? I've figured out I'm not happy, I've made a commitment to solve this problem. I've looked locally, there's no solution here. What are my options? Because we don't need to limit ourselves to what we know about.

If we were just fresh out of residency and we kind of knew what a physician advisor was, we kind of knew what a medical director was, but there's thousands of jobs out there that we know nothing about that still depend on your knowledge of healthcare and on your medical background. And so, the next step in my opinion is that now is the time to really spend some time learning what's possible, what's been done before, how did that work out? Did those solutions sound like it's something I'd be interested in?

So, what you should spend your time doing, in my opinion, is becoming an expert in nonclinical options. And you start reading books. You start reading journal articles, you start listening to podcasts if that's your thing. You start reading blog on a blog posts, you decide whether you want to do something that's really on the fringes or completely nonclinical, like get into real estate or investing or things of that nature. I've talked to guests that have gone into essentially full-time investing, working as a representative, and a private equity firm or something like that, a partner, and actually still practicing, if you can imagine that. But you just need to learn what's out there.

Now, there's an infant number of things you can do, so you don't really have to spend years learning it, but you should spend at least three to six months figuring out that there's a whole pharma industry, figuring out that you can do a lot of things in hospitals and health systems that maybe you weren't aware of. Figuring out medical writing, consulting, doing something in government, including things in public health.

There are small businesses physicians can run or start. There are startups you can do, there's a lot of things. There's an infinite number of things you can do, but you should spend three to six months looking at those. I produced live content that will show you what's out there. A lot of other people do too. I'm not going to get into that right now.

But again, let's go through those steps just to make it clear. Acknowledge something is wrong. Commit to fixing or addressing the problem. Look for a solution in your current world. Don't assume it's not malleable, I guess is the way I would put it. Something in your zone of control. Maybe you can bend it to your will. Look for a solution near your current world, something that you're already aware of or know is out there, or have an inkling that it is and get a coach, get a mentor or something. Find out more, read, look at videos online. Take some courses if you would. Look for a solution out there somewhere if those two don't fill it.

And especially if you think "I really want to do something different" or "I want to combine something, that avocation I had in the past, art, music, something else with my healthcare background", go for it and look out there. But what you're going to have to do is look for the options, spend some time learning what's possible, what's been done before, and how did that work out for those that did it? How happy are they? What are the pros and cons? And once you've got a knowledge of 5, 10, 15, 20 possible different options, you can narrow it down to the two or three and then narrow it down even further and then learn about how to go through the process of pursuing that particular career that you're looking at. All right, I'll stop there.


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