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.

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.

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.'

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.

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.

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.

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.

Question: I work with a doctor who seems so unhappy. It is awkward for me to bring it up, but I think he would be better off doing something else.

Answer: Medical professionals in every area of medicine- nurses, pharmaceutical representatives, therapists, hospital administrators, and doctors- often write to me, "I know a doctor who really could use some information about alternative physician jobs." The doctor may be a colleague, student, friend, spouse or even one of your supervising doctors. You may be hesitant to broach this precarious subject. You might be worried that if you bring up the idea of non-clinical physician opportunities, you could unwittingly add to the physician's unhappiness by inadvertently sending the message, "you aren't a good doctor, you should find something else to do."

Tread Gently
Your colleague or friend is fortunate to have you as a sympathetic ally. If the physician has expressed dissatisfaction, it would help to reassure the doctor that he or she is doing a good job taking care of patients, but might enjoy learning about the wider array of professional opportunities available to physicians.
A gentle nudge affirming that the doctor has viable options will almost certainly be well received when paired with reassurance of professional competence. It also helps for you to approach your friend with the concept that a physician career is a continuum, and that some doctors do not continue to practice patient care for their whole careers. Find out more about the physician career continuumhere.
Remedial Training?
If, on the other hand, you are actually concerned about the doctor's ability to do a good job as a physician, then you have a responsibly to direct your friend towards remedial training to improve clinical performance. If this suggestion is combined with assurance that there is reliable information about respected and well paying non-clinical physician jobs, the doctor will be well equipped to evaluate which direction to pursue to make the changes necessary- whether remedial training or non-clinical work.
If you have noticed a doctor's shortcomings, there is a chance that others have noticed as well- or will notice in the near future. You will be doing a great service if you help direct the doctor to a path to become either a better clinical physician, or a physician who can work to attain professional satisfaction in the non-clinical arena.

There are a number of resources you can discuss with your colleague, including nonclinicaldoctors.com and Careers Beyond Clinical Medicine.

As all doctors know, maintaining up-to-date proficiency in patient care skills and medical scientific developments is essential. Medical science typically advances in a forward direction, utilizing new diagnostic tools and treatment measures that improve patient outcomes and ameliorate shortcomings in disease care. Everyone agrees that better patient outcomes is a good thing. But when it comes to healthcare policy and healthcare delivery changes, not everyone agrees about what 'a good outcome' means. This is one of the greatest challenges for modern physicians. The challenge of staying up to date with healthcare policies and regulations, while maintaining a high quality clinical practice.

Staying up to date on healthcare delivery
Healthcare system and organizational changes develop quite differently than scientific advancements, without the advantage of double blind controlled studies and prospective trials. Shifts in healthcare delivery systems and economic changes in healthcare occur without the same rigorous scientific standards that are required for validation of patient care techniques. These administrative modifications are generally applied to all patients in an often awkward 'one size fits all' method without the option of individual customization that is the cornerstone of clinical treatment.

Examples of a few relatively new healthcare delivery methods and organizational developments include the patient centered medical home, medical tourism, health insurance mandates, telemedicine, and concierge care. Doctors need to stay on top of medical innovation to deliver the best care. But they also must stay on top of these economic and logistic changes in order to survive professionally.

Are healthcare 'changes' just short-lived trends or are they here to stay?
How can a physician determine if a new administrative or health care delivery system development is a fleeting trend that will fizzle, or if it is really an emerging health system enhancement that is here to stay? How much time should a physician devote to adapting to proposed regulations that may lose favor?
What is the risk of underestimating the impact of impending rules and subsequently finding oneself behind the eight ball?

Young doctors are the barometer of healthcare
A good rule of thumb is to look at young physicians in training and to listen to what they say about how they view the new changes in health care delivery.
Young physicians and medical students of this generation have a general tendency to reject counterproductive circumstances as an immutable reality 'just because that is how it is done.'
Young physicians know they have professional options and will undeniably alter the supply and demand balance of the physician workforce in a manner that is transparent and fair. The response of young physicians to proposed developments in health care delivery serves as a good barometer of the survival of these developments. If young doctors will not put up with something an administrator wants to shove down their throats- then the 'something' (or the administrator) will not last.

Healthcare changes that are here to stay
Examples of relatively recent changes that overwhelmingly appear to have staying power include hospitalist inpatient coverage and electronic medical records documentation. Both suit the frame of mind of young modern physicians and both are quite different than traditional approaches. Future developments will likewise either enjoy widespread acceptance or will go away based on a thumbs up or thumbs down response from young physicians.