Decades ago, choices for a career in medicine were limited to small private practice or large academic, primarily research, settings. So, physicians in training could focus on acquiring vast amounts of clinical knowledge as well as technical skills. If they wanted to go into research, there was always the option of choosing an MD-PhD path. If a career in public health was the goal, it was highly recommended to get an MD-MPH. The advent of managed care The advent of managed care in the 80s opened up a slew of new career opportunities on the business side of medicine. Suddenly, doctors could be health plan medical directors, experts in utilization management, or Chief Medical Officers. They could run large practice groups or even run hospitals. Soon after the managed care revolution, the country went through serial efforts to reform our increasingly dysfunctional healthcare system (remember the Clinton plan?). This opened up opportunities for careers in health policy and health services research. The digital health explosion Later, the explosion of digital health teed up entrepreneurial opportunities unimaginable to prior generations of physicians. Now, docs could start companies, fund companies, or become advisors to start-ups. This was so enticing that a number of young doctors I met in the health tech field decided not to complete their training. They told me they felt they could help many more people by developing and deploying their innovative health technology solutions. TV anyone? The current pandemic has opened up a new possibility – becoming a medical pundit on cable news. We have had medical experts talking to us from TV for a long time (think Sanjay Gupta), but the number of MDs who get this gig has been small compared to what is going on now. Of course, many of these docs don’t get paid for their appearances. However, some of them may be able to parlay their experiences into a full or part-time job. So, it is an exciting time for physicians, but it is also a confusing time. How can doctors prepare themselves both for the present and the future? What types of skills, beyond clinical, should they be acquiring? When should they acquire them? And, how? Careers in medicine can last a lifetime I like to answer these questions by reminding people that careers last a lifetime. You don’t have to do everything all at once. And, you don’t have to do anything forever. You can take left turns. And, you can reinvent yourself. You can do this in a planned or in an opportunistic way. I know alot about the latter because that was the serendipitous and convoluted path that I have followed. My long and complicated career in medicine I trained in academic endocrinology at the University of California San Francisco, working with some of the giants in the field (Peter Forsham, John Karam, Claude Arnaud). At the same time, I was moonlighting in the ER at Kaiser Permanente in San Francisco to bring in some extra cash. It was the early days of emergency medicine. There was not even a residency in San Francisco at the time. So by day, I was working up complex endocrinology cases. But at night, I was intubating asthmatics and treating desperately ill patients in heart failure. One day, after getting back ambiguous results after a year-long workup for a rare endocrine tumor, a giant light bulb went off in my head. Emergency medicine thrilled me, endocrinology did not. So I left UCSF and became a Permanente Medical Group emergency physician, a position I held for the next 15 years. I also got involved in my specialty society, eventually becoming the first woman President of the American College of Emergency Physicians in California. This opened up a chance for me to do a 2-year Pew Fellowship in Health Policy at UCSF’s Institute for Health Policy Studies under Phil Lee who went on to serve as Undersecretary of Health in the Clinton administration. Leaving clinical practice Once again, these experiences led to an opportunity to leave clinical practice and start a new career as a Physician Executive for the national Kaiser Permanente organization. I was the first director of National Accounts. In that role, I helped sell the health plans to large employer groups by talking about our clinicians and clinical programs. That position led me to yet another position – one that was quite unique. General Motors was struggling with the cost and quality of their health plans. They worked with Kaiser to bring on a team of people to help them with their managed care strategy. I was the doctor of the group and the team lead. I spent the next six years as an executive on loan to General Motors. Along the way, I picked up a healthcare-focused MBA from the University of California Irvine. Failed entrepreneur I made two attempts to start companies, but, in retrospect, I have discovered, sadly, I am missing a key ingredient of a successful entrepreneur—sticking with it at all costs. In between my attempts to build a company, I moved in and out of healthcare consulting, probably the most lucrative and educational of all of my endeavors. I also had several different positions with different health plans, including serving as Chief Medical Officer of a Medicare Advantage plan in Houston. In 2006, in the early days of blogging, I created The Doctor Weighs In. I have have been running it ever since. It has morphed from a diet and weight loss blog to what it is now – a multi-authored health news site. I, now, consider myself a full-time health journalist. I tell you all of this not to puff myself up because you are probably thinking I am a flake or at least a bit crazy. Rather, I tell you this to emphasize that the opportunities for physicians to make contributions to healthcare are endless and ever-changing. You just have to be willing to try new things. It is a very exciting time to be a physician. A few words about how and when to add new skills as you prepare for your chosen career in medicine I have had some intense discussions with medical students, residents, and early career doctors about whether they should complete their training. However, I still believe that a strong foundation in clinical medicine is part of what differentiates doctors from others who go into the business of medicine. Yeah, the internship is a drag. And you may be chafing at the bit to get started in real life. But I have found that really knowing medicine has been a cornerstone for my career. At least get the MD, a license, and practice a bit even if it is in an urgent care center or a retail clinic. It is simply invaluable to have the experience of actually taking care of patients. How the money flows If you think you would like to work on the business side of medicine—for a health plan, medical group, or hospital, you need to know these two things: the politics of healthcare, and how the money flows That means formal or informal training in health policy and specific knowledge of the financial aspects of the type of organization you want to work in. Consider getting an MBA, but be sure you find a program that focuses on healthcare and offers some hands-on experience with the industry. Internships, if you can find them, are invaluable. Prep for other career paths If public health is your thing, the club card is an MPH. Be sure to find a program that can give you real-life experiences and provide you opportunities to network with people who can help you get a job. Join the American Public Health Association and go to their meetings. Volunteer with a non-profit doing public health advocacy work—these organizations would be thrilled to have a physician working with them. If your dream is starting the next big thing in digital health, move to Silicon Valley (just kidding). Healthcare entrepreneurship opportunities are available all over the country. Volunteer to help a start-up, join an incubator, participate in Hackathons, and hang out with the people who are doing the work. If you dream of being a real TV doctor, invest in getting a PR agent who specializes in getting doctors on various news shows. Take some classes and practice the needed skills. I actually had to take lessons on how to control my blinking! Foundational to whatever career path you choose is developing leadership skills. The types of leadership skills that will propel you forward in business, public health, or in the media are very different from the ones that make you successful in the OR. Take classes, read books, or better yet, find yourself a good leadership coach. Early to mid to late – always keep learning No matter what stage of your career you are at, it is never too late to learn new things, take on new challenges, and acquire new skills. Healthcare is a huge and growing part of the global economy. Doctors bring unique skills into the field. You can have a very long and exciting career in medicine if you couple an insatiable desire to learn new skills with a fearlessness to walk away from the same old, same old. Even if you don’t get tenure, a gigantic 401K, or a cushy pension, you will have had a very wild ride. And I promise that you will still be in love with medicine at the end of it. Source
