Career Transitions: What Are Other Options to Clinical Practice That May Align with New or Evolving Priorities/Goals?

Abstract

Career transitions are an essential part of the evolution of one's professional life. Transitions can take place at any time and for a variety of reasons. In this article, I review career transitions in the context of my own experiences and offer some advice and guidelines for making a career transition. The article also reviews what opportunities exist for career development and how that can lead to new and future prospects. Finally, achieving work–life balance can be difficult in today's health care landscape. Setting priorities and revisiting one's life plan on a regular basis establishes a professional “true north” to help navigate the challenges and disruptions of health care.

I am grateful to be asked to write this article. The disclaimer is that this is my story of career transitions. My comments reflect my experiences, both positive and negative; all were invaluable. I also write about the careers of the many men and women whose careers I have observed from near and afar. Their courage and resilience have quietly inspired me throughout my career.

Crafting your career is one of the most important things you will do with your life. It is no different from other important life decisions and will have significant reverberations for years to come. We are all different with different priorities. Mentors and role models are critical to show you what is possible, but ultimately you must find your own path. It is important to take the time to contemplate your career and ask: what am I passionate about, what are my strengths, what do I struggle with, and what are my short- and long-term professional goals? At the same time, we must consider how our professional goals integrate with our personal definition of a fulfilling and happy life. Corollary questions to ask about professional goals are: whom do I care deeply about that will be impacted by my career decision, am I achieving the work–life balance that I need, what am I willing to sacrifice to get what I want, and am I taking care of myself? Too few of us take the time to ask ourselves these questions and even fewer take the time to revisit our goals, recognizing that over time our priorities may change.

Everyone will experience at least two career transitions in their life. The first is when transitioning from training to practice, and the second is transitioning from practice to retirement. Many of us will transition more than two times in our professional lives. These moments can be driven by personal ambition or life events. In either case, these transformational moments require careful consideration, planning, and reflection. This is especially true for surgical specialists who invest significant time in education and training, often delaying other critical milestones such as marriage, children, travel, and self-discovery. The idea of deviating from the familiar and safe path seems daunting and risky; however, transitioning with the goal of living your “best professional self” can be the right decision when presented with the right opportunities.

On-Ramps and Off-Ramps

At different times in my life, there were opportunities to get on and off the “great highway” of a fast-paced career. Many times, I was convinced that I could do it all and have it all: a fulfilling family life, a busy career, leadership roles, and a successful research portfolio. Those moments would quickly pass when I was brought to my knees by a patient complication or a family event. Those painful situations taught me to be more realistic with myself because I did not enjoy the feeling of being inattentive to the things that mattered most to me. When the time was right, and the opportunity presented itself, I decided to make transitions.

At various points in your career, you will be presented with on-ramps and off-ramps that will impact your career. Medical school and residency are opportune times to take advantage of parallel education tracts such as a PhD, MPH, MBA, or MHA. These educational opportunities can be associated with stipends and grant funding that can offset the cost compared with the cost later in life. When combined with medical education, many of these advanced degrees can have less onerous application requirements and shorter times to completion. Similarly, many academic health systems have opportunities for midcareer physicians to take advantage of advanced degree programs. At my institution, there is an executive MBA program that is a shared investment between the health system, the department, and the individual. Keep in mind, many of these education grants come with an expectation that the recipient will stay with the sponsoring organization for an agreed-upon period to allow for a “return on the investment” from the sponsor's perspective. Typically, these programs are a win-win for the physician and the system.

Why Obtain Additional Education?

Physicians have seen more shifts in scale, finances, innovation, and workforce in the past 10 years than in the previous 50 years. The pandemic has accelerated the pace of uncertainty and opportunity. Traditional medical education has not evolved to keep pace with the changes facing the next generation of health care workers. If physicians are to continue to be the “leaders” of the industry, to protect the mission of education and patient advocacy, we must get more involved in health care decision-making at every level. Most can get ahead with our basic instincts, knowledge of patient care, and years of experience in the industry. However, increasing one's knowledge of finance, operations, and management principles is necessary to climb the corporate ladder in large health care systems, as this is where major decisions are made. Similarly, those with dual degrees in public health, medical education, or informatics have a unique perspective that can build bridges, connect dots, and problem-solve many of the modern-day challenges facing our health care industry.

All forms of education can inject new enthusiasm and energy into a career that ultimately leads to career transitions. Physicians have a unique position in society and an unparalleled lens through which to observe our communities and patients. This spectacular vantage point can lead to the development of a newfound passion or career trajectory, such as a desire to focus on a particular area of clinical care, engage in formal education as previously discussed, or choose something completely outside of the field of medicine.

Degree Programs

Physician leaders who gain expertise in relevant and complementary fields become invaluable to the health care industry. Examples include a master's in business administration, health care administration, bioinformatics, or public health. This additional education allows physicians an opportunity to focus their practice, research, or leadership with an eye toward more “system” related issues. Additional degrees are not mandatory to pursue career transitions but increasingly they are being looked upon as value-added for those looking to recruit a physician with a broader perspective. Key takeaways for degree programs are to be cognizant of the cost–benefit ratio, the anticipated time commitment, and above all else clarity on how this will positively impact your career trajectory.

Fellowship Training

Other forms of education include additional clinical training. Obtaining additional training can augment your research portfolio, enhance your clinical practice, or provide focused education in a specific area. For example, several of our junior faculty have obtained additional fellowship training in bioinformatics. This background has allowed them to leverage the electronic health record (EHR) for data mining and research or to secure leadership roles such as a Chief Medical Informatics Officer (CMIO) or Chief Digital/Innovation Officer (CIO). More often, I learn of colorectal surgeons pursuing additional training/research to focus their clinical practice or skills. These include additional training in surgical oncology, critical care, or palliative care. This dual specialization allows for better integration of multidisciplinary teams and fits well into a tertiary and quaternary care model.

Certifications

Training in a specific skill set can help position you for new career opportunities or help you accomplish specific tasks in a current role. Professional certifications include project management programs such as Lean Six Sigma , lifestyle integration courses such as Culinary Medicine , or clinical courses such as robotic surgery. Certifications traditionally require a small investment but can provide a significant return for professional development and career growth. When highlighted on a resume, certifications will identify you as an expert in an area, or someone with the knowledge and skill to build a clinical program.

Timing Is Everything

I am a wife to a busy cardiologist and a mother to three terrific children. Every professional opportunity that came my way had to be carefully considered in terms of how it would impact my work–life balance. Some opportunities I had to forgo for the sole purpose of being a parent who was “present” in my children's lives. I have never regretted those decisions. For the career opportunities that I cared deeply about, I made the necessary adjustments at home. I have never regretted those decisions either.

Timing is everything and deciding on the factors that will impact your decision to transition is essential. Important considerations include where you are in your career and where you are trying to get to. It is easier to make changes early in your career (first 5 years) when you have not made sizable investments in the practice or job, the so-called “golden handcuffs.” Early transitions tend to be about location, practice environment, and opportunities. For example, I started my first academic job in the city where I grew up, but my husband remained in San Diego. After much back and forth and an opportunity to build my own division, I changed jobs. At the same time, many of my colleagues moved because of a change of heart about being in academics or vice versa, and/or a job that turned out to be not the right fit.

From my observations as a Division Chief, early career transitions most often fall into these categories:

• Recognition of a preferred practice environment, i.e., academic to a community or private practice setting and vice versa.

• Relocating to a preferred destination, i.e., a move closer to family or a particular part of the country, or a spouse's job has shifted locations.

• A need to change jobs due to conflicts arising from the practice environment, i.e., job description was not what you anticipated, not the right “fit,” you are fired, resigned, or your contract was not renewed.

Midcareer is a great time to think about the next 10 years and to ask yourself if you are exactly where you want to be and if you can achieve your career goals in the current environment or if you need to transition into doing something different. If the answer is the latter two, then you need to put together a strategy to get to what you want. The saying “chance favors the prepared mind” is especially true when making important career decisions. Midcareer transitions tend to focus on the following:

• Job satisfaction: 10 years into a surgical career, most are comfortable managing any clinical situation, so the question is “do I want the next 10 years to be the same as the last?” For most of us, the answer is yes with a few modifications here and there. For some of us, the answer is a resounding no, and it is time to get serious about making a change.

• Compensation: there are pros and cons to focusing on monetary compensation alone. A career as challenging as surgery requires a certain amount of financial reward to stay engaged; however, compensation can come in different forms such as covering the cost of additional education, courses, and protected time. It is important to be flexible, creative, and strategic when defining compensation.

• Opportunities for career growth: this is the most common reason a midcareer surgeon will look toward a career transition. We all desire growth and intellectual stimulation in our professional lives and after 10 to 15 years of practice, most professionals have a good sense of their career aspirations and are often looking for new challenges.

Career transitions in midcareer are challenging as they will almost always cause unrest among stakeholders, and most will perseverate over the issue of “is the grass truly greener?” Still, it is a perfect time to reevaluate one's career trajectory and to take stock of personal goals. Compared with the prior decade, the midcareer point is often a time of stability and growth. It can be looked at as a launching pad for the next 20 years. These important decisions can be augmented by mentors and coaches who can help you fine-tune your professional goals and assist you with creating a road map for how to get there.

Creating a Team

Before I changed jobs, applied for an MBA, or considered a new position, I always sought out the advice of my professional coach, my mentors, and people who were in similar positions. Each time I talked through my thought process, I developed greater clarity and insight around that decision.

When reimagining your career or plotting your next transition, it is helpful to put together a team of people who can help you on your journey. The best decisions are informed decisions. Creating a team of people around you and your decision can help provide the necessary data that are needed to achieve the best outcome. The team can be anyone with a deeper knowledge of you and your career trajectory (mentors/sponsors), someone who has been there and done that, or someone who currently has a position that you could see yourself doing in the future. It is also important to include someone who will be brutally honest with you as well. Any combination of people whose opinions you value will be relevant to your decision process. As you articulate your vision, you will gain greater insight into your goals and have a clear idea of what you want and what you do not want. Professional/career coaches can be extremely effective at helping you to synthesize your career goals. I found that just having a coach gave me the permission I needed to take time out of my busy life to focus on my career development. Common questions asked of people who are considering career transitions are “why are you doing this and why now?” Vetting those answers by a mentor or coach will ensure that your answers are well thought out, clear, and project confidence.

Final Thoughts

The pandemic has created a wave of transitions in health care as many health care workers are rethinking their career plans. In a national survey of nearly 3,000 physicians in 2020, nearly 33% of physicians intend to leave their practice in the next 2 years. ^{1 2} The rate was higher among women and minorities. Burnout and well-being have played a major role in these decisions as have issues related to compensation, work–life balance, and the “commoditization” of medicine. There is very little literature on surgeon career transitions but there are some important inferences that can be made about women and career transitions in other fields. In a survey of over 2,000 randomly selected women graduates of international business (25% response rate), 47% of the women surveyed had stopped working at some point in their career citing numerous reasons for leaving. ^{3 4} Only 35% of the women who stopped working cited rearing children as their sole reason for opting out and 62% of the women reported that their career focus had changed. It is evident that having children, raising children, and, more recently, caring for elderly parents can have a significant impact on career decisions for women. Increasingly, employers outside of the health care sector have made major efforts to support their valuable female employees to achieve a balance between work and the demands at home. Surgery has lagged behind other fields, leading many women to consider nonclinical career transitions. Darves, in her New England Journal of Medicine paper, suggests that physicians have more nonclinical opportunities today compared with 20 years ago. ^{5 6} These include pharmaceutical drug development and consulting in medical technology and informatics, health insurance, utilization management, and jobs within regulatory agencies. She also lists “side gigs” such as chart review, expert witness work, biotechnology, health care business and technology startups, and medical writing.

The good news is that many of the skills required to become a surgeon are readily transferable to different occupations and responsibilities. Taking that leap of faith is always the most challenging aspect of a career transition, but equipped with the right motivations, a clear road map, and a supportive team, anything is possible.

Practical Advice

• If you are thinking about a career transition, consider reaching out to someone whom you think has a similar background, parallel career path, or has made a successful transition and talk to them.

• Online platforms such as LinkedIn and Doximity are great places to look into career transition information and opportunities. This is exactly where you can build your online presence as you prepare for a career transition, or after you have already made a transition or added a new skill that you want to highlight.

• Professional or career coaches are very helpful to facilitate introspection and career goals. If you find yourself struggling with your current position or desire new opportunities, a good professional coach can help you get there. Ask colleagues in your hospital executive team, industry, or any successful physician leader. They will usually have a few recommendations to offer you.

• You must be proactive if you desire upward mobility in your job. After 5 to 20 years in a position, you might be a little rusty on how to sell yourself. Physicians, especially women physicians, are not great at self-promotion. Make appointments to meet with senior leaders in your job and express your desire for more, highlight your skills, and share your 5-year plan. The mark of a great leader is succession planning and mentoring. Give them an opportunity to help you.

• Several national surgical societies have leadership training programs and mini-education opportunities. Consider applying for one of these programs. They are short, you meet some key leaders, and the goal of many of these programs is simply networking. Mini-education programs such as the policy program scholarship at Brandeis University funded in part by the American College of Surgeons can give you a focused time-limited experience in an area that may stimulate further study ( Table 1 ).

Table 1. Resources.

• AAMC ( www.aamc.org )

– Early and midcareer development courses for women physicians

– Minority faculty development

• AAPL ( www.physicianleadership.org )

• ASCRS ( http://fascrs.org )

– Surgical leadership institute program

– ACS and ASCRS health policy scholarship

• ACS ( www.facs.org )

– Leadership and advocacy summit

– Surgeon as leaders program

▪ Traveling fellowship

▪ Health policy scholarship (with ASCRS)

• Physician Side Gigs: www.facebook.com/groups/PhysicianSideGigs

Abbreviations: AAMC, Association of American Medical Colleges; AAPL, American Association for Physician Leadership; ACS, American College of Surgeons; ASCRS, American Society of Colon and Rectal Surgeons.