I'm reading a lot more stories about doctors leaving medicine for good. An internal medicine physician wants to spend more time with her children. A primary care physician desires to attend to his mentally handicapped adult son. A surgeon needs to escape a "toxic" workplace. A has no avenue of appeal after he is unfairly reported to the National Practitioner Data Bank. A family medicine physician retires prematurely because practicing medicine has become a grind and lost its luster. A physician recollects, "the thing about primary care is 'poop rolls downhill' – and I'm absolutely glad I'm out of it."
The stories and reasons for leaving go on and on, but one theme many have in common is the realization that physicians no longer control their professional destiny -- it's in the hands of attorneys, corporate CEOs, government officials, and the like.
Over 500,000 healthcare workers have since early 2020. To be sure, the coronavirus pandemic has hastened the exodus. But the firestorm was ignited long before COVID-19 arrived on the scene, when, at baseline, physicians were overworked, underpaid, bogged down, second-guessed, litigated, and burned out beyond belief. The pandemic simply brought the cauldron to a boiling point.
In a perverse way, some physicians have laid the blame for this misfortune at their own doorstep. On the one hand, it is recognized that physicians are fighting tirelessly on the COVID-19 frontlines and are casualties of a broken healthcare system. At the same time, however, the medical profession has been by some physicians who do not consider their peers "heroes," reasoning that the status quo of medical practice does not rise to the level of responding heroically to an emergency. Nonsense! Is "heroic" not the right adjective to describe the clearly laudable behavior of healthcare professionals during a pandemic? Why shouldn't doctors consider themselves health heroes, battling forces seen and unseen – pre-COVID, during COVID, and undoubtedly in life after COVID? Paraphrasing David Bowie, we can be heroes just for one day -- or for ever and ever.
To add insult to injury, medical decision-making has been taken away from us. Nowadays, with , it's difficult just to get patients to first base. Requested medications and procedures go through bottom-line oriented algorithms and lesser trained individuals only to land squarely back in our laps, forcing a change in treatment plans or an appeal of the denial of care. COVID-related decisions that should be medically based -- masking, vaccinating, quarantining, gathering, etc. -- have slipped through our grasp and into the firm hands of politicians and science naysayers. Where does that leave physicians relative to their practice autonomy? Whatever happened to the sheer joy of practicing medicine: rendering care to patients unencumbered by third parties; enthusiastically imparting pearls of wisdom to trainees eager to learn; and providing sage advice and guidance to the next generation of physicians?
Until medicine crumbles and the public demands that doctors be placed back in charge, I don't see a way out of this mess except to explore alternative and "encore careers." The latter choice simply means that doctors will end up doing something they love but have delayed doing it for the sake of medical practice. They will undertake new and meaningful vocations that traditionally played out later in their careers, only the timeline is now accelerated. This could be good news! I've about encore careers before. The possibilities are endless: physicians have turned to careers in music, art, literature, coffee roasting, wine making, and many other satisfying endeavors.
A slew of options exists for physicians who wish to leave practice but stay involved in the medical profession. Chief among them are careers in the pharmaceutical and health insurance industries. I have discouraged physicians from the latter because most of those jobs have limited career potential, and the actions of physicians conducting are a plague to the practice of medicine.
Plum jobs in the pharmaceutical industry are becoming more competitive. Fortunately, there are a vast array of positions to choose from among multiple therapeutic and functional areas, such as pharmacovigilance, medical affairs, R&D, and field work. Working in the field as a medical liaison is a good way to break into the industry. Popular non-pharmaceutical jobs include medical writing and editing, consulting, and disability claims file reviews. A book by Sylvie Stacy, MD, MPH, , explores these and other possibilities in greater detail.
Practicing medicine was once an ideal. Practicing medicine was once coveted. Practicing was once enjoyable. I'm confident that disenfranchised physicians can find something more rewarding than clinical work (abuse). Now is the time to build back better until -- and if -- the real thing comes along again.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board, a 2021-2022 Doximity Luminary Fellow, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.