Building your confidence
Doctors may begin to lose confidence in themselves after working in a hostile or discouraging environment. If you are told that you take too long to document your notes, if your productivity is not meeting targets, if you were not the best resident in your program, or if you can't get into a residency, it can take a toll on how you view your options. Yet, there are doctors who were never "the best" who are extremely successful. Once you begin to realize that you can succeed, you can begin to look beyond your limitations to see that you can become a great doctor.

Knowing your options
If you know that patient care is what you want to do, then you need to seek out different practice options sooner rather than later. A bleak work setting often leads to high staff turnover, which can make it nearly impossible to achieve optimal patient care. Finding a work environment with a constructive and well-designed approach to patient care can make all the difference for you.

For some doctors, non-traditional professional paths can provide more professional satisfaction - and an equal or better salary than patient care. Once you know about your options, you can take the steps to reach your professional goals.

There is a demand for doctors outside of patient care
As medicine is becoming increasingly complex, the healthcare industry is relying more and more on experienced physicians to lead the medical field in roles outside of traditional clinical practice. If you find yourself wishing you had other options as a physician- you may be more suited to a different position within the healthcare field.
Physicians who have the skills and certification to provide patient care can also guide other areas of healthcare- such as the financial, technological, educational, or utilization aspects and more.

Giving yourself permission
There are advantages and disadvantages to every type of job.  But, if you are a physician, you should know that there is nothing wrong with working at a job that would make you happy. And remaining in a job that you don't want to do would only make sense if there were no other options that could provide you with equal or more compensation. However, the vast majority of doctors have other options. There is no reason for a physician to stay in a bad job.
It is important to realize that a physician's career, which usually spans over 30 years, is a continuum, with options for increasing levels of expertise, promotions, and career pivots. There are a number of ways to serve patients, the community, your family, and your own well being, while earning the income that you aspire to.

Seizing your options
There are not many resources that consolidate all of the non-clinical career alternatives for physicians. That is because the companies and industries that need physicians in non-clinical roles recruit separately based on their own needs and criteria. This makes finding a non-clinical job different than applying for the match- which lists all residency specialties in an easy to find format.

As you explore your options, it is important to remain confident in your abilities, intelligence, skills, and qualifications. When you face rejection or obstacles, remember that most leaders did not achieve their success without hard work and persistence.

1. Evaluate why you want to get out of clinical medicine.
Each doctor has a unique story. Start by evaluating your current goals. Some doctors want more money, some want more recognition, some crave free time, and some want new challenges. You can use Careers Beyond Clinical Medicine or this list of professional priorities to help identify your own personal and professional needs and aspirations. You must remember - your own objectives are valid and worthy of follow through. Identify your goals and be proud of what you aim to achieve.

2. Learn about the options in the non-clinical world.
There are many important roles for doctors in health care besides patient care. Non-clinical jobs for doctors is a catch-all label that covers a wide array of choices. Explore the resources around you to find out as much as you can about the different options. Learn what to expect in terms of salary, time commitment, work environment, and future prospects for promotion. There are also opportunities completely outside of healthcare that you can excel at. You can find a substantial amount of useful information here on nonclinicaldoctors.com and there are useful links to help you find other online resources as well. Consider joining social media groups, talking with other doctors, and browsing job boards as you explore your options.

3. Match your goals to the available career options.
Find the right fit for you. Narrow your career search to focus on the jobs that suit your current and future career aspirations. You might decide to stay in patient care, and make some adjustments to your job. Or you may decide to stay in the medical field in a job that does not involve as much patient care as your current job. You might decide to leave patient care completely, or you might even decide to leave medicine completely. These physician success stories can help you get an idea of the day to day life of a non-clinical physician.

Frequently reported survey results suggest that an increasing proportion of  doctors express wishes of leaving medicine. Yet the vast majority of physicians don't leave clinical practice. Even if the thought of leaving clinical medicine seems appealing once in a while, many physicians are happier and more productive in jobs that involve direct patient care.
 
Here are some questions to ask yourself as you consider whether you really should put some energy into finding a non-clinical job or whether you are more likely to find career satisfaction by remaining in patient care for the long-term.
 
1. What do you think when a young person mentions that she wants to become a doctor?
A. What a smart, ambitious kid! Good for her.
B. Poor kid doesn't know what she is in for.
 
2. If you were handed an offer to participate in committee meetings one day a week instead of seeing patients, with no overall change in your reimbursement, what would you do?
A. I would not want to sit through a committee meeting. I would keep my schedule as it is.
B. I would grab that opportunity. One day a week of working without demanding patients and medical malpractice risk sounds like a relief.
 
3. If you ran into a patient of yours on an airplane and he enthusiastically greeted you, how would you feel?
A. I would be happy to see that he is enjoying a vacation.
B. I would want to run away- my patients are a pain.

It is true that most doctors have many different skills and talents. Yet, many doctors cannot easily find non clinical positions. At the same time, I also hear regularly from recruiters who tell me that they can't easily fill their well-paying positions. Why are there so many doctors who want non-clinical jobs while there are unfilled jobs? The reason is that doctors and recruiters often don't speak the same language. I have learned that there is a wrong approach to looking for a non-clinical job and there is a right approach. Sticking to the right approach saves time and prevents disappointment.

Wrong Way
There are no job descriptions for 'a doctor who wants to change direction.' Recruiters are very specific in their needs. One of the first questions recruiters ask me is, "do you know someone who is a good fit for this position?" They typically describe the experience and skills they are looking for.

The wrong way to transition out of clinical medicine is to look for, ‘anything else’ without specifying what it is that you are looking for. If you state that you can do anything (especially that you want to provide advice) you are less likely to be taken seriously than if you are specific and targeted in your approach.

Managers and recruiters try to avoid hiring people who seem like they want to 'get away' from something.

Right Way
The right way to obtain a non-clinical job is to:

1. Honestly evaluate your goals and professional priorities. There are so many options, and there is no reason to pivot to a position that will not fit in with your life goals. This includes your level of interest in the work, as well as other priorities you might have (stability? flexibility? working from home?)

2. Study your options and narrow down your choices to the type of jobs that match your professional and personal objectives. Finding the right fit is the most important part of landing the right job. Doctors who are changing direction need to reevaluate their goals before, not after, they start looking for the right non-traditional job.

Each type of non-clinical job requires a different approach. Before applying for any non-clinical position, it is helpful to become familiar with the work environment, typical salary, work expectations, and, of course, the best approach for finding a job in that specific field.

Find out if you are qualified for what you are looking for. Learn how to become qualified for the most common non-clinical jobs to see if you have the time and interest to make yourself a good candidate.

You could sabotage yourself by offering to do 'anything' or 'provide advice'. You can use nonclinicaldoctors.com and the many resources for physicians who are looking at non clinical jobs to find more details about how to effectively tailor your job search for the job you really want. This will give you a huge advantage as you look for the right fit.

Recent surveys show that at least 50% of doctors would leave medicine if they could. The road to becoming a doctor is challenging and loaded with hard work.

The road out of clinical medicine is not easy, but it is certainly easier for you to find a great non-clinical job at any stage in your medical career than it was for you to get accepted into medical school and become a licensed physician.

A non-clinical job can be the right move for some doctors, but not all. Find out if you should take action and start redirecting your career path.

These are the top 10 signs that you need to get serious about finding a non-clinical career.

1.You are more interested in your work activities outside of patient care than you are in your clinic or hospital work. If you are more enthusiastic when listening to a seminar or dabbling in medical technology, research, writing or editing, teaching, consulting or serving on committees than you are when seeing patients—then it is about time for you to get paid for doing non-clinical work.

2. You don't look forward to patient care. After all the studying and training and test taking that you have done, you have earned the right to look forward to your daily work. If there are jobs that you would like more than what you are currently doing, there is no reason to stay in a job you do not want to be in. You can move forward in your career continuum. Find out more about your non-clinical options to see which type of position would be the right fit for you.

3. You keep putting off that project you have been dreaming of. If you want to start your own business, do something innovative or work in medical technology someday, it is worth your while to figure out a timeline - 5 years, 10 years, after retirement? Decide if and when you want to be ready to take a professional leap that you have been craving.

4. You have already applied to non-clinical jobs and your applications have been ignored or rejected. Most doctors make a few feeble steps at sending non-clinical job applications or inquiries, only to be rejected. The non-clinical world is different than the clinical world when it comes to looking for a job. You need to learn how to position yourself so that your applications will be effective and land you the position that you want.

5. You are jealous of physicians who have non-clinical jobs or resentful of professionals who are not doctors. You should not remain in a position that leaves you bitter. Jealousy is a sign that you are burning up with complacent dissatisfaction and you need to learn how to make a change now.

6. You are feeling trapped in medicine. Medicine is not an involuntary imprisonment. However, if you are feeling that it is a life sentence - you need to do yourself a favor and find the key to get out- you are the only one holding the key!

7. You have a nagging feeling that you are missing out on something. If you keep looking at the world outside of medicine as a bright, missed opportunity - then by all means grab the opportunity and let it take you wherever you want to go.

8. You hate your work. It is bad enough if you don't look forward to your work. (See #2) You have put in too much time, sweat, money and effort into your career to stay in a job that you hate.

9. You became a doctor to please someone else and you are spitefully waiting for the payback that you think you deserve. You will never get enough payback to compensate you for sacrificing your aspirations and dreams for someone else's approval. Sacrificing for someone else is a type of martyrdom, and if you expect extreme payback for being a doctor because it wasn't your choice, then you need to stop expecting disproportionate payback—because it will never come. You have to decide to either continue to live someone else's dream or to live for yourself.

10. You wish that you weren't a doctor. The fact that you became a doctor is nothing short of awesome. But tomorrow is another day and you can use your education, skills, certification and smarts to become whatever you wish you could be.

You can succeed and find a job that gives you personal satisfaction and at least the equivalent of doctor's salary if you learn about your options and how to position yourself to get the job that best suits you. Explore nonclinicaldoctors.com and Careers Beyond Clinical Medicine to learn what you need to do to transition into a non-clinical job.

Medicine Is Evolving
Medicine is rapidly changing, and your career management is going to have to expand in light of the fact that there is more than one way to be a doctor.
Doctors can directly care for patients. And, doctors can also do much more:

• Doctors can run hospitals.
• Doctors can control payer reimbursement.
• Doctors can find cures for medical illnesses.
• Doctors can create biomedical devices.
• Doctors can inform and empower the public about issues of health and wellness.
• Doctors can promote preventative care.
• Doctors can educate the next generation of doctors.
• Doctors can lead healthcare policy.
• Doctors can create medical care guidelines.
• Doctors can manage population health.
• Doctors can enforce the quality of healthcare delivery.
  
• Doctors can shape priorities in the funding of healthcare.
• Doctors can direct the goals of nonprofit organizations.

And that list does not even come close to including all of the potential jobs that doctors can do.

As a health care professional, you are not limited to specific  career model. You can find your own professional path within or outside of healthcare.

Health care is not exclusively about patients going to the doctor to get a prescription or to have a procedure. If you want to see how you can work as a doctor outside of those confined definitions, you may be surprised to learn that you have more career options as a physician than you thought.

After reading the following physician descriptions, think about the ideal work description that you envision for yourself 2 years from now.

 Do you see yourself in one of these physician profiles?
*Dr. Kramer is an ophthalmologist with subspecialty training. She is employed by a major medical center in a large city. She frequently travels to speak at specialty conferences and writes peer received articles—primarily case reports and literature reviews. She has to make occasional concessions in her practice due to administrative demands. For example, he had to relocate her office to another floor in the medical center, and she has not been able to obtain access to her billing and collections reports- despite repeated requests. But, she loves her day to day work and she is compensated well due to her sub-specialty expertise and because of her popularity among patients and referring physicians.
 
*Dr. Lee is an internist working as a senior medical officer for a health care management company. He has recently relocated to another part of the country because he received a  job promotion. His duties include selecting care guidelines establishing goals for physician reviewers and nurse case managers and evaluating the results, as well as coming up with ways to implement a better work flow. He attends at least 1-2 meetings per day, primarily with non-physicians, and he sees his role as a bridge between 'medical talk' and 'business talk.'

• Writing- Many doctors consider writing to be fairly tedious, but for those to whom writing comes naturally, it is an appealing source of revenue. In general, breaking into non-medical writing jobs takes dedication and time. Here are tips about self-publishing for physicians. And medical writing, another interesting route, requires some planning, as discussed here. Medical writing jobs can involve writing for pharmaceutical or biomedical device companies, CME, or educational writing.
• Teaching- Medical education is a wide ranging field that includes many different roles. Working as an adjunct professor is among the most beloved part time pursuits for physicians because it offers a community of creative colleagues and a young, energetic university or medical school environment. Generally, finding a teaching job requires networking within your local education community. Find out more about how to use your medical qualifications to find a teaching job here. Additionally, physicians can work as clerkship directors, test prep writers, and can give lectures in medical school or other health professional schools.
  
• Concierge care- Concierge care is patient care, but with a somewhat different arrangement than usual. There are companies that help physicians with the logistical aspects of setting up a concierge practice and. A physician explains how he integrated concierge care into his practice here.
• Disability exams- While performing and documenting disability exams is patient-based, it does not require on call duties, and thus is an attractive option for doctors who want to add a generous extra income without incurring additional patient follow up commitments or medical malpractice exposure. You can potentially do this type of work along with clinical care or full time. More information here.
  

• Product affiliations- Doctors have varied degrees of involvement when it comes to product affiliations. Some physicians directly sell products in the office or on social media, and some endorse products or serve as a spokesperson. You can contact a leader who guides physicians through the process here and a physician who has built an expanded her team here.
• Investments- Investing in the stock market, in real estate or in start up companies can provide a revenue stream for doctors who already have a reasonable financial foundation and an interest in spending the time necessary to thoroughly vet potential growth opportunities.
• Franchise ownership- As with investing, franchise ownership is a route chosen by people of all backgrounds and professions. There are so many franchises in a variety of different areas, and some companies, such as this one, for example, help people sift through the options to select the best fit.
  

Some features of good non-fiction writing include the following:

Content rich 
A strong article or book contains substantive material that readers can learn from or glean some valuable information from. Very good articles are those that readers consider worthy of saving or bookmarking for future reference.

Relevant
No book or article can be relevant for every reader. Some topics have wide appeal and relevance (example, over-the counter-medications for the common cold) while others obviously have a small niche audience (vaccinations for adults traveling to southeastern Asia.) Your topic may have a small or wide audience, but it should be relevant to at least some readers. 

Knowledgeable
A well-written article should demonstrate that the author is well informed about the topic, while maintaining a language and a level of detail that is appropriate for the target audience.

Qualified
Most readers value authors who are qualified to write about the subject matter, which goes beyond self-taught familiarity with the subject. Qualification involves formal designation, while knowledge is about experience.

Interesting
Not every person who is knowledgeable and qualified can write something interesting about the topic. But, being interesting isn't always important, depending on the purpose of the article. Some readers or publications prefer lists or charts that are full of accurate facts, some are looking for a reference piece, and some are looking for an interesting read with a thought-provoking, inspiring, or reassuring message. Tailoring how interesting your medical writing should be is about understanding your audience, and most importantly, the publisher's objective.

Depth, breadth, specific, detailed 
Depth, breath and specifics also depend on knowing your audience. Some readers are looking for a wide range of information about a broad topic, without too much detail, while others are interested in understanding a topic in great depth. Most well written articles and books are content rich, but do not have to have the qualities of depth, breath, specifics and detail. Instead, the author and publisher select the purpose of the piece and stick with either depth or breadth, unless it is intended to be an encyclopedic reference source.

Insightful 
Most readers are looking for some form of insight. This means that the author provides additional information about the topic or a different interpretation of the subject matter that makes the article or book more valuable.
Insight is a characteristic that is not judged uniformly by all readers. A reader considers an author who agrees with his or her own (the reader’s) overarching beliefs as insightful. When the author’s 'insight' is based on a different core viewpoint than that of the reader (example, vaccines are safe vs. vaccines are not safe) the reader is likely to dismiss the article, the author, and possibly the publication, even if the author is qualified and knowledgeable.  

Helpful, useful
Most readers of health and medical articles are looking for something helpful. This could be simply to understand a health condition, to learn how to take a medication, or to know when a symptom is normal vs. worrisome.

Practical 
Most readers are looking for information, knowledge or how-to that is easy to apply. This means that most readers cannot take on enormous, overarching, life changing plans and advice.

Timely, current
When it comes to health information, updated information is considered better than old information. When readers see health and wellness articles with well-established advice, most readers expect some type of acknowledgment from the author that, 'this has been the prevailing method for years, and new research continues to uphold this as the gold standard.' 

Real
Readers expect a genuine tone and voice from the writer, particularly from books and articles about health. An artificial or condescending or 'miracle cure' attitude is typically dismissed.

Honest 
Honesty is highly valued, and your audience can easily perceive your level of honesty.

Friendly 
Most of the time, the tone of a health, wellness or medical article should be pleasant- but not too casual to the point of not being authoritative or untrustworthy. Reference articles do not need to be friendly.

Balanced
An easy way to bring a sense of balance to a health article is to share a few facts. Instead of saying, 'the vast majority of people who take medication Y do not experience side effects,' it is more balanced to say, 'of the 70,000 Americans who use medication Y, approximately 4.7% experience side effects.' This takes the appearance of bias out of the equation.

Not offensive
Articles that offend the reader are a huge turnoff. In fact, articles that insult anyone are generally regarded poorly, even if the target of the insult is very different from the reader.

Not bitter
Healthcare can be a highly political subject. Controversial topics can make for good writing, but a bitter or angry tone makes the author sound as if they have an agenda, which discredits the article as being not geared towards helping the reader.

Funny
This is a tricky one. If you have a great sense of humor, you can try it. But humor in medical writing requires an exceptionally talented writer, and it doesn't usually work.

Organized, flowing 
Well-structured material is critical. When it comes to writing health or scientific books and articles for the public, the science can be complicated, and logical organization is the trick to making difficult material interesting and understandable.

Clear
Often, clarity is more important than attention-grabbing material. If you can be interesting and clear at the same time, then you will be able to keep readers engaged and informed.

Succinct
If you can avoid repetition and get your point across briefly, readers are more apt to enjoy your material. 
 
One of the ways that your audience shows appreciation and approval of what you have written is by sharing it with others. When a reader shares something that you wrote, this is a statement that they found your article useful and are comfortable being associated with it. This is a huge compliment to any author. It is impossible for any piece to have all of the qualities listed above, but if your writing has most of those qualities, it is more likely to be well received.
Find out more about how to get a job as a health and wellness writer here.

Which of the following priorities do you value the most?

*Challenging yourself
*Feeling that you are a good person
*Job security
*Comfortable around patients
*Personally experienced a medical problem and want to help others in the same position you were in
*Work environment is enjoyable
*Aspire to imitate a role model
*Being appreciated
*Solving problems
*Prestige
*Respect
*Approval (of someone in particular?)
*Avoiding disapproval (of someone in your life?)
*Proving that you are good enough for your job (did someone say you couldn't do it or that you weren't good enough?)
*Competing with someone
*Having free time
*Fitting in
*An income that you consider desirable
*Being attractive for a romantic partner
*Helping others who are sick
*Improving patient quality of life
*Perks, such as conferences
*Feeling like a leader
*Financial freedom
*Having a busy schedule
*Flexible schedule
*Feeling needed
*Meeting expectations
*Bragging rights
*Feeling 'in demand'
*Feeling important
*Enjoy understanding how the body works
*Feel a connection with patients
*Divine/ spiritual calling
*Enjoy seeing the results of your work

When you think about which of these qualities you consider most important, you might notice that your current job is or isn't fulfilling your priorities. Some of the above professional characteristics are so important to some people, but do not matter to other people at all. Take 'feeling important', for example. Some people consider that a necessity of the work day, while many others simply don't care. Some people are inspired by the example set by a role model, and are willing to overcome hurdles to reach that role model's level of success and expertise.
Re-evaluating your goals is a good idea every 6-18 months, because your goals might change. I have talked to many doctors who need to see a full schedule in the appointment calendar in order to feel secure and in demand. But after 5-7 years, that need is often fulfilled, and then a different aspiration arises, such as the need to practice leadership. You can achieve your aspirations as milestones throughout the years of your career.
If it is time for you to make a transition, you can start with instructions provided in the nonclinicaldoctors.com transition toolkit for tips and use the useful links to get started on the process.

5. The next step is choosing a domain name. This would be ‘yourwebsitename.com.’ Your domain name is going to be on your business cards and on your social media links, so think about this carefully. It should be easy to remember, but also specific enough that it describes the feel and purpose of your website accurately. Thinking through this step may take you longer than any other step. If you change your domain name at some time—whether it is 3 months or 3 years from when you publish your website, old links using your previous domain name will not work anymore, and that could have a significant impact on your website traffic and on your credibly if people try to search an old link and reach a page that says, 'this page no longer exists.' As an alternative, you can redirect your old page to a new one, and this requires learning some coding.
Registering a domain name requires a fee that must be renewed every year, and you should be able to find simple instructions for registering a domain name through your web host
 
6. Build your home page using the web host’s template for a home page.  A home page features your website title and a description of the website. Your home page is the page that people reach using your web address, so this will be your most visited page. Your website visitors will use your home page to decide whether they want to learn more and whether your business is right for them.
While templates are available, you do not have to use them—you can be more creative and build pages from scratch or even code your own pages if you want to.
 
7. Additional pages can follow a web host template. And each page has its own title that is part of the web address for that particular page. For example, an additional page web address would be 'yourwebsitename/ournewfeatures.com.' Additional pages may follow a simple page format with information and pictures or may follow a blog format, which features articles and pictures. As with the home page, you can opt out of pre-designed templates and create your own set-up or program codes for special features if you are skilled at coding.
 
8. Graphics should follow a similar theme and color scheme throughout the whole site. Graphics are extremely important to website visitors, as they relay a powerful message about you and your business. You can usually use graphics provided by the web host or you can upload your own photos.

9. Marketing your website may be important if you want your website to be a highly ranked destination. If your site is primarily playing the role of serving existing customers, then you probably do not need to focus on marketing your site. But if your website is one of your marketing tools for bringing in new patients or customers, then you need to have a marketing strategy. Sharing your site or sharing articles from your site in special interest groups or on your social media channels are some of the ways to build traffic. Collaborating with other websites that are similar or complementary to yours by guest posting can also help build cross-traffic. For example, if your site is relevant to the content on nonclinicaldoctors.com 'medical career strategies' or 'tips from your doctor,' submitting an article can help drive traffic to your own site. 
 
10. Revenue tools include automated ads or collaborations. If you want to earn revenue from your website, you can negotiate with individual businesses to advertise on your site or sign up for automated advertisements with programs such as such as Google AdSense or Amazon.com, among others.
Automated Advertisements
If you want to use advertising with a company like Google or Amazon.com, you need to apply to become an affiliate before they accept your site for their targeted advertisements.
If your website is accepted as an affiliate, you will receive your own code that you can place on your website so that you can feature targeted advertisements on your website. Your own web host will have a special tool that looks like something this < > for you to put into your web pages in order to place your designated codes for your ads. Then, depending on your traffic, you will earn revenue that can range from pennies per day to thousands of dollars per day if many visitors come to your site and stay on the site.

Commission and Partner Advertisements
If you want to place individual affiliate advertisements or links, you can negotiate an upfront fee or a commission with individual clients. These fees can be based on sales that the client obtains from your site referrals. With individual affiliate arrangements, your website and your posts serve as sales tools for your clients.

Personal Qualities 
Most university and graduate school department chairmen receive numerous inquiries from highly qualified professionals who want to teach. If you want to be considered for a teaching position, you should have evidence of certain personal qualities in addition to your medical degree. And, a chairman or departmental committee will check your references to see if you have these qualities. 

• Experience in teaching: Most physicians have taught junior residents or medical students in hospital rounds. You have probably also given a few grand rounds or prepared morbidity and mortality meetings. You may have also given a few lectures or case study sessions in the medical school setting. 
  
• Good feedback from students or peers: If you have taught before, it is likely that your teaching skills have been formally assessed. Recommendations that reference your teaching evaluations can be valuable when you are applying for a teaching position. 
  
• Demonstration of organizational skills: Teaching a course for a whole semester requires organization of lectures, exams, and creating a syllabus. While it may be difficult to demonstrate this ability if you have not previously taught a whole semester class before, experience with tasks such as organizing an on-call schedule or a clinic schedule can demonstrate that you are capable of preparing a course for students. 
  
• Attentive to learning goals: This one can be difficult for physicians. As a high achiever, you may have strong opinions about your teaching objectives. However, while your goals are probably commendable, teaching a course isn’t about you. It is about ensuring that your students learn what is necessary at their educational stage. 
  
• Encouraging and fair: Students learn when professors empower and challenge. Students need to be given instructions, opportunities to demonstrate skills, balanced feedback, and chances for improvement.
  

What to Expect 
It is also important to know what a teaching position may entail. 

• Full time vs. part time: If you want to teach undergraduate or graduate level courses, you may qualify for an adjunct position if you don’t want to do research, or for a full time tenured position if you want to do research. Sometimes, there are full time teaching positions for non- researchers, but these are not at common. 
• Compensation: The pay for university teaching varies, and it is typically calculated per credit hour or per course taught. The hourly rate may be competitive, particularly as you gain seniority and if you are knowledgeable about the subject matter and organized in your work. 
  
• Vacations: There are typically built-in vacations, as you will rarely be expected to work when school is not in session. 
• Professional development: Most universities provide opportunities for professors to learn new skills and stay up to date. The university setting is generally more updated when it comes to technology than a small medical office or a small company, and you will quickly learn how to use the most efficient and updated systems. You will also have the opportunity to learn about updated teaching strategies. 
• Smart colleagues: One of the major benefits of teaching is the exposure to creative and energetic colleagues who are devoted to students, their research, or both. 
• Student interaction: Teaching can be a great option for physicians who like interpersonal interaction. It does require patience, kindness, and the ability to grade and evaluate students fairly. If you want to leave medicine to escape from anxious patients, then teaching may not be a good fit, because students can be anxious as well. 
• Professional opportunities: University professors are highly sought after as experts in industry. Publishers, medical manufacturers, and conference organizers are likely to offer you well compensated consulting opportunities. 

How to Find a Job
In general, most teaching positions in higher education require a PhD. Physicians are not the typical applicants, but some are able to find teaching jobs in college, medical school, or another type of graduate school. There are some helpful methods to keep in mind in your search.

• Applying: If you want a teaching position, it is best to apply widely to several universities. Finding a job in a prestigious university may take longer, as you wait for job openings. However, if your objective is to gain experience in teaching, it is best to apply to a variety of universities, even those that are not especially prestigious. 
  
• Networking: If you are interested in teaching, it is helpful to network and to mention your interest to physicians and professors so that you can learn about openings, and so that people will know to contact you when teaching positions become available. Chairmen and professors often know about opportunities that come up in other departments and universities, and may share information with you when a good fit comes up. 
• Clarity: It is not uncommon for physicians to teach a few lectures on a volunteer basis. If you are looking for a paid position, you need to be clear about your goals and objectives. 
• Accepting a compromise: Depending on the universities in your area, it may be difficult to find a full time position right away. However, an adjunct teaching job can open the door to a full time position after a while. But if your goal is a full time position, it is best to confirm that it will be an option at some point in the future before you accept a compromise that cannot lead you to your long term goals.

 
Many doctors express a desire to teach. Teaching can be enjoyable, and it opens many doors professionally. However, teaching requires dedication so it is important to decide if you really want to teach before you start looking for jobs.

I have many folks that I work with who are passionate about some cool stuff- toy trains and art and music. Heck, my wife is one of those amazing artists. Some of these businesses are actually quite profitable.
They have revenue.
They have expenses.
They have a profit.
The IRS loves those businesses because they can TAX those juicy profits. The gray line becomes when there is NOT a profit.
Maybe there isn’t revenue and there are only expenses. Or the revenue is minimal. What if it’s the latter of those two scenarios? What if this business doesn’t have a profit?
Can I still write it off?
Just because a business doesn’t have a profit YET doesn’t mean that you should toss it away and not take the write-off.
As a matter of fact, there are some cases where you should take a tax loss and it’s perfectly acceptable.
Heck, I even encourage you to pursue having a business as one of my 5 Smart Strategies To Slash Your Taxes in 2017.
Before we carve into the meat of the article, let’s figure out what the IRS says about this.

There are 9 specific questions that the IRS poses to determine whether or not your business is a hobby:

• Does the time and effort put into the activity indicate an intention to make a profit?
• Do you depend on income from the activity?
• If there are losses, are they due to circumstances beyond your control or did they occur in the start-up phase of the business?
• Have you changed methods of operation to improve profitability?
• Do you have the knowledge needed to carry on the activity as a successful business?
• Have you made a profit in similar activities in the past?
• Does the activity make a profit in some years?
• Do you expect to make a profit in the future from the appreciation of assets used in the activity?

So, let’s break this down a little bit.

Question# 1. Does the time and effort put into the activity indicate an intention to make a profit? The key word here is INTENTION.
You need to have documentation that you have INTENTION.
For example, do you have a 1 page business plan? What have you invested into your business? Do you have a website? A Facebook page with active postings? A Twitter account posting your content?
Do you have any products or services? Have you tried to market them?
If you’ve never put any money into marketing the business- for example, you don’t have a website and you’ve never tried advertising and you’ve never tried guest blogging or podcasts- you may have a very difficult time to prove that you intended to make a profit.
Are you just writing off a portion of your house bills or your cell phone or your new computer, but don’t have any activities to point to show that you are INTENDING to make a profit?
Make sure you have documented evidence!
Here’s more from the IRS on this issue…
“An activity is presumed for profit if it makes a profit in at least three of the last five tax years, including the current year (or at least two of the last seven years for activities that consist primarily of breeding, showing, training or racing horses).”
So, unless you are into horse breeding and raising, you could write off at least 2 years of business losses- but once you get into year three… you really have to think long and hard about your intention to make a profit.
The second question can be a key one for continuing the write-offs…

Another client I work with is the spouse of a high-earning client. The primary bread winner makes $300k to $500k a year. His spouse has an incredible heart. She takes old ties and turns them into pieces of art. She sells them at craft show and often donates half the proceeds to charitable causes.
In this case, there’s still a cost of supplies- quite often the business produces a loss.
She doesn’t advertise. She does it on the side and doesn’t really care whether or not she makes a profit. Some years she makes $2k or $5k. Other years she might lose a few hundred dollars.
This is a case that’s right on the edge.
There is revenue. There are expenses.
However, it’s not their main source of income. Heck, it’s so relatively small, it’s really unnecessary. 
Some CPAs would call this a ‘hobby’. Others might call it a write-off.
If you have a similar side-hustle to this case, it could depend on how aggressive you want to be with your taxes. You do stand a good chance that the write-off could be disallowed if you get audited. However, it might be okay too.
Just remember… you have two years! So, there’s some runway to get your business to lift off.

Question# 4: Have you changed methods of operation to improve profitability?
The IRS is also willing to give you a pass if you are trying to do something different.
For example, let’s say that you had a podcast and it wasn’t generating any revenue after 1 year. You would be perfectly in your right to write off the losses.
Let’s say you generated a little bit of revenue, but had losses in year 2. You’re making progress, but you aren’t there yet. That should be fine to write-off too.
Then, in year 3, you change the way you do things. You start sending e-mails to prospective advertisers and you try to find some affiliate deals. You even make some arrangements and put advertisements in your podcast. You write a new book and try to sell the book on your podcast.
In this case, you have documentation in the forms of e-mails, podcasts, and other ways to demonstrate that in fact you changed your operations to improve profitability.
Remember how important documentation is in everything related to the IRS.
Final Thoughts
There are so many amazing opportunities in the world today. You can sell courses on everything from podcasting to land flipping to painting toy trains to underwater basketweaving.
You can seek plenty opportunities outside of clinical medicine.
Pursue them! Go after them!
You can even write them off for a couple of years and who knows, maybe that side-hustle income can skyrocket and even go way beyond the salary of your clinical career.
More Advice by Dave Denniston- The New Retirement and Does Stuff Own You?
For some more tax-saving ideas, make sure to check out 3 Answers to The Tax Questions Physicians Have Been Asking and The Little Tax Secret for Physicians.

About the Author
Dave Denniston, Chartered Financial Analyst (CFA), is an author and authority for physicians providing a voice and an advocate for all of the financial issues that doctors deal with. He also has 1 wife, 2 kids, and a bunny named Black Snow (which is a lot better of a name than Yellow Snow).
More Advice by Dave Denniston- Does Stuff Own You? and The New Retirement

Medical malpractice angst
*Are you tired of medical malpractice anxiety? Most of the time, you will not be held directly responsible for patient outcomes in the non-clinical world. And this is one of the most appealing factors that draws doctors to non-traditional jobs.
Ironically, even physicians who work in areas such as utilization review or as expert witnesses face far less scrutiny and liability than practicing physicians, as unfair as that may seem.
Connecting with patients
*Will you miss taking care of people? Some doctors are really good with patients but not so great with colleagues and meetings- the balance will change dramatically in the non-clinical arena, where you will interact almost exclusively with peers and professional colleagues, not with sick people.
Job security
*Do you value job security and stability? Clinical medicine is admittedly becoming less secure than in the past. While some non-clinical positions offer more job stability than others, overall, non-clinical jobs are less secure than clinical jobs. And, even if you have a leadership position, may have to deal with sudden company downsizing. If you are assigned to lead a project on a medical product that becomes obsolete, outdated, or is shown to be less valuable than competitor products, you could find that keeping your non-clinical position is dependent on factors that you have absolutely no control over.

There are a number of effective ways to master healthcare regulation. You can use the following approaches to build regulatory expertise. Most doctors do not need to use all of these methods, and instead mix and match these tools at a self-appointed pace.

• Join one of your decision-driven hospital or university committees (such as pharmacy committee or payer relations or compliance or resident education or CME) You might not get appointed right away, but if you show interest, ask to attend a few meetings as a 'guest,' and contribute usefully to the discussion (or, at least, don't anger too many people) you are likely to get an appointment in the next appointment cycle.
• If you are offered a part-time consulting job, consider it. Most doctors turn their noses up at chart-review jobs or consulting opportunities that pay $150-200/hr. However, the experience of doing 'behind the scenes' work provides more insight into the realities and complexities of healthcare policy than most formal courses.
  
• Attend programs sponsored by your professional specialty association. Most regulation centered programs do not count as CME- but they can be worthwhile for your own educational and practical benefit. These presentations are generally well designed and relevant.
• Take a course in healthcare policy at a local college to fill in the gaps of your regulatory knowledge and to tailor your learning.
• Use free online resources. Almost everything anyone would ever want to know about healthcare laws, rules, regulations, payment, licensing and so forth is available online. Here are some links to introductory resources to get you started.
  
• Consider getting an MBA, healthcare MBA, executive MBA or MPH. So many doctors are getting these extra degrees now, that many administrative positions unofficially require them. In considering whether to get an extra degree, it is important to keep in mind that these programs can provide a mechanism to help you understand healthcare regulation- but they might not. It depends on the curriculum of the program you are considering. There are some advantages to studying for an MBA, a healthcare or executive MBA or an MPH, and these different degrees are not all the same. You should carefully examine the curriculum of several programs to get insight into what the programs have to offer- and then decide whether a program can help you in achieving your objectives. A doctor shares her decision making process and experience with the dual MD/MBA degree.
  

Overall, expertise in medicine is not enough to catapult you to the next step in your career. The details of regulatory and policy issues are unfamiliar to most healthcare professionals. However, a mastery of these laws and rules is a necessary step if you want to attain a leadership role in the medical world.

Professional career paths
Many physicians have considered exploring non-traditional career paths. Yet, physicians often view a non-clinical career transition as a major life decision. This is in stark contrast to other highly qualified professionals. The majority of attorneys do not practice trial law and this is not typically thought of as a colossal decision. A significant proportion of nurses transition from one type of job to another, frequently taking leadership roles in health care, a move often viewed as a career advancement. PhDs regularly have multifaceted careers involving a combination of research, teaching, and administrative positions in the scientific and business aspects of industry. These professionals often view different roles as a professional continuum, rather than as 'leaving.' Yet doctors of medicine more often perceive a career shift as a tremendous undertaking, requiring great consideration, and sometimes even justification.
Lack of clear direction
One of the many reasons for the different attitudes regarding career transitions for doctors in comparison to other similar professionals is the lack of clear direction and openness when it comes to discussing the options available for medical doctors. In fact, there are a surprising number of alternative jobs and roles for qualified physicians, dentists, chiropractors and podiatrists. Here is a list of over 50 nonclinical health care jobs. Physicians can be leaders, innovators, business executives, directors, speakers and authors. A physician's career can undergo a continuum of different roles, each with new responsibilities and greater influence than the last.

Self-Publishing Tips for Physicians, by George Smolinski MD
I often am asked, “I have a great idea for a book (or alternatively, ‘I have a book I wrote’), how do I publish it?” Publishing a book, like many things in life, can be as simple or as complex as you want to make it, but in today’s world of eBooks and digital media consumption, producing your own book is can be a fairly painless task.
 
Its estimated that over 80% of Americans feel that they have the makings of a great book rumbling around in their brain, but only a select few ever put a pen to paper (or fingers to a keyboard) and write their book. Part of the reluctance stems from the intimidating nature of trying to get one’s book accepted for publication by a major publishing house, but fortunately in today’s world, there’s an easy work-around. Its called Kindle Direct Publishing.Let’s back up a bit. I’ll take for granted that you already have your book written and edited. That is by far the hardest part, but unless you have a book done already, most of this blog post will unfortunately not apply to you. Assuming you do have your book written, there are several key questions that many people have regarding self-publishing. I’ll answer these in the following paragraphs to help you on your way to self-publishing success.

1.    I have a great book idea, how can I get it in front of a publisher?

This is a superb question, but let’s take a look at some realistic appraisals of the publishing industry. First, although the concept of being picked up by Random House or the like has definite allure, its pretty close to impossible to have your book reviewed and accepted by them. Here’s a fun fact: One of the most successful book series of all time—Harry Potter—was rejected by over a dozen publishers and even the small publisher who did accept it (Bloomsbury) initially rejected the book. It was only when the editor’s eight year old daughter read the first chapter and deemed it worthy that the book was published. In competitive genres like self-help, medical texts, and fiction, its nearly impossible for a publishing house to notice you. As such, I highly recommend that you look at publishing on Kindle (and alternatively, or in addition, iBooks), as their Kindle Direct Publishing and iBooks Author publishing platforms are incredibly easy to use. You simply upload your book, your cover, write up a description for your book, choose your price, and that’s it! That way, your book is guaranteed to be published AND you retain control over pricing, distribution, and promotion. I’ve co-authored a book that covers the details of the Kindle Direct Publishing platform and gives you step-by-step instructions on how to get your book onto Kindle, “How To Publish A Book: Publish on Amazon Kindle with Kindle Direct Publishing & Build Your Business Now!”, available on Amazon by following this link.

2.    How much will it cost me to self-publish a book?
This is a superb question, and the honest answer is “zero dollars to well over $5000 dollars”. In today’s digital age, if you have the skill (or time to learn the skill) to lay out your book into a format accepted by Kindle Direct Publishing (such as a MOBI format) or iBooks (an ePub format) and design your own cover, you can do it yourself! As a matter of fact, I did just that with a children’s book I published myself with my twin sons back in 2013, “The Story Of Jubby Jubby Jow Jow” (Note 1: this is an actual book you can still find on Amazon. Note 2: my sons were 7 when we published this). The layout and cover are very important, as a great-looking book--both inside the book and the cover--will provide your reader with an optimal reading experience. However, if you haven’t the time or skill to do this, you can easily outsource the cover creation and layout of the book. Websites such as Fiverr.com and our own Gutenberg Reloaded site (www.gutenbergreloaded.com) have contractors that can produce a book layout and cover at a reasonable price. Normally, for a great cover and layout, a price of $200-$300 will yield a great looking book and cover design without breaking the bank. Obviously, top designers will charge far more, even into the thousands of dollars for a book cover, but for most self-published authors starting out, that’s a bit out of reach.

3.    How much will I get paid if I write a book?
Yet another great question, and the answer is, “It depends on how hard you want to work!”
Truthfully, when you self-publish a book, there’s numerous options available to help you promote your book, and the better your book is promoted, the more money you’ll earn from royalties. This is a lot of work, but can yield great results if you know how to promote a book effectively. Amazon’s royalty structure for eBooks priced from $2.99 to $9.99 is 70% to the author, 30% to Amazon. That’s a pretty reasonable royalty share, but know that for books from $0.99 to $2.98, the share is only 35% to the author, and 65% to Amazon. But, for even for the baseline $2.99 book, you’ll earn $2.08 for each sale. That may not seem like a lot, but top sellers on Amazon sell dozens, even hundreds of books each day. If you can effectively promote your book (something that we also help folks with), you have a great chance of earning a reasonable amount of money with your book publication.
 
In closing, publishing a book today is easier than ever, and if you’ve already written your book, you’ve done the hardest part! The entire publishing part is simple, straightforward, and by using contractors to outsource the cover and layout design, you can easily get your book published in a very short time. We are always happy to discuss the book publication process and answer questions—please contact us at contact@gutenbergreloaded.com and we’ll be happy to help!

Q: I am about to finish my Internal Medicine training and I want to try to find a non-clinical job. I am not sure that will work out, so I am concerned that if I ask for recommendations from my attendings, they will see me as less dedicated to clinical medicine, and I will lose my chances at good recommendations for clinical jobs if I need them.

A: You don’t need to worry about your attendings seeing you as less dedicated if you ask for letters of recommendations for more than one job or for more than one type of job.
It is typical and in your best interest to evaluate several options before you accept your first job offer. Unless you have specifically heard your attending criticizing a particular work environment, you should not worry.
However, sometimes it can be best to ask an attending who may have observed you in one setting (as a senior resident on the wards for example) recommend you for one type of position while another attending who has observed you in another setting (presenting grand rounds) recommend you for another type of position. For example, if you are applying for a job at a medical consulting company, you may want to ask for a recommendation from a faculty member who saw your work when you volunteered on a hospital committee. If you are applying for a job in a substance abuse treatment setting, you might want to ask for a recommendation from a faculty member who supervised your interaction with difficult patients.
An important factor to keep in mind is that regardless or whom you list as a reference, future employers are more likely to call their acquaintances in the department where you are doing your training- even those who you have not listed as references.

Why do you want to write a book?

• Do you have a creative story, a personal story or useful information that you want to share with others? Do you want to write fiction or non-fiction?
• Do you have enough information to write a whole book (at least 50,000 words) or just enough for an article (350-2000 words) or to create your own  blog (5000-50,000 words)?
• Do you want to write a book because you want to provide information for others, because you want to make money from book sales or because you want to promote and market yourself or your business? Rank these three in order and always keep your priorities for writing a book in mind to help you stay on task.
• Would you be willing to pay to self-publish your book, or do you want to have it published through a professional publisher?

Professional Publishing
It can be very difficult to get a publisher to look at your book idea. You must have a well-written proposal. I have already had many doctors tell me, ‘I just want to run this great idea by a publisher.’ If you are not already an established author, it is not easy to get a publisher to listen to your idea. You must have an excellent, well-written, clear and flawless book proposal.
Self Publishing
It is a good idea to look into self-publishing before you approach a publisher so that you can get a handle on the cost of getting a book in print. Calculate the costs of editing, printing, marketing etc. Estimate how many copies of your book will sell. Do you think your book would be profitable if you self publish it? Any publisher will do the same calculations; so think the numbers through even if you prefer to write your book using a publisher.
Building a Brand
Consider starting by writing an article about your topic of interest. Then gauge reader's comments and interest in your topic as you construct your book proposal. You can consider submitting an article to nonclinicaldoctors.com to see if you are ready to hear reader's responses to your writing. (article submission guidelines here.)

Face the Fact that Medicine is Changing
Medicine is also experiencing some positive changes stemming from advances in science, technology, public health and patient knowledge and empowerment. Any doctor who imagines that over a fifty year career in medicine, he or she will not be required to attain new knowledge and skills is in for a very unpleasant reality.

Whether it is adapting clinical practice to constantly improving devices and medical therapeutics or learning to use unfamiliar patient records or dealing with new and often temporary policies on multiple levels- it is the physician who is able to easily adapt and roll with the punches who will thrive.

Changes in rules, regulations and organizational structures of health care will continue to cycle, twist and turn, while the reality of the demand for caring, compassionate and capable doctors will remain constant. The challenge for doctors is to continue to improve competence, always providing the best care, while understanding and, more importantly, taking the initiative, to actively shape and influence the peripheral factors that encompass patient care.

There are ways you can adapt to the changes in medicine without losing your mind!
*Keeping up with regulations is one of the most effective ways to manage a healthcare career. Find out how to increase your regulations know-how here.
*Recognizing that a medical career is a continuum instead of a static destination can help you throughout your whole career path. There is more than one way for a doctor to make a difference.
*Periodically re-evaluating your professional goals can help you redirect your career if necessary.
*Know your options. As medicine changes, it is crucial for doctors tohave a grasp of the range of professional options. You might want to remain in patient care and adapt to the changes in healthcare. Or you might want to leave patient care as you adapt to the changes in health care. Either way, the one factor that will not change is that every doctor must adapt to the changes that are affecting in health care.

Recent polls suggest that  physician mothers of young children are more likely to feel torn between home and work than mothers of teenagers or young adults. Nevertheless, most successful physicians who are mothers of older kids did not suddenly get there overnight. They were, at one time, mommies of babies too! Mom MD's of older children often have good advice to share. However, one of the comments that I have heard from physician-mothers of older kids is that it seems to be getting harder to manage the combination of parenthood with being a physician than it used to be. Some of the reasons that maintaining a clinical practice while raising a family is so difficult for moms in recent years is that some things have changed with the times while other things haven't.

Some Things Have Changed...
Licensing and board certification exams
The years in your life when you are studying for certification exams are often the same years that you find yourself sleepless with young babies and sick kids who wake up at all hours of the night. This makes it tough to carve out dedicated study time in between work and caring for your family, much less to concentrate on studying during that time. On top of all this, re-certification is a new requirement that is more time consuming than ever before. 

Documentation
Paperwork and regulatory requirements require a different mindset than patient care and take your focus away from your core duties as a physician. The threat of being accused of improper billing if you forget to hit 'save' on just one of your EMR notes is enough to make you double and triple check everything you do. While that level of compulsiveness is admirable, we are trained as physicians to be compulsive in checking patients' electrolytes and medication doses. This reality of additional administrative/documentation responsibilities divides physician attention at work.

Some Things Haven't Changed...
Persistent gender roles
Dads want to be equal partners at home. While modern dads have made great strides in caring for young children, the work environments of modern dads have not caught up with the 2 working parent reality. Most workplaces are not any more accommodating of a dad's participation in child care than workplaces of the past. In fact, many would point out that the demands of high powered positions and mid-level jobs provide tenuous job security and are more stringent than ever, making it scary for fathers to request flexible schedules in order to share responsibility for kids in a 2 parent working family.

You can make it work
Regardless of the factors sabotaging physician mothers, there are numerous ways for physicians to balance work and family. As you evaluate your future goals as a physician, know that you have unlimited options and that nothing you aspire to is out of reach. Leaning In is not only about working as much as you can. It is about making your own work situation work for you.

Business Know-How
Women earn less than men in most professions, including medicine. One of the most important tools you need to have in order to be a better negotiator is an understanding of the economic and regulatory factors that come into play in the world of healthcare. This means diving right in and unraveling the complicated financial matters and reimbursement situation at work. It may take months or even years of 'self study' to understand the complexities of where your value comes from. But, once you master the language and the details of the business of medicine, you position yourself as a better negotiator.

Collaboration
Teamwork is about more than just getting the job done. Being a doctor who is trusted by other physicians and other healthcare providers goes beyond strong patient care skills. We all appreciate camaraderie and we are more likely to work well with others who are gracious and understanding in the work setting, rather than threatening or accusatory. It is a subtle, almost subconscious response to avoid those who are judgmental and hostile. Working well with others while maintaining patient safety is a delicate balance that makes the daily work of a physician smoother.