Transitioning Out of Clinical Practice in a Tough Economy?

I'm launching my blog with a topic that has been on my mind, and I know on the minds of some of the physicians that I talk to who have been exploring the option of leaving clinical practice and expanding their professional lives into new career areas.  The topic is how does one think about making a career change and transitioning out of medicine when the economy is so bad?  Certainly leaving clinical practice is an exciting idea for some physicians - the risk, the excitement, the learning curve, the beginning of "something new".  But in today's economic climate it can seem - how do I put it - crazy?  Is one dependent on the state of the economy to determine whether or not they pursue a new profession?  Or is it something more immune to the ups and downs of the market?  I know many who are wondering this - when things are bad around you, do you still entertain those nagging thoughts of change or do you abandon your plans?

That’s what I started thinking about – I mean, it makes sense to be worried when it seems like the country is falling down around us… Unemployment is up, people are losing their homes, jobs are less secure than ever.  You hear about these realities everyday on the news, from your friends, neighbors and patients.  It is unnerving to say the least.  We know that we all must tighten our belts and reconsider our financial situations.  And at the same time, we know it is important to try and stay above this collective sense of "financial hysteria" that it seems many people are falling into, and maintain our own sense of equilibrium.  Figuring out what this equilibrium is, and how it relates to our professional needs and aspirations, is the challenge.

 So if you are one of those physicians out there who desperately want to make a professional change, where does this leave you?  What do you do when things within your professional life have simply become unmanageable, and change is required for you to keep your sanity?  How do you reconcile the desire – if not the need - to make a professional change with the inclination to just hunker down, sweep the frustrations and dissatisfactions under the rug, and stay put until things calm down?  In all honesty we know being a physician is a good career, right?  It is a high-status job and is well-respected, it pays well, is intellectually challenging, it is easy to find work and there is high job security, and there many different options for careers within clinical medicine.  All of which are good things! 

 However, the flip side of practicing medicine is what typically drives the physicians I’ve met to want to leave:  more managed care, less respect, longer hours, more paperwork, more oversight, greater regulation, a “ceiling” on income and growth potential, and a sense that one must work harder to maintain the same standard of living as in years past.  Many physicians try to counter these things by doing things like working harder, delegating some responsibilities, utilizing new technologies, trying to focus their practices on more rewarding areas, etc.  However, the feeling that they have less autonomy, less power, less time, and less control still prevails.  For many this saps them of the joy and energy that they brought into medicine, and they begin to have that nagging need to look elsewhere professionally, in order to regain that lost control and recover that sense of professional wellbeing that has somehow become elusive in their daily lives.

 However, it is a tricky proposition to consider leaving clinical practice – many don’t know where to begin, what options to pursue, where to start their research.  It is not typically a topic of conversation that they discuss with their physician colleagues, because they know that the response will most certainly be “What?  And waste all those years of time and investment?  Why??”, not to mention the sentiment of disloyalty to the profession that even approaching the idea tends to bring up in many physicians.  As such, most docs exploring this option tend to keep it to themselves, which can build into a sense of isolation as they go through the process.  The idea of leaving medicine may also bring a sense of grief and doubt around a potential loss of stability, a loss of everything that has been worked for, a loss of money, prestige, respect, and even a loss of their identity.  They may even feel like they will no longer be a “real doctor” if they are not practicing medicine. 

 A stumbling economy can make those doubts even more pronounced.  It is easy then to step back from that nagging need for professional change, and push on with what is secure, no matter how unsatisfying.  For some this may feel like the easiest thing to do at this time.

And, for many it is.  If you are a physician in this position, perhaps now is the best time to invest some serious time in doing the “footwork” it takes to make a career transition a success.  If the economy is forcing you to take a step back, perhaps now is the best time to make that step count, so that when the time comes - when things have improved to the degree that you feel comfortable starting something new - you have a head-start on your career change.  There are many ways you can do this, starting with some honest assessment of where your head is at regarding a possible career transition.  I think of it in the following ways:

1. Understand your motives:  Make sure you have really figured out what it is that is causing you to feel dissatisfied with your clinical profession – i.e., make sure that you are thoroughly exploring your feelings with your current profession before you start looking for solutions outside of your situation.  A big “aha” for many comes when they realize that the reason for dissatisfaction with their career usually comes from within.  Oftentimes physicians will list any one of the external reasons that we discussed above for being unhappy (e.g., loss of control, working too hard for too little, etc.), when in reality at this point in their lives they are just ready for a change.  Perhaps you just feel the need to experience new things and to grow as a professional and as a person – there is nothing wrong with this.  Just know why you want a career change.  If you premise a career change only on factors not truly responsible for your desire to leave clinical practice, you may find yourself in a new career with what seems like a great team, opportunity, and environment that still doesn’t satisfy you.  Take that inventory on yourself, and really spend time thinking about why you need this change, exactly what it is that is driving your biggest dissatisfaction , and the “must have” elements of a new career that would need to be in place for you (and your family) to consider it a success.  
   
   
2. Consider any new opportunities carefully:  During this “stepping back” time, ensure that you do not make the mistake of rushing into a new opportunity thinking it will solve all of your professional issues.  Do not make the mistake that so many career changers do by entering into a new profession expecting your previous frustrations to be magically resolved.  If you have not done your due diligence and clearly understood what drives your desire for a change or what your professional “must haves” are, you may find yourself in a new career experiencing many of the same frustrations as you experienced before.  What a way to feel stuck.
   
   
3. Partner with your family to ensure you’re thinking through the initial “critical success factors” for your career change:  First thing that comes to mind is your financial situation – which is top of mind for most people these days given the economy.  You need to ensure that you’ve realistically considered:
1. Your current situation – savings/investments/etc.
2. How long you could go without an income if you needed to
3. How much money you would need to make in a new position to be satisfied (and to maintain your standard/quality of living)
4. How much your spouse is willing and able to help during your transition period

To that point, the other major factor is the degree of support that you have from your spouse/significant other in making this career change.  Many spouses are rightly concerned about finances and how the family will replace the income that is earned from practicing medicine.  However, more and more spouses are starting to see the reality of declining income and longer hours in medicine, and are now starting to wonder how much money the family is losing by having the physician stay in an unsatisfying practice.

4. Know what you’re “worth”:  With the economy as uncertain as it is, knowing your worth from a market perspective is more important than ever – especially if you think you might want to make a career change.  There are online tools such as www.salary.com that can help you find out what professionals of your caliber are making outside of clinical practice, and whether or not that number has gone up or down since the recent economic downturn. Make sure you clearly understand how any potential industries you may be interested in have been impacted by the economy and what that means for the job-seeker or entrepreneur in those areas.   If you have the opportunity, speak with other physicians who have made the move into your target industries and find out how MDs are positioning themselves financially.  Do your homework during this time to ensure that when the time comes you have all of the data you need to make informed choices.

5. Deal with your “mental roadblocks”:  During the stepping back time, you have a great opportunity to identify and deal with any unresolved issues that are stopping you from moving ahead with your career transition.  Job security is a biggie, particularly since medical practice is a fairly secure profession, and other possible avenues – corporate roles, consulting, start-up ventures – are not.  Dealing with your feelings around losing the persona of “being” a practicing physician is also a hurdle for many.  And there is also of course the issue of the economy, and what that means for your prospects outside of medicine right now.  For some that is a huge, but also a somewhat “convenient” roadblock.  Arlene Hirsch, a Chicago career counselor and author of Love Your Work and Success Will Follow (John Wiley & Sons, 1996), states that "Many people rationalize to themselves that, because the economy is bad, they may not find anything else, so they stay in a job where they're unhappy… But in the end, they may become so unhappy that they sabotage themselves by not doing a good job, or even by assuming their job is safe when it really isn't.”  I love Arlene’s point because it highlights the relationship between job satisfaction and job performance.  We know that over time, no matter what the profession – physician, laborer, CEO, childcare worker – if people are not generally happy with their work and/or have an overall sense of fulfillment, their performance will slip.  Of course for physicians the consequences of that are much higher than for most other people.  And while traditional job security is generally not an issue for physicians, the ability to maintain a rewarding, empowering career is certainly something that is less than secure in today’s healthcare environment.  

Transitioning out of clinical medicine and venturing down a new career path is an extremely complex issue for the physicians who are contemplating it.  For the professionals who I speak with about it, the decision has typically has been a long process evolving over a number of years, until it finally becomes an issue of weighing the internal factors versus the external factors when determining if and when to make a change.  It is a deeply personal decision, one that is not simple nor easy.  It is, however, do-able with the right amount of introspection, planning and strategic action.