St. Louis Business Journal
Why physicians are leaving
the practice of medicine

By Anna Navarro

July 2000 - It used to be that medicine was one of the most distinguished and sought after professions in the United States. But there is evidence that its appeal may be diminishing.

The data is still fragmentary, but it all points in the same direction.

Eighteen years ago when I started Work Transitions I rarely had physicians as clients. I worked with lawyers, engineers, accountants and other professionals who were unhappy with their careers, but doctors hardly ever knocked on my door. Today, between one-quarter and one third of my clients are physicians, and I see more of them every day.

Professional journals for physicians are carrying stories like; "Do You Have An Exit Strategy?" "Thinking About Career Change" and "Goodbye Hippocrates! Yes,There Is Life Away from Medicine."

It's tempting to shrug this discontent off as only applying to older physicians who can't cope with the way medicine is practiced today. But the trend is also showing up in medical school enrollments.

Statistics compiled by the Association of Medical Colleges show that medical school applications dropped by nearly 13% between 1996 and 1998.

Why is this happening?

My physician clients report they are restless because they didn't get what they bargained for. And I think their frustration is having a ripple effect on the next generation of potential physicians.

Picture the situation of current doctors.

To get a shot at entering medical school, they often started preparing in high school. They took the tough science courses while the other kids took study hall. Once in college pre-med, they skipped the parties to hit the books.

In medical school and as residents they worked 72-hour shifts and didn't have a life. Plus they piled up huge debt.

All for the sake of being a physician.

In exchange, they expected to be at the top of the career pinnacle in this country.

Sure, they'd still get up at 5 a.m. to do hospital rounds before seeing their office patients. And they'd have to deal with life and death issues.

But the tradeoff was they they'd be self-employed, make good money, and have a chance to help people.

It was a great plan that didn't work out.

Few doctors today can be self-employed solo practitioners. Managed care providers prefer to contract with large groups of doctors. So many physicians are now employees of large healthcare systems or medical groups.

They don't have as much freedom to practice, either. Managed care companies provide guidelines for how many minutes they can spend with each patient. And what treatment plan to use.

Their incomes are actually going down relative to inflation. This is especially difficult to deal with at a time when the rest of the country enjoys unprecedented affluence.

The disillusionment is especially keen among doctors over 40, who decided to go to medical school before managed care changed the whole scenario. But I think their attitude is infectious, and may be a major factor in declining medical school enrollments.

The reality is that doctors, as well as would-be doctors, have other career options.

With the permission of the individuals involved, I can give you some examples of the career changes doctors I have worked with have made.

Some of the physicians I work with leave the practice of medicine altogether.

One cardiologist became an executive recruiter. A gynecologist went into real estate development. A surgeon became a medical device sales representative.

Others choose to stay in medicine, but often in roles that don't require direct patient care because that is the area that is causing doctors the most pain. They've gone into drug research, quality control for health insurance companies, or purely administrative roles.

Physicians as a group are smart, self-disciplined and hard working. They tackle the tasks of career change with vigor. These same traits make them very appealing to employers in fields other than medicine, and serve them well if they choose to become self-employed.

It's a long, arduous path from restlessness to a new career. The process often takes one to two years. But the former physicians I have worked with tend to fare well in their new careers.

Anna Navarro is the founder of Work Transitions, a nationwide career consulting firm that trains independent career strategists and consults with individual clients.

This column was originally published by the St. Louis Business Journal. The actual title of the column and date in which it appeared in the Business Journal may be slightly different from what appears on WorkTransitions.com.