When doctors don’t want to practice medicine

Consider those willing physicians hired by Big Tobacco decades ago to undertake research “proving” that cigarettes were not dangerous to our health. Back in 1969, for example, Post-Keyes-Gardner (the ad agency for tobacco giant Brown & Williamson) relied on the paid testimony of hired guns with the letters M.D. after their names for a new marketing campaign “to set aside in the minds of millions the false accusations that cigarette smoking causes lung cancer or other diseases.” (Handbook of Public Relations, Heath & Vasquez, 2004).

Such doctors represented a shocking departure in the public’s perception of the noble physician’s role, a shift away from the hospital or doctor’s office setting to the slightly unsavory world of physicians on the take from industry.

Why, many wondered, would doctors spend all those years struggling through medical school only to abandon the practice of medicine in such a distasteful fashion?

U.K. physician Dr. Adam Poole was himself recruited away from medical practice to a business development position in Medical Affairs with drug giant GlaxoSmithKline. He described in the British Medical Journal the reaction of others to this initial decision:

Once the decision has been made to become a doctor (at the age of 18), it really is still a job for life. Medicine – seen as the glamorous and respectable profession of selflessness and helping others – is not something you simply leave.

“The two reactions I have witnessed to my own career moves are absolutely typical. I was asked not, ‘Why did you decide to do your current job?’ but ‘Why did you leave your practice?’ The reason for this question is that – across society – there is still a perception that medicine is a vocation, like the priesthood.

“And, underneath the question often lies a sneering ‘You-Couldn’t-Cut-It’ type of reaction.”

That response may be more common that you might think. You can almost feel the sneer fairly dripping out of this medical student’s observation:

“Drs. Sanjay Gupta, the late Michael Crichton, and Howard Dean did not really need a medical degree to pursue their careers. Gupta is now merely a reporter; Crichton was a science fiction writer; and Dean long gave up anything remotely related to health or science.

“If anything, these men took on needless amounts of debt and schooling only to keep someone else from that spot in the applicant pool from becoming a real clinician.”

But doctors who want out of their jobs as “real clinicians” are unfairly criticized, says Celia Paul, a career consultant who teaches a course called Career Alternatives for Physicians at New York University.

The people in our classes are successful by traditional definitions; they have status and high income. But they’re unhappy, and they don’t feel obligated to subordinate their personal lives to the demands of the profession.

“In the first class I gave, the majority of doctors were residents or new physicians who were under stress and worrying about building a practice. In subsequent classes, more were over 50 – successful, but convinced they were in a rut.

The biggest obstacle physicians may face in making a career change, she adds, is psychological:

“Once you’ve become a doctor, you’re supposed to have it made. It takes real courage to break with everyone else’s expectations.”  

According to Paul, the most common reasons some of her physician/clients have given for leaving clinical practice include:

  1. Premature burnout. After only one year in practice, a young pediatrician at a clinic in New York’s South Bronx had developed a substantial discontent, even though she still enjoys working with patients. “I know I’m filling a real need,” she explains. “But what I find disheartening is the attitude of some clinic staff members. They scare patients away by treating everyone as a number. The bureaucracy is unbelievable. Even so, I’m not sure I’d be better off anywhere else. After the clinic, I just can’t see myself taking care of upper-middle-class kids with runny noses and nervous mothers.”
  2. The seven-year (or eight-year) itch. A psychiatrist at a major metropolitan facility for the past eight years says dealing with hospital politics and cost-containment edicts leaves her exhausted. “The hospital is a constant battleground, with daily arguments about where to ‘turf’ the patient,” she says. “My work is challenging, but I feel agitated most of the time.”
  3. Health problems. A 50-year-old internist who works at an ambulatory-care center claims that a midlife crisis brought him to Celia Paul’s class: “I feel as if this is the last chance I have to make a change in my life, and I want to see what else is available.” Then he confesses to a more immediate concern: “I’ve had some hearing loss, and it’s making my job more difficult.”
  4. Wrong original choice. A resident in internal medicine concedes that he became a physician because of family pressure. “My father is a doctor, and it was just expected that I’d be one, too.” And a 4th year med school dropout explained: “I knew from about the middle of the first year, a career in medicine was not for me but it took me three years to get the courage to leave. I had this delusion that I was the only person who wasn’t excited by the entire experience that is medical school.”

Harry Graham works for a New Jersey search firm that specializes in placing physicians in the pharmaceutical and biotechnology industries. His company receives about 300 inquiries every month from doctors eager to leave patient care:

“Sixty five percent are doctors between ages 35 and 40. Most physicians are nearing their peak in skills and earnings in those years. Right now, cardiologists and infectious disease specialists are in greatest demand.

Where do these docs go?  Some go into the medical device, biotechnology, medical advertising, publishing or pharmaceutical industries (some doctors already enjoy lucrative financial relationships with drug companies even while still practicing medicine full-time). Many docs become hospital/health care executives or physician-entrepreneurs, starting their own companies for health care products or services. Some turn to writing (a number already run popular medical blogs). Paul has observed that some of the doctors she has counselled have merely switched specialties, while others have gone into the restaurant business, real estate, or financial planning. One medical student described his own course correction like this:

“I’ll hang in there to get my M.D., but I won’t go into patient care. I’d like to work on the business side of setting up ambulatory health clinics, or home-health-care services for the elderly.”

How does it happen, this transition from the priesthood-like vocation of medicine to non-patient care?  Again, Dr. Adam Poole explains that moving out of mainstream medicine into a different career altogether is a two-stage process:

  • Stage 1: consider your options
  • Stage 2:  make the decision to change your career

Stage 1, he warns, is actually the harder of the two, and starts with information-gathering.     

“The information gathering stage is rather like the childhood game of turning over stones in a muddy garden to see if there are worms underneath. It is a question of not being afraid to start turning over stones.”    

He also offers some basics on moving into the pharmaceutical industry. All entry-level positions (and those for several years later) fall into the categories of either clinical research or medical affairs, adding these perks of the industry:

“The environment is more comfortable – from the office, to the hours, to the quality of the coffee.”

Dr. Poole claims that physicians who work within drug companies are respected and considered senior, do an interesting job, and work in a rewarding corporate environment. Decision-making tends to be more collaborative than in medicine, he says, but important clinical decisions such as those regarding safety are still made by the doctors.

Dr. Janice Boughton of Idaho was a busy primary care internist for over 20 years before she made a career change, but not out of medicine; she went from a primary care practice to a job as a hospitalist. Here are some bluntly practical reasons for that switch:

“Practicing full-time as a hospitalist means working 12 hours a day, seven days a week, every other week. With that schedule, I can make what was an entire year’s salary in my office practice in only five months. I am really truly not working on my weeks off, plus I can take real vacations without feeling guilty about leaving my patients in the lurch. And I don’t have to take telephone calls at night when I am not working.

“For physicians to go into – or stay in – primary care, it will need to be delicious.

“It will need to satisfy our very human needs for competence by having work loads be within reason, for meaning by allowing us to use our own creativity to solve patients’ problems, and for connection by giving us time to talk to patients, colleagues and to engage with our families and friends.

“It wouldn’t hurt if primary care medicine also paid even close to what hospital medicine does.”

The high levels of stress and frustration common to today’s primary care providers may be fuelling not only the migration of doctors to other medical fields but also the abandonment of patient care entirely as docs move over to industry. John Iglehart, founder of the peer-reviewed health care policy journal Health Affairs, wrote this recently in the New England Journal of Medicine:*

“We need to address the income gap between specialists and primary care physicians, build high-performing teams that include nurse practitioners, physician assistants, and allied professionals, and reduce the rate of cost increases, or the health care reform initiative will fall well short of expectations.”

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* John K. Iglehart. “Primary Care Update — Light at the End of the Tunnel?” N Engl J Med 2012; 366:2144-2146. June 7, 2012. DOI: 10.1056/NEJMp1205537

See also:

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14 thoughts on “When doctors don’t want to practice medicine

  1. There have been opinions that it was not the tobacco that ’caused’ health problems, but the chemicals used in curing the tobacco for the individual trademark taste of the tobacco. Guess we will never know for sure – the goal was money and the deep pockets of the tobacco companies not cure for the health hazards caused by smoking or we would no longer have cigarettes.

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    • Since few smokers ingest raw un-cured tobacco leaves, it really doesn’t matter if the culprit was processing chemicals or not. The point is: industry paid medical “experts” to support their cigarette marketing goals.

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  2. This is tricky. I’m not sure that at 18 you can be certain about decisions for life. Many people choose to leave professions so why should doctors be any different? In Australia surveys show over 50% of primary care doctors would leave tomorrow if they had a viable alternative. It is not so much about patient care. It is due to litigation, unreasonable patient demands, and mindless bureaucracy which impacts on patient care. And the stress levels are very high and whilst the money is reasonable it is not that much in relation to the responsibility.

    Strange as this may sound, doctors are people too and subject to the same forces as the rest of society. And they respond in the same way. Ultimately people withdraw their labour if they feel that it can be better rewarded (financially or “emotionally”) elsewhere.

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    • Hi Dr. Joe – you’re so right. What do we know about what we want to do for the rest of our natural lives when we are 18 and applying to universities? This is true whether you’re studying medicine or English literature, but it seems the investment in time, money and expectations is so much greater when you are accepted into med school.

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  3. Tobacco causes cancer, government has to take serious action on the companies who are trying to show smoking is harmless. By spreading this rumor number of smokers will be increased dramatically.

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  4. Thanks for this thoughtful post, Carolyn. You have succeeded in changing my mind. I used to think, as the quote here implies, that docs who left their patient practice “just couldn’t cut it” in “real” medicine. Now I’m thinking that, given the hierarchy status we bestow on a medical degree, it may just take a heroic amount of guts to walk away from that for a new career, yes even a pharma career.

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    • Thanks for that perspective. I too had a bit of a shift while researching and writing this post. You know what part “got” me? The part where Dr. Poole describes his drug company role as being “respected” within his workplace. Many docs work very hard for their patients, yet may not feel that level of “respect” on the job.

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  5. This is an interesting topic – made me wonder why I have no concerns at all when lawyers I know decide not to actually practice law but instead use their degree(s) to further careers in politics, public service, business, etc. and YET I am royally ticked off whenever I hear of yet another doctor who took up space at med school all those years – thus depriving somebody who really WANTED to practice medicine of a spot – but then chucks it all once the ink on the M.D. degree is dry.

    Double standard? Maybe so!

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  6. Eleven-ish, that person who “took up space” may have wanted to be there, and through out the course of their studies realized a more productive avenue for themselves. Can you seriously fault someone who is making the best decision for themselves?

    Many times, these people who “chuck” their M.D. still go on to further their careers in public service, business, and even politics. Why are you perpetuating that double standard by getting royally ticked? Did you not get into medical school?

    Getting into medical school is not like going to college. The process of getting accepted is rigorous, and managing to complete your studies well, is another story. I applaud anyone who can get in and out of medical school. They have truly earned that degree. Additionally, being a doctor is to be a healer, an individual who cares for their patients. Many times these people still find ways to incorporate patient care into their lives (if by becoming an administrator, dictating policy, or acting as a facilitator between physicians and other stakeholders). If anything, those individuals are better equipped to handle the patients’ needs because they can see more of the bigger picture and the other factors involved in a patient’s environment.

    Physicians don’t have higher powers and aren’t the only ones interested in the outcomes of their patients. Providing healthcare is like riding a bike. The physician may steer the bike that is healthcare, but there are other entities involved in the pedaling and braking (so to speak). Everything and everyone needs to work together to make a better ride.

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    • I also wanted to thank you for your thoughts. Breaking the stigma of physicians who choose not to practice is a difficult one, and requires a lot of introspective thinking on the part of the physician. As much as we try not to think about what others will think, it is hard to escape the judgmental looks and ‘you couldn’t cut it’ stares (even from colleagues). I appreciate you bringing light to this.

      Maybe others will be more understanding and appreciative of the road travelled and chosen.

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  7. I agree that it takes a lot of guts to leave medicine. I am currently at med school and feeling like maybe this was the wrong choice but I wouldnt dare voice that opinion to anyone as the guilt that someone else could have had this place and the hope that if I enter the right specialty it will all be worth it makes me stick it out.

    But if I did decide to leave medicine, there will be a lot of people with mainly negative opinions and some very disappointed family and friends. most people seem to think that leaving is a ‘can’t hack it’ issue but as someone else has already stated, making it through any time at all in medicine is a great achievement in itself as the level of workload we are expected to contend with is pretty tortuous.

    However, for me the main problem is that I have started looking to the future and as a woman, I can’t see how I will have that lovely little family life I yearn for and still practise – there doesn’t seem to be much of a work/life balance and this was not an aspect I considered at 20 when I entered med school. Is this a serious case of the grass is greener??

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    • Dear disillusioned – sounds like you have a real dilemma on your hands now. Which is worse: the pain of staying in medicine despite your belief that you’ve made the wrong choice, or the pain of leaving and facing family/friends/your own guilt. There are many many female physicians who are also parents – hope you take advantage of their counsel. Good luck to you – whichever you choose.

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