[Editor's Note: I wrote this article for my regular MDMag column in response to a question I see frequently on physician-specific forums, usually from mid-career to late-career docs, but occasionally even from medical students and residents. These docs are looking to escape from medicine for a number of reasons. In this article, I discuss the reasons and some potential escapes.]
I am frequently asked by physicians who have grown tired of their job for a list of non-clinical options they can do. Upon further questioning, what they often really want is something that pays just as well (or better) than clinical medicine, but that is much easier to do. Unfortunately, that can be a very difficult proposition. You see, most jobs pay much less than practicing medicine in any specialty, and most jobs that pay an income similar to that of a practicing physician are at least as hard, risky, and time-consuming. The median physician income is approximately $200,000, and the median household income in the United States is about $52,000 per year, and that often includes two partners working. In fact, only 25% of American households have income over $100,000 and only 6% over $200,000, with half of those between $200,000 and $250,000. The infamous “1%” starts at just $389,000, less than that of many physician households, especially a two-physician household. The bottom line is that almost all jobs pay less than that of a physician practicing clinical medicine. So if you want a job that pays just as well as that of a physician, your choices are very limited.
5 Ways to Get Out of Clinical Medicine
1. Retire Early
In some cases, it turns out the physician just doesn’t want to work anymore. They want to be financially independent and be living off their investments. The good news is that physicians are generally paid enough that if they can live a middle-class lifestyle during their career and in retirement, they can retire completely a decade out of residency. The math looks like this: Make $200,000 per year, pay $50,000 per year in taxes, live on $50,000 per year, and put $100,000 toward retirement. If you earn 5% after-inflation, after 10 years you’ll have a nest egg worth the equivalent of $1.25M in today’s dollars, enough to give you an income of $50,000 a year for the rest of your life. However, I have noticed that very few physicians hate working enough to live on only $50,000 a year for the rest of their lives. Most would rather work at least a little more and spend more. There are real consequences to a very early retirement.
2. Fix Your Job
The best option for most physicians is simply to fix whatever it is about their job that they do not like. That might mean dropping call, dropping a portion of their clinical practice (like obstetrics for an OB/GYN), cutting back on shifts or hours, or changing jobs to one with a slower pace, a less litigious population, and/or a more supportive administration. Nearly every physician I’ve ever talked to who has cut back their hours by 20-33% raves about how much more they enjoy medicine than they used to. Yes, this approach often comes with a pay cut, but it’s often not all that large on an after-tax basis, and certainly no larger than what they would see transitioning to a non-clinical career.
3. Entrepreneurial Pursuits
Perhaps the best pathway out of medicine is becoming an entrepreneur. Unfortunately, there is some risk here. Most small businesses fail, and most small businessmen make less than a physician anyway. However, a physician has a bit of an advantage here. She often has significant capital, which eliminates the main reason small businesses fail—borrowing too much money. She also can ease into the business part-time while maintaining her main, stable job as a physician. Plus, physicians are generally intelligent, personable, reliable, and not afraid of hard work. These traits serve them well as entrepreneurs. It would be impossible to list every possible entrepreneurial pursuit out there, and in fact finding an unserved niche and filling it is part of the fun of entrepreneurship. But the possibilities range from those that often remain “side hustles” like writing, speaking, and consulting, to the relatively competitive field of real estate investing to the design and manufacture of new medical devices.
4. Non-Medical Jobs
Many physicians transition out of medicine completely into a new profession. This often requires another degree or training, such as a JD, an MBA, or a financial advisor certification. Some physicians wish to leave medicine and do something else that pays much less than medical work. These are the classic “encore careers” where you become a chef, a teacher, or a tour guide. This is a similar issue to retiring completely, but the more you have and the less you spend, the more job options that are available to you.
5. Medical Jobs
The vast majority of doctors who leave clinical medicine don’t have the interest or skills necessary to be successful as an entrepreneur, nor the money required to move into an “encore career.” They tend to go work for healthcare-related pursuits involving a diverse set of interests such as medical writing, resource utilization, health insurance, medico-legal work, pharma, or managed care. Hospital administration or practice management consulting positions are available to those who have developed non-clinical skills during their career. Coaching other physicians and working in information systems are other possibilities. As you are well aware, the design of most electronic medical record systems suffers from having little input from actual end users, and doctors with IT skills are highly sought after commodities. Health and disability insurance companies need physicians to do reviews. Venture capital companies interested in evaluating and acquiring medical businesses may find your expertise very valuable, especially if you can learn to speak their language. Recruiting physicians for drug trials or locum tenens companies is another option. You can also help write, produce, and present continuing medical education courses. Many of these can be paired with a part-time clinical career as well, which might even make you more valuable as you will still be seen as “one of us” among physicians.
If clinical medicine has become less attractive to you, then consider your alternatives. They include retiring completely, modifying or changing your clinical job, starting a business, leaving medicine for another career, or most likely, using the skills and knowledge you acquired in medicine to pursue a non-clinical medical career.
Number 1 sounds like an attractive option.
Have a great weekend!
-Physician on FIRE
I definitely think that a lot of these issues need to be carefully considered by med students well before matching. It is difficult to get a good grasp of the true lifestyle of any medical specialty in med school, and it is often very difficult for many specialties to “ramp down” in any meaningful way before practicing for several decades. They don’t really do a good job in med school of teaching you that if you are a surgeon, you are not just having fun in the OR all day, you are also usually rounding and managing a clinic, and often seeing 30+ patients on clinic days-even if you have a midlevel do a lot of your work you are still signing off on all of those charts, answering calls, being asked about pain med refills, etc etc. I can imagine that the same is also true of OB, and that it is not that easy to get a job with little to no OB unless you are pretty subspecialized…
They need to be considered when applying to medical schools! If your tuition is $60K/year and living expenses $40K in that particular town and you’re going to borrow all those dollars add a decade to your work life versus getting an HPSP scholarship or even lucking out and only needing $45K/year for tuition and living expenses (and makes living at home during med school, if possible, look more and more attractive).
I don’t know what the future holds, but one option I’m considering is down the road when I’m no longer interested in working full time (maybe 15-20 years), I can work part time nocturnist 1 week a month and make approximately 100,000 a year.
I love option #2. Physicians have more power to change their work life than they may realize.
One of the best things about Emergency Medicine is that it is completely & easily scalable. I’ll be down to about 4 shifts a month next year in what I am calling semi-retirement. It means that medicine is one of the things I do, not THE thing that everything else needs to be squeezed-in around.
One thing to be careful about is that you need to work enough to stay competent. Nobody really knows where that level is at, but that is the reason my group set a minimum of 6 shifts a month to remain partner. I just don’t think I’d stay good at EM if I only did it 1-2 days a month.
I completely agree. How many shifts that figure is, I do not know. But if you are not regularly seen real acuity, I think your skills will fade rather quickly. 4 shifts a month in my opinion is just not enough to keep the kind sharp.
6 shifts seams much more reasonable. Most people I talk to say 6 shifts in a high squirt facility or 8 shifts if the population you are seeing is healthier. Free standing EDs is where physicians become useless.
My semiretirement plan will be 8 shifts a month with some months dropping down to 6 when extended time off is needed.
Interesting debate! I think one shift a week should be enough to maintain competence. I guess I’d worry more about working at a super low volume (think 5000 a year) facility or taking extended time off. I’m surprised about the six shifts a month for competence. Very interesting!
So a post about getting out of clinical medicine is 0 for 2 on non-clinical options that pay anything?
??? I think I counted 5 on this list. They can be combined though. For example I cut back my clinical hours. That gave me more time to devote to investing and business opportunities, explore tax reduction methods etc. There can be a synergy once you get multiple streams of income up and running. Last year for example my investment income exceeded my expenses. I could cut back work more but I don’t want to because I love what I do. Part of why I love it is because I don’t have to do it and I can decide to refuse the parts that I don’t like.
This is the main issue right? Its not easy to find jobs that pay doctor level money and certainly with doctor level security that can be easily and instantly scaled into. They just dont exist. You can build it up over time, and put in a lot of work, but you cant just quit on friday and find a similar pay for less work/hassle than being a doctor.
Also lots of risk in anything entrepreneurial of course, things could change fast impacting your earnings. First world dilemmas for sure. Obviously there is a good amount of work to pull in a low to mid six figure income in any field or else everyone would be doing it.
I’m a 3rd year med student and I love business. If I do family practice, I’m considering doing Direct Primary Care….but I’ve also thought about just practicing for 10-15 yrs while trying to transition into either hospital administration or being a program director at a residency. My state school has a top 20 MBA program that I could acquire part time after I get some more “real world” experience as an attending. Anyone on here have advice for how to walk down the path of becoming an administrator?
No admin experience but if you want an MBA get it during med school. Probably one of the biggest regrets education wise I have. They arent necessarily needed for anything, but this will be by far the easiest time to incorporate it.
I see your point, and my school offered a dual degree/MBA program, but it came with certain restrictions on clerkship opportunities that I didn’t want to deal with…..It was also through a regional university that doesn’t have much name recognition outside of the state. I do hope to obtain it shortly after residency before life gets too busy with family,etc.
Unless you are going to a top 10 business school and planning to use that degree to get a job at a bulge bracket investment bank the school doesnt really matter.
MBA is absolutely unnecessary for academic medicine, just need to accept ones fate and trudge up the ladder and tick off the appropriate boxes to that end.
Will these restrictions inhibit your ability to get the residency or position you ultimately want? You mentioned FP, so no offense but I cant see any way shape or form any clerkship changes matter. It will be so much more difficult (and less fun) to do so while practicing.
I don’t think you need an MBA to be a program director. That usually has a progression like clerkship director, assistant program director, then program director.
That’s good to know. I am only in the beginning of 3rd year, so I haven’t had much experience yet with the program administrators. Are there any physician MBA’s in your group’s practice or hospital administration? if so, do you know if they thought it was worthwhile?
I have a finance MBA from a top business school. I did it mainly to learn more about finance and business. I have always enjoyed the topic. I also saw fellow physicians make terrible financial decisions due to ignorance of basic principles. The program challenged me, taught me a lot, and opened opportunities. I made several great friends during the training and one of them got me my current job. Despite all these benefits it isn’t required by any means. I wouldn’t recommend it to every physician – just those who have a lot of interest and want a more formal schooling in business. It is definitely a positive when applying for hospital admin positions. Being able to speak the language of business makes you more effective in those positions once you get them.
You do not need an MBA to be a program director. I am 3 years out of EM residency and am the PD of the TY program at my hospital. It was a right place, right time, right personality domino effect.
Most important to be a PD is to meet the ACGME requirements for an EM PD, which are available on their website. If you meet those, then it’s all about personality and skill set.
I read management and process improvement books like a banshee (my favorite is Creativity, INC, by Ed Catmull). This is my poor-man’s attempt at being a better manager en lieu of an MBA.
More important than an MBA is the right set of skills for any manager.
Many of my hospital administrators, and even within the medical group, do not have MBA’s. Again, it’s about skill set, interpersonal abilities, and presenting ideas in a successful way. An MBA might teach that, but you can also develop it on your own.
Taking the TY job has cut down on the number of my ER shifts, and has me feeling as though I can keep on going without constantly looking for a non-clinical exit.
I considered the MD/MBA dual degree option and I’m really glad I waited on the MBA. I’m 9 years out of residency and halfway through an MBA program. I don’t think I would be getting nearly as much out of the MBA if I didn’t have some experience. I’m using it to try to keep my group independent and growing, but if you’re interested in administration in a large corporation, it would be quite useful there as well — I’m in a physician-only program where a lot of my classmates are trying to go down that road and virtually all of the physician-administrators I interact with in the parent corporation of my main client hospital have an MBA. Even then, you will need to get involved with medical staff leadership at your local hospital to get credibility for that first administrative job. Volunteer for any committee they will let you sit on and then work your way up to the biggies — credentials, peer review, med exec — so you can become chief medical officer or chief of staff. Don’t rule out building your own business, though — running my group has been incredibly rewarding despite the challenges.
While an MBA will be challenging and very time-consuming either way, I’ve found it manageable in full-time practice. I’d recommend a physician-oriented program like Auburn or Tennessee over a big-name executive program like Wharton. Unless you’re trying to be the biotech guy at a venture capital firm or hedge fund, the physician MBA programs will be much more relevant and useful (I’ve discussed this issue with people who did each of the programs I mentioned).
I did the program at Auburn.
You might want to submit a guest post on this. You obviously have some expertise on the subject that is fairly rare.
I think I could put something together.
I actually have a MBA. I did a program specifically for physicians. A combo of online and on campus classes. I was 49 at completion of the degree. I really enjoyed the finance and accounting. Do I use it? Not so much. I just wanted to challenge myself in my fourties. The chief medical officer at my hospital and several people in large groups have one that I am aware of.
that’s good to know, thank you. I could see myself also enjoying both the challenge and the possible switch into part time administration sometime down the road
JPA
Please do your self a favor and specialize
JPA, depending on what options you wish to have down the road, there are a few things you can do. A MBA or MHA both open doors to management and leadership positions, especially if you wish to move farther up the ladder than medical director in a healthcare organization. The degrees are not substitutes to street smarts and experience though, the degrees just help get your foot in the door. Also consider joining organizations such as the American College of Physcian Executives or the American College of Healthcare Executives, good contacts from organizations like these, access to information and also helps open doors in executive positions. I hope you enjoy practicing medicine, but it nice to have options to choose from in your future too.
ACPE is now the AAPL by the way. American Association of Physician Leadership.
Not too many physicians are either too good or even suited for much else other then clinical work. Some old yellers are fortunate enough / mild tempered enough to get token administration posts without much responsibility, but only after decades of hard work.
I suppose if you are financially secured you could go back to school and be a LPN/RN, perhaps be a bartender or better yet a barista.
But for the most of you who maybe miserable, think about cutting back or looking for a different practice maybe a wiser decision. Not everyone can have successful financial blog after all
It looks like we have several people that could comment on maybe the usefulness, the how, when, and why of getting an MBA as a physician. I know I would love to know more about it, Im sure others would as well.
I just scheduled a guest post on it, but I bet some of the commenters here could write a better guest post than the one I’ll be running in a few months.
It sounds like wealthy doc and Arthur also waited a few years before getting the MBA. I also think waiting a few years before pursuing the degree makes sense. I think that most people who comment on this blog would like the numbers part of it. MBA also has classes in organizational psychology which I found interesting. I thought I might leave clinical practice after doing it but I did not. The reasons vary for wanting to pursue the degree. My class was all practicing docs ranging in age from 29 to 62. Lots of different specialties. Several people were in academics, medical politics, down to solo practice. I think people wanted a challenge and to understand their business better.
Yes, interesting stuff. My suggestion to do while in school was simply an opinion of course and came from the efficiency and least disruption to your overall life which seems like it would be harder as you’re older and in practice. However, that clearly didnt stop any of you guys and it seemed to resonate well after you knew what you didnt know so to speak.
I hope that the commenters who have done this will make a guest post as its interesting from a practicing doctors perspective. For me I cant justify the cost of more schooling right now.
I thought about doing the MD/MBA route. I couldn’t manage the timeline, letters of recommendations, GMAT + MCAT all at the same time and dropped the idea. It isn’t a bad way to go though. You are already in the school/test mode and the business courses can be a refreshing break from medicine. I had friends who did it. They lose some elective time from medicine and business but can finish in 5 years total with both degrees. They see business opportunities and investment principles early in their career. They all are doing very well financially and I don’t think that is a coincidence.
I was academic faculty so my tuition was paid by my institution. After finishing the degree I was recruited for a job (largely due to the MBA) that involved a pay increase. My ROI was therefore extraordinarily high. If you are paying 40-60K for a degree and then doing the same job it may not be a great deal. You can learn much of it by OJT or by readings recommended by the Personal MBA. (https://personalmba.com/best-business-books/)
Finally, there are pros and cons to doing a health care MBA or physician focuses program vs. general. I did a traditional MBA with a concentration in Finance. I felt I knew healthcare. I just wanted to learn the other stuff I didn’t know. Arthur brought up some good points about other options and I look forward to his guest post.
Good stuff. Yes, I have that book but confess I havent finished it. I would probably also want to do a finance MBA as Im interested in the “other” side of things and not necessarily looking for more healthcare focused info, as partially its just for personal growth and interesting.