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:
- 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.”
- 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.”
- 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.”
- 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.”
* 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
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