Begin Your Career Transition in Earnest

In today's episode, we revisit the topic of 5 persistent myths that clinicians believe when they begin to contemplate a career transition. This presentation was given at the 2023 Licensed to Live online conference.

In today's fast-paced healthcare landscape, many professionals find themselves yearning for a more fulfilling and rewarding career path. To embark on this transformative journey, the first crucial step is recognizing the widely held beliefs or myths that hinder progress. The prevailing misconception that the only way to succeed is by adhering to the status quo may be one of the main barriers preventing professionals from embracing a more fulfilling path. 

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5 Persistent Myths

Once the myths are dispelled, a world of possibilities opens up. This journey often involves exploring alternative career options where one can leverage their expertise and training to make a meaningful impact in unconventional roles. Embracing a different direction, such as pursuing a nonclinical career or venturing into healthcare innovation, allows professionals to find new avenues for personal and professional growth.

In this list, we debunk the following persistent myths:

1.  “There are no jobs.”
2.  “I'm not qualified.”
3.  “The salaries are low.”
4.  “I'm abandoning patients.”
5.  “I won't be respected.”

Best Kept Secret

The first of the 5 persistent myths pertains to available jobs. In fact, there are several large industries that hire thousands of physicians each year to do nonclinical work:

• Hospitals and health systems,
• Pharmaceutical and medical device companies,
• Medical publishers,
• Educational institutions,
• Consulting firms,
• Federal, state, and local governments, and,
• Life and health insurers.

Additional Training Not Required

The next of the 5 persistent myths pertains to necessary training and skills. For most of these new careers, the primary qualification is the completion of medical school. Such physicians have broad exposure to the life sciences, an understanding of the U.S. healthcare system, and how to interact with patients. Additional education during residency and fellowship and board certification are sufficient to qualify us for most of the remaining positions.

Sometimes, additional certifications and degrees may be preferred. But for the most part, it is the physician's unique background, training, and experience that prepares them for these nonclinical jobs.

Incomes Improve

The next of the 5 persistent myths pertains to income levels. Salaries may be less than those for clinical work initially. But that will be offset by improved lifestyles and work-life balance. Benefits and vacation time are often quite generous. And most physicians experience opportunities to quickly advance and enjoy very attractive income levels over time. 

What About the Patients?

You'll be helping patients in new ways and sometimes much broader ways and in larger numbers as you can one patient at a time…

In pharma, you'll help develop life-saving drugs. You'll reduce pain and suffering for large groups of patients in public health. And in consulting, you'll bring new and improved models of care to hospitals, and help implement new service lines.

Reputations Improve

The last of the 5 persistent myths relates to your reputation and identity as a “doctor.” Generally, these positions have an impact on larger groups of patients. And physicians become content experts, managers, and leaders over time by combining their medical expertise with skills in their new industries. 

Summary

In the ever-evolving healthcare landscape, it is vital to challenge long-held myths and beliefs that may hinder professional growth. By breaking free from corporate-style, high-volume models of care, healthcare professionals can unlock their true potential and enjoy their work again. Leveraging one's medical expertise in innovative ways is the key to unlocking a fulfilling and purpose-driven career when the traditional healthcare system fails us.

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

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Links for Today's Episode:

• How to Kill the Myths About Alternative Jobs for Clinicians – 252
• Month One of the 12 Month Roadmap to a New Career – 269
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 309

Let's Dispel These 5 Persistent Myths About Nonclinical Careers

John: All right, nonclinical nation. Let's get right into today's presentation in which I do my best to dispel five persistent myths about nonclinical careers. Let's start by talking about Dr. Brenda M. She's two years into her first job as a hospitalist, and she's feeling very unhappy and disappointed.

Now, when she was in medical school, she really enjoyed it, although at times it was a little bit overwhelming, but all in all, she felt maybe some slight burnout during certain parts of that for a year program. And then she went on to her internal medicine residency anticipating becoming a hospitalist. And during that time, again, she was happy to be there, but she really started to feel as though she was getting burned out. There just was too much work to do. There wasn't enough support and not enough recovery time before the next shift or the next clinic and that sort of thing.

But she thought, "Well, I'm going to try and find a really good job in a location that I'm interested in, and by then, things should get better." And we've all heard this, right? And some of us have felt it recently. It seemed like the burnout from medical school to residency to practice just kept building on each other.

But she joined a group. She thought, "Well, it seems like the coverage is good. There's enough of us to take care of this hospital." She was promised a certain number of days off each month, and things were going well at first, but then the support staff seemed to be falling off and not being replaced. And the volumes that she had to see during those two years kept increasing to the point she felt like she never really could keep up. She had to go back and do her medical records when she was at home online. And she just thought that things were not going the way she anticipated.

Now, she was really starting to think, "Well, maybe this just isn't what I thought it would be, and maybe I need to do something else." But every time she had those feelings, she sat back and thought "There's just no way I've spent my life learning to do this job. I don't really have other options. I'm going to see a drop in my income." With still having some outstanding loans, even though there was some partial payback through her employer, she felt constrained. That's what someone in the past called the golden handcuffs, in a sense. You make a good living, but at the same time, there's huge pressures. The income doesn't really seem to go up unless you just work longer and harder. And it also seemed as though she would be letting people down if she were to not continue on in her clinical career. Her family, her friends, and even her patients.

This is a common thing that we see in today's healthcare environment. And if you're frustrated or disenchanted about your work in healthcare, if you feel as though you're being ignored and taken for granted, or that you've been forced to forfeit your autonomy to do what's best for your patients, then it is entirely reasonable and even necessary to consider a nonclinical career in order to maintain your integrity and maybe even maintain your sanity.

You certainly aren't alone. In fact, tens of thousands of clinicians over the last decade have come to the same conclusion. However, many of us like you are hesitant to do that because of several myths that our employers and training programs promote in order to maintain the status quo.

We continue to suppress our feelings that something is wrong and delay implementing the solution to these problems. So, what is the solution? Well, for the most part, it is to take the next step in your professional life and join all the other professions who make at least five to seven job changes, and try and find a career that leverages your training and experience outside the traditional unrewarding assembly line corporate style approach that is currently the predominant way that healthcare is being provided.

But to do that, one of the first steps we must take is to recognize these widely held beliefs or myths that hold us back and dispel those myths and enthusiastically embark on the next phase of our professional lives. That is really the major solution. Other solutions would be to retire early, do something else. If you're independently wealthy or you have a spouse who's willing to provide the financial while you do other things, that would be great. But basically what we need to do is set ourselves on a new path. But first, most of us have to try to overcome these widely held myths that hold us back.

All right. So, let's talk more about that. I think if Dr. Brenda does the same thing, she will find herself in a better place. And so, I want to answer these questions today as we go through this discussion. First of all, what do I mean by nonclinical career or nonclinical job? What are the five most common persistent myths that we encounter? And how can I dispel those myths and prepare you to find a nonclinical or non-traditional career, if that is your goal?

All right, what I'm talking about today when I'm talking about a nonclinical or non-traditional career, it's an alternative career, an unconventional career, one that is based on your background, your education, training, and experience in medicine, or even nursing or dentistry or pharmacy. Because a lot of the concepts I'm talking about today apply to those other clinicians that often find themselves on the same team and in the same situation as we are in which is we're being overworked, we're being abused, and we need to try something different.

Now, those nonclinical jobs usually include a term that indicates that it's still within the healthcare system. For physicians, it means it might include the term physician or medical. For nurses, it'll include nurse or nursing. And dentist, dentist or dental, those kinds of things.

For example, I'm talking about careers like physician advisor, medical director, medical writer, executive medical director, chief medical officer, chief medical information officer. It could be the same thing. Chief nursing officer, nursing director, that kind of thing. And these kinds of jobs also apply to those other specialties in other fields that I mentioned a minute ago.

Now, I'm not addressing what some might call self-limiting beliefs, the feeling that I'm not good enough, I might fail, there's something wrong with me. It's too much to learn, it's too hard to do. Those are internal, again, self-limiting beliefs that are really generally pretty easily overcome. We had to overcome those kinds of thoughts when we contemplated going to medical school or nursing school, or get our PharmD or our DDS, those kinds of things.

I'll list the five most common myths that I encountered. I'm going to list them, state them in a way that is at the extreme. What we're saying to ourselves, what our former instructors and professors and employers wanted us to think while we were in training and even in our current positions.

And these are the kind of things they want us to think we fall victim to. One is that there are no jobs for us that aren't within healthcare, per se, in patient care, that I don't have the qualifications. I have no qualifications. I'll make no money. Obviously, you'll make some money, but the money I'm going to make is going to be completely inadequate. That I won't be helping patients anymore, which is what I really went into healthcare and medicine, or nursing or pharmacy to do. And then I'm going to lose my stature. I'm going to lose all my respect because I'm just going to step away and do something that's not as noble in a way.

I'm going to take each of these individually, describe them in more detail, and then address how to really understand why these are myths and therefore, kind of take away those barriers to you moving forward with your next professional advancement and next stage in your professional career in that field. You can be a physician, you can be a nurse in the nursing field, in the medical field, but not in the same clinical way that we've done in the past.

I remember a colleague and a mentee of mine, Dr. DH, I'll use his initials. He was a vascular surgeon, and he really got to the point where he just felt like he could no longer do his job. He was in this situation, we often find ourselves in, particularly if you're a specialist, which is relatively uncommon. What happens is you end up working somewhere and there's a few number of you helping each other, supporting each other, and covering for each other.

So you go to, let's say, even a big academic center, and they say, "Look, we need to have a service of three or four vascular surgeons." Okay, great. That's a profession that takes a lot of training. So you're careful. You do all your interviews, you find you're going to join this group of three other vascular surgeons, you're going to be able to do this surgery that you want to do, and not be doing general surgery, for example, when really you were trained to do vascular.

And some of the vascular surgeons even narrow that down further, of course. Well, Dr. DH found that he was there and things were good at the beginning, and then they had EMR issues, and they had to change EMRs. And all of a sudden he was having to do a lot of documentation at home and on weekends, because it wasn't really that efficient. They were still trying to bring it on and develop better protocols and order sets and so forth. So that didn't help.

And then the staff, again, I mentioned this with Dr. Brenda, the staffing was cut back on the areas where he was working, whether it was in his clinic or even in the OR. And then it turned out one of his partners left and they dragged their feet. Even though he was recruited to be one in four, they dragged their feet, then he was one in three call, and then if someone took vacation, it was one in two call for a week or two at a time.

And there seemed to be no effort to really find a replacement and no ability or desire to hire locums, even to provide some temporary relief. And so, he found himself in an untenable situation. Meanwhile, his kids were growing up, he was working long hours, he didn't get enough time to spend with them, and he found it was time to make a change.

At first, he thought "I'm going to have to look for a different kind of clinical job because of this myth of I don't know how to do anything else or I can't earn enough money." He was a really good one to remind me about this common myth that "There aren't any nonclinical jobs that a vascular surgeon can do. I hear about my primary care friends doing these jobs, but I don't think there's anything I can do."

I'll come back to his story in a moment. But before I finish off with Dr. DH, I want to explain something to you about maybe one of the best kept secrets in medicine and healthcare, and that is this. What we're taught and what people talk about, especially in medical school, in our residencies, in our fellowships, is that there is this process.

You go from medical school to residency, you may have a fellowship after that and then you make a choice. You go into an academic practice, maybe you go into an employed situation that's not academic or in a small percent, you may even find yourself in an independent practice. And that's it. Basically, that's what you have to choose from. You have to kind of make a choice. Academic, large employed, maybe you can do something independent with two or three partners come in initially as an employed physician, and then later become a partner.

But what's going to happen in all those situations is as payments to physicians go down, even though you're sheltered a little bit from that in an academic setting or an employed setting, eventually it's going to trickle down to you that you need to produce more RVU and see more patients and do more procedures to maintain the income that justifies your salary.

Some large institutions, especially procedural ones, an ortho, other surgeries and cardiovascular can subsidize that through those procedural activities. But the bottom line is you're going to have to do more, and you're going to have to do them faster, and you have to see more patients to feed into that. And so, the whole system kind of breaks down, and it usually leaves us really disappointed and disillusioned.

What most people don't really realize, especially while they're still in their training and early in their career, is there is something beyond those options. In fact, as I think about it, I can define and describe at least nine major industries, all of which hire hundreds or thousands of physicians every year to do nonclinical or non-traditional work. Let me just go through that list. And again, your instructors, your professors, your employers, they won't tell you about this, but sometimes you'll see it. It's obvious. If you're working in a hospital system, you'll find out, "Wow, there are people who are leaders, who are managers in these health systems." Whether it's a freestanding hospital, a three hospital system, a large academic system. They all pay physicians and other non-physician clinicians to do management and leadership.

Pharma companies hire tens of thousands of clinicians every year to work full-time jobs in pharma that do not involve direct patient care. The insurance industry that includes disability insurance, somewhat more so life insurance. And then the big one is really health insurance. They hire a lot of physician advisors, medical directors, who become senior medical directors, who become chief medical officers. There's a lot of education by physicians in which they're doing straight education. It doesn't have to be in the context of direct patient care. It could be at universities, at medical schools, at PA schools, nursing schools. It could be online.

And there are, again, thousands of jobs. There are medical writing jobs. That's one of the most common nonclinical careers. There are consulting jobs, both freelance, individuals, small groups, consulting, as well as national and international companies that hire consultants.

There's consumer health, which means teaching the consumer about medical care, about the healthcare system, about anything related to that. There's government jobs, and a lot of those are in public health and so forth. And then there's lots of nonprofits that are related to the healthcare field that have to hire physicians with their expertise.

Again, I just wanted to remind everyone of this first one, that it's foolish to think there are no jobs. In fact, there are thousands of jobs. And it turns out that these jobs are available for every specialist in any area with any length of training, with any degree of experience. That's myth number one that we need to really put aside. You have to realize there are a lot of jobs out there.

Sometimes you've got to learn and do a lot of research to find the jobs, and there's some strategies to that. I'm not going to get into that today, but let me just say, go on LinkedIn, look up medical director, and you'll see page after page after page of jobs, and then it's necessary to figure out which of those might be appropriate for you, located in the appropriate places, and then begin the process of trying to find them.

That's exactly what Dr. DH did. He really started doing research. He was involved in a mastermind that I was running. So he had the opportunity to engage not only with myself, but with other physicians in various stages of their career transition. And he really did reach out to other past colleagues, did some networking, and within a very short period of time, had two or three options. Some of them were part-time clinical options, doing just a very smaller part of his specialty.

And he was looking at wound care and vascular, but other types of non-traditional jobs that did not require being on call, did not require long hours, didn't have complicated and difficulty use of EMRs. But ultimately he found a utilization management job in which he could apply his vascular background. And he became a UM physician advisor or really a medical director when you, when you're working for a healthcare plan. And he was the vascular surgery specialist as well as doing some general reviews. And he's been very happy so far.

Okay, that's myth number one. Now, what is the second myth? Well, that is like I said, "I don't have the training. I have no expertise." Sometimes I hear this put as "Well, all I know is medicine." And if you think about that, in a way, medicine isn't a thing in and of itself. We obviously talk about as though it is, but to provide medical care is really a compilation of many, many skills in different areas that one outside of medicine wouldn't think of putting together necessarily. I usually like to go through this thought experiment where you're at a large ship and the ship is sinking and everyone's jumping into the life rafts to try to get somewhere safe, to someone can come by and pick you up or find yourself on a desert island.

And in the experiment, just think about the professions of the people you would like to be in the boat with. Just think of all the people you run into. Sales people, managers, directors, instructors, police, welders, taxi drivers, you name it. If you were going to be able to choose the people in the boat with you, and there were two people you'd want to be with you in that boat, who would they be? And I contend that they would be an engineer and a physician. And some of this relates to the broad experience, a broad education both of those types of people have.

But how many times the people come to you to ask a question, whether it's about chemistry, whether it's about their pets, experts in medicine. There's many, many sub, I guess I would call them, expertise that we have that makes us attractive. And we're excellent employees.

I'll give you an example too of Dr. MA. She was a foreign medical graduate, basically, and she also did some work in preventive medicine, but she was having difficulty finding a position in the US because she couldn't get licensed. She started networking, she started taking a lot of courses, and she became aware of the fact that there was a job called the medical science liaison, which is quite often open to those without residency or a license or board certification.

And after about a year of networking and taking courses and joining the MSL society, she landed her first job. And really everything that she does as an MSL does use her skills as a physician, as an MD or some places would be an MBBS and so forth. But everything that we know is included in the curriculum applies to jobs like this. The biochem, the pharmacology, physiology, pathology, microbiology, anatomy, epidemiology, statistics, laboratory interpretation, physical examination, interacting with patients, radiography, interviewing skills, teaching and presenting to colleagues, healthcare, economics. There's just so many areas that we become experts in when we're going through our medical education. And there are many jobs even for those with the medical school background, a medical degree without residency.

If you're a physician, if you're a nurse, especially with an advanced degree in MSN, definitely an APN. If you're a physician assistant, if you're a PharmD, you have a lot of skills, knowledge, and also work habits that employers are looking for.

And so, let's really dump myth number two is that you need special qualifications, or you need an MBA, or that all you know is medicine, when in fact you know a lot and the combination of things that you know put you in a position to fill a lot of these jobs, otherwise, you will not be qualified for.

Now, the big one that also affects us more so in the last 10 to 20 years is this idea of really making no money or making an inadequate income because a lot of us have loans and those have to be paid off. And sometimes you get a clinical position where they're going to help you knock off $10,000 or $20,000 a year on your loan. But if you've got $150,000 out there, it's going to take a long time to get that paid off unless you're making a really, really super high salary, and you can accelerate that. And thinking, "Well, I know I'm going to take a big hit in this career in my salary, this nonclinical career, then it'll really hold you back."

I can think of Dr. ML, who was an OB-GYN, and she was very busy. A lot of OBs, a lot of weird hours, a lot of call, similar situation. Staffing was cut back. Some of her partners left, even though she was part of a large multi-specialty group. She was employed, and it just became quite miserable. And she thought, for sure, I don't have any special skills and there aren't that many jobs out there in a nonclinical field for an OB-GYN and also it's not going to pay enough for me to pay my bills.

Well, she ended up looking around, networking, working on her resume, working on her LinkedIn profile, and she ended up landing a job after several months of search, working for a Medicare MAC. For people that work in the hospital that have anything to do with billing, they will know that a MAC is a Medicare Administrative Contractor, and it's an intermediary that processes the payments between CMS and hospitals. And she became a chief medical officer at a MAC.

And so, she made a very good income. She had to work fewer hours. In fact, mostly now she's working from home, which was enhanced a little bit by the pandemic. But she has children at home so she can be available for them, work for this Mac, make a very good income that is commensurate with her clinical income.

And again, as I mentioned before, our incomes are going down, Medicare's paying less for each patient care visit, not keeping up with inflation. And a CMO job pays very well. In fact, if you look at some of the stats out there, this is from last year, from salary.com, the typical physician advisor, which remember includes some that are not licensed, that simply have the medical degree, would be about $134,000 a year. Now, that's a median. So people make more, people make less.

If you're an experienced clinician, you become an MSL and you've already got some contacts for that job, you're definitely going to make well over $200,000. Overall average for a medical director is $295,000 per year. And quote, chief medical officer is over $400,000 a year.

I don't know what she was making per se. I would say that she's probably at least in the 300 thousands. I think those higher salaries are for CMOs and hospital systems, pharma and big insurance companies. But definitely if you have a CMO position, that is usually a very awesome, well-paid position.

So, this whole idea that there's inadequate income, it's a farce. And plus you have to compare apples to apples. If you end up working a job like she's doing, which is for sure no more than 40 hours a week, most times, most of these nonclinical jobs are 40 hours a week, sometimes even less. Often they offer complete or at least part-time remote work from home and while traveling. To compare that to a OB-GYN who's doing 60, 70 hours a week of work minimum, being on call and having a really disastrous schedule, because you never know when you're going to have to leave home, really, there's no comparison if you have to take a little bit of a pay cut.

But everybody that I've talked to that's started a nonclinical job, within two to three years, they have surpassed their clinical income because now they're really hitting their stride and really providing benefits and support, and really are doing something at the job that really helps their employer succeed. That's three of the myths.

Fourth one, patients. "I dedicated my life to patients, and I won't be helping any patients in a nonclinical career. And it's hard for me to do. I don't want to abandon people." Well, here's the thing. If you look at it from a different perspective, there are reasons these jobs exist, and there's reasons why these jobs need a physician, because a physician or a nurse or a pharmacist is providing the expertise that's going to benefit patient care. That's the whole point.

You can go through almost every industry, and maybe it's not 100% across the board, but if you're working for a hospital system, you're probably helping with quality and improving quality improves patient care. If you're working in pharma, you're developing new drugs to either save lives or improve lives. There are some extreme examples. Imagine the people that worked on Gleevec. Now there's a drug that took what was a pretty much uniformly fatal disease and turned it into nothing. If you take Gleevec every day for that particular illness, you will never have a recurrence. I personally know a family member that's been using this drug for 15 or 20 years now. And there's hundreds of those drugs coming out every year.

And so, obviously, if you're a physician working in pharma, as a medical director or a chief medical officer, you're definitely benefiting patients. What if you're working in UM in the insurance industry? Well, I'll just say that you will on occasion stop patients from having a procedure or surgery that really was unwarranted to begin with, and you've avoided a possible death or disability or error resulting from that procedure. You're teaching in any capacity. You're helping bring on the next group of nurses, pharmacists, doctors, PAs, NPs, who are going to help patients.

Writing. You're educating by writing or doing journalistic writing or doing technical writing to protect patients. Again, I can go on and on. Consultants are bringing new services to hospitals and pharmacies and pharmaceutical companies and home health, consumer, health wellness nutrition, helping patients, sometimes better than the actual physician is helping them. When you step into a nonclinical, non-traditional clinical job, oftentimes you are greatly enhancing patient care, community care, and so forth.

All right, the last one that I want to talk about is "I won't get any respect." It reminds me of Rodney Dangerfield. Do you remember the comedian? He's been deceased for a few years, but he always talked about not getting no respect. He gets no respect. I guess I'll use myself as an example. We all have a decent amount of respect and admiration and a certain recognition in our communities as physicians. Everybody knows it's hard to do. It's a difficult career to pursue and maintain. It's a lot of hoops to jump through. And there's licensing and there's board certification and recertification.

And so, we think, well, we have that stature in the community, and it's fun, and it's good. It helps to interact with people, and it puts us in a position that helps us to help people actually. So, if you go into a nonclinical job, your reputation, your influence is going to be gone. Could say your gravitas as a physician might disappear.

But I'll use myself as an example. I was a physician, family physician, and back in the day when I first started, I was working at the hospital. I had admitting privileges, I had nursery privileges, and I even had OB privileges. I knew a lot of people. I did all those things as long as I could so I could grow my practice and over time I started to cut back. And I also did other things because I was interested in that. So I did physician advisor for a while and medical director for a family planning clinic and some other things.

But I was one of a hundred primary care doctors on staff at that hospital. I had no special sway or pull, people didn't listen to me a whole lot like the other family physicians. They had a little more likelihood of being heard if they had a concern or a request at the hospital, at least if they were a surgeon, particularly an orthopedic surgeon, neurosurgeon, cardiac surgeon, and so forth.

But over time, as I became VP for medical affairs and then chief medical officer, instead of being one of 500 primary care doctors that didn't bring a lot of revenue to the hospital, I became basically one of the most well-known and go-to physicians on the medical staff or in the medical and administrative hierarchy because I was responsible for quality and safety and hiring new physicians and recruiting groups to work for our hospital. I was over the lab in the pharmacy and people would come to me talk about formulary.

Really, when you get into these other positions, you're still a physician. Everybody's still calls you doctor, but now your influence and reputation in certain areas will actually be much more enhanced. And so, I've never really felt or heard or talked to anyone who said that as a result of them moving into a medical director role, or chief medical officer, chief quality officer, any chief role, for sure, that they had less of a reputation or felt like they were contributing less, and that it was recognized than when they were a physician.

You're still a physician. You'll always be a physician. You're likely going to end up managing a team. You're usually seen as a content expert. That's why they're hiring you in the first place as a physician for that role. And you're often a leader. In the hospital setting, you've always got a CEO or COO, but you've got a chief medical officer, chief nursing officer, and so forth. Same thing in pharma, same thing in health insurance. You're going to end up there if you persist.

That's what I wanted to talk about today. There were five common persistent myths that I hear about all the time and that are concerns to physicians, nurses, pharmacists, trying to move into a nonclinical career so that they can have a better lifestyle, they can have more control, more autonomy, and less feeling like an assembly line worker.

And so, these myths are wrong and there are a lot of jobs. You are already qualified for most of those jobs. In some cases, you might need to do a little bit more. You'll learn on the job for sure. Sometimes getting an MBA or an MHA or an MPH or something would be helpful or another certification. But basically you've already got the qualifications you need.

You will make a similar salary and you'll have the opportunity to make even more. I made much more as chief medical officer than I would as a family physician. You'll be helping patients in new ways and sometimes much broader ways and larger numbers as well than you can one patient at a time, and you'll still be respected. You'll still have that gravitas or that recognition.

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In actual fact, I had about 70% of a post ready to go two days ago. But I decided that it just sucked, so I sent it to the WordPress trash bin.

Since then, I have been vacillating over what to write about. At the same time, I have been thinking to myself “Why bother?” It is Thanksgiving day. Nobody is at home. And if they are home, they're cooking or eating dinner. Or they're already in a turkey- (tryptophan-) induced coma.

(Please, don't argue this point – I know that eating turkey does NOT cause increases in tryptophan, or melatonin. As a vegetarian that doesn't eat turkey, I can attest to the fact that I still get very sleepy after Thanksgiving dinner.)

Oh – one other admission…

If I was a good blogger, I would not be fretting over this, because I would have several posts already written and in the queue. That's more evidence of my failure as a blogger.

Maybe I'm being too hard on myself. After all, I ‘m not a professional blogger.

But I am trying to instill good habits in my blogging. And two of the rules are:

1. Be consistent and post on a regular basis, and
2. Write posts ahead of schedule so that little “hiccups” do not interfere with following rule #1.

Unforgettable Patients

So, I decided to write about the types of patients I have seen over the years that gently, or not so gently, reinforced my goal to stop doing any clinical work whatsoever. I had already begun working as vice president for medical affairs full-time. But I was still seeing patients 2 or 3 half days each week.

Keep this in mind: when you transition from clinician to administrator in your home hospital (as opposed to taking a job in a new city), it is easy to end up working one full-time and one part-time job. But I digress…

My primary reason for stopping the clinical work was to focus 100% on my administrative duties. I was getting very busy with administrative responsibility for six clinical areas within my hospital:

• Quality Improvement
• Risk Management/Patient Safety
• Pharmacy
• Physician Services
• Laboratory
• Imaging

Needless to say, the clinical work sometimes interfered with some of that work. Juggling both could get challenging. I clearly remember, however, some of the patient types that made me dread certain days in the office. I certainly did not miss the following types of patients when I left practice:

• The chronically ill and addicted. I had several Type 2 diabetic patients who were just NEVER able to get their glucose levels under control. I tried every kind of cajoling and combination of the  medications available. But they continued to drink alcohol, would not follow a diet, and refused to lift a finger to exercise. They were always surprised when they developed a foot ulcer or a scrotal abscess that would not heal.
• The 30- or 40-year old with one day of cold symptoms. They were often planning to travel and wanted to make sure they would not be ill while on their trip.
• The hypochondriacal patient with no confirmable medical illness. They came in weekly for whatever new hint of a symptom they had. According to my board prep CDs the treatment for this is to proactively schedule visits every week or so. What these patients really needed was reassurance and some face time with a physician. I get that, but it's hard to do when you're trying to care for several thousand patients with the help of a nurse practitioner and only 2 half days in the office.
• The overly familiar patient. He thinks that he's in the office to shoot the breeze for 20 minutes. My least favorite one of these had such severe obesity and sleep apnea that he had a tracheostomy and was on a home ventilator. His respiratory tree was chronically colonized with MRSA. He'd come in the office coughing through his trach and the staff would scatter.

Working in urgent care now, I don't usually see many of those kinds of patients. But I see many trivial illnesses that could be cared for via telemedicine or simple home remedies. It makes me wonder about the future of medicine.

It being Thanksgiving Day, however, I am reminded to be thankful. And I am. For my wife and family; my career; and even my patients. And my opportunity to try to serve my audience here on the Vital Physician Executive.

I hope you had a great week.

Thanks for listening.

John

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