Medical Education Must Adapt to Support the Broadening Role of Physicians

By SYLVIE STACY, MD, MPH

As a physician and writer on the topic medical careers, I’ve noticed extensive interest in nonclinical career options for physicians. These include jobs in health care administration, management consulting, pharmaceuticals, health care financing, and medical writing, to name a few. This anecdotal evidence is supported by survey data. Of over 17,000 physicians surveyed in the 2016 Survey of America’s Physicians: Practice Patterns and Perspectives, 13.5% indicated that they planned to seek a nonclinical job within the subsequent one to three years, which was an increase from less than 10% in a similar survey fielded in 2012.

The causes of this mounting interest in nonclinical work have not been adequately investigated. Speculated reasons tend to be related to burnout, such as increasing demands placed on physicians in clinical practice, loss of autonomy, barriers created by insurance companies, and administrative burdens. However, attributing interest in nonclinical careers to burnout is misguided and unjustified.

Physicians are needed now – more than ever – to take on nonclinical roles in a variety of industries, sectors, and organizational types. By assuming that physicians interested in such roles are simply burned out and by focusing efforts on trying to retain them in clinical practice, we miss an opportunity promote the medical profession and improve the public’s health.

Supporting medical students and physicians in learning about and pursuing nonclinical career options can assist them in being prepared for their job responsibilities and more effectively using their medical training and experience to assist various types of organizations in carrying out missions as they relate to health and health care.   

A shifting locus of control from physicians to patients

A major reason for the expanding need for medical doctors outside of patient care settings is a shift in health- and disease-related locus of control from providers to patients. Medical information is increasingly available, comprehensive, accurate, and free of charge. Individuals wishing to learn about their own health can do so, often without the help of a doctor. Similarly, large data sets, new technologies, and analytical techniques are taking on a progressively significant part of patient care and consumer health.

Domains of patient care that were historically the responsibility of doctors are now in the hands of not just patients themselves, but also corporations, regulators, policymakers, and others whose efforts will ultimately impact patient actions and outcomes.

Physicians in nonclinical roles ensure that the most appropriate decisions are made from a clinical and scientific perspective, despite that fact that these decisions are being made outside of a traditional patient encounter. Physicians can, for example, provide clinical expertise in the development of a device, confirm that scientific data are interpreted accurately, and effectively communicate medical information to stakeholders.

Medicine is becoming less of an art and more of a science

In addition to technologies changing the way that individuals maintain their health, they are altering the way that clinicians deliver care. Electronic health records, health care analytics platforms, and artificial intelligence algorithms play a role in guiding physicians’ medical decision-making in every type of care setting.

As the role of technologies in clinical care becomes more widespread, involvement by physicians throughout the full lifecycle of these tools to ensure that they are scientifically accurate, medically sound, usable, reliable, and valuable. Medical professionals, more so than others, can ensure alignment with the needs of both clinicians and patients as a product or service is being developed.

Nonclinical work addresses a need for systems-thinking in the medical profession

There is little emphasis within medical education on building proficiency on an organizational and system-wide level – and even less on a societal level. While it is vital that doctors are competent in handling medical situations involving individual patients, they should further be able to contribute their knowledge and skills outside of a clinical setting.

The medical profession is not lacking in medical expertise. What is lacking is education on how to use this expertise in a broader capacity, including in the type of work that is the focus of many nonclinical roles.

Medical students and residents who are interested in using their medical expertise outside of patient care are quite limited in their training options to be prepared for this. Some may have the opportunity to do a rotation in an area such as quality improvement or clinical informatics. A few may take time off from their program to pursue an internship with a consulting firm or federal government agency, though are likely to be challenged by logistics, funding, and scheduling issues.

The options available to practicing physicians to participate in continuing medical education on nonclinical topics have been increasing, with courses on topics such as leadership skills, health care financing, and addressing burnout. Nonetheless, there is a need for additional education, especially programs that teach physicians how to use their skills and expertise in settings where their training didn’t take them: outside of the hospital and clinic.

Currently, burnout leaves doctors thinking that they want to “leave medicine” when, if fact, they would be fulfilled in a career that utilizes their medical and clinical knowledge to a great extent, just in a different way than they’re used to. Though a career pivot might mean that they stop directly treating patients, it is far from “leaving medicine.” This misconception leaves too many physicians feeling stuck, not realizing that they have viable options to explore. Many don’t realize the extent to which their experience and knowledge will come into play in other types of work settings.

Moving toward improvements in medical education and protecting the medical workforce

The issues described above can be addressed from multiple angles and on different levels, in light of the fact that opportunities for physicians outside of clinical care are growing in number, breadth, and interest to doctors.

Undergraduate medical education must foster and invest in learning environments that prepare physicians to be both clinicians and medical experts. Medical schools and residency programs, where possible, should support and encourage trainees to rotate in nonclinical settings and capacities. Continuing medical education providers should make an effort to include topics in their content that enable physicians to utilize their medical knowledge outside of clinical setting.

If they are trained sufficiently, physicians who experience burnout or frustrations in patient care can transition smoothly to a rewarding nonclinical role. Once there, they can make just as much (or more) of a positive impact on our population’s health than they did while directly treating patients.

Sylvie Stacy, MD, MPH is a preventive medicine specialist and blogs about career fulfillment for medical professionals at Look for Zebras. She recently published the book 50 Nonclinical Careers for Physicians.

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