Decades ago, when healthcare career choices for physicians were more limited (small private practice or large academic, primarily research, settings), physicians in training could focus on acquiring vast amounts of clinical knowledge as well as technical skills—mainly surgical. If they wanted to go into research, there was always the option of choosing an MD-PhD path; if public health, an MD-MPH. But 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 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?) offering doctors opportunities for careers in health policy and health services research. More recently, the explosion of digital health has teed up entrepreneurial opportunities unimaginable to prior generations of physicians. 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 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, 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 because that was the serendipitous and convoluted path that I have followed.
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), but I was moonlighting in the ER at Kaiser 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. And 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. During that time, I became involved in the issue of domestic violence and ended up founding a non-profit, Physicians for a Violence-free Society. 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.
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 (helping to sell the health plans to large employer groups) followed by spending 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.
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 and had several positions with different health plans, including serving as Chief Medical Officer of a Medicare Advantage plan in Houston. In 2006, I started a blog, The Doctor Weighs In and have been writing ever since. 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. 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
Although I have had some intense discussions with medical students, residents, and early career doctors about whether they should complete their training, 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, 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 or a retail clinic. It is simply invaluable to have the experience of actually taking care of patients.
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 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.
If public health is your thing, the club card is an MPH. Again, 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.
Foundational to whatever career path you choose is developing leadership skills. The types of leadership skills that will propel you forward in business or public health 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.
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Early to mid to late career – 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. Coupled with an insatiable desire to expand your skills, a fearlessness to walk away from the same old, same old and try something new means you can have a very long and exciting career in medicine. Even if you don’t get tenure, a gigantic 401K, or a cushy pension, you will have had a very wild ride, and I guarantee you will still be in love with medicine at the end of it.
I had the pleasure of being interviewed by Taylor Brana, founder of The Happy Doc on a similar topic. The Happy Doc is a platform that provides “inspiration, knowledge, and tools to enhance creativity, joy, and success in the field of healthcare.” Here is a link to the site and the podcast.