Physician, Inc: A Post-Residency Guide to Launching a Medical Career by @ZocDoc‎

ZocDoc has published a new white paper titled, "Physician, Inc: A Post-Residency Guide to Launching a Medical Career." 

When residents graduate from residency programs, how do they prepare for their medical career? Health care transformation is leading to some sweeping changes in physician employment, practice management, and medical career progression. The job market is evolving. Physicians value work/life balance. Some may even want to supplement their income or diversify their skill sets by diving into entrepreneurship or part-time non-clinical jobs.

Physician, Inc: A Post-Residency Guide to Launching a Medical Career brings together some of the nation’s best practice management consultants and physician leaders – along with a wealth of essential data – to answer key questions in all of these areas. From insight into the current job market to a detailed practice launch checklist, an extensive reference appendix, and more, this resource serves as a powerful and practical framework for pursuing success as a practicing physician.

Medical students gaining experience in Quality Improvement (QI)

I find it inspiring that medical students are getting experience in Quality Improvement. QI is not a normal part of the medical school curriculum. You may learn some basics around general QI concepts, but you don't generally get to work on a QI initiative.

Some medical students enrolled in dual-degree MD/MBA programs have worked on a QI project by applying business principles in a health care setting. After all, business principles related to process improvement can be applied in health care.

The IHI (Institute for Healthcare Improvement) Open School project has given today's medical students the resources and framework to work on a QI project. As an example: Colleen McCormick is a fourth-year medical student at Wright State University who will be doing her pediatrics residency at Northwestern University in Chicago, has written weekly posts for the IHI Open School blog. McCormick used the IHI Open School Quality Improvement Practicum to set up and execute her QI project.

If you're a medical student or resident interested in quality improvement, make sure to take get involved with the IHI Open School project.

Didn't match into a residency spot?

Ever year, I get a series of emails in March when 4th year medical students do not match into residency. In some circumstances, the graduating student may have a "red flag" in his or her academic history. In other cases, it's a matter of bad luck or not applying to enough residency spots.

In general, I tend to give the same advice:

1. Find a research opportunity during your transition year. This will be highly instrumental in boosting your chances of getting into a residency next year. Do your best to get something published.

2. If you have the funds and the time, you can get a one-year MPH. Do you have the time and money to make that investment and to be in school for yet another year?

3. Enjoy that year. Travel. Spend time with family. Play. You won't get this type of break again anytime soon unless you quit working.

4. Finally, there is the practical issue of finances: what do you do if you really need to generate income that year? You'd be surprised to hear what some people have done to make ends meet during that year. You can work at a restaurant, but you will always be tired because of long work shifts. Sounds like residency, doesn't it? You could do some tutoring or teaching with test prep companies. You could work for a library, a public health organization, or a You could also find a "regular" job, but most companies will know that you are probably only interested for a year of employment, so who's really going to hire you? Some consulting firms may. Or, you may get some traction finding a corporate internship within a pharmaceutical or technology company, but these jobs don't usually pay very much. Finally, there are a growing number of startup companies that may have the financial resources to employ a medical school graduate for a year. Look in SF, NY, or Boston for these tech startups.

No matter what happens, do not give up and do not lose heart. You have made it through 4 years of medical school. If you plan properly, you should be able to get into a residency so that you can pursue a clinical career. As a last resort, you can also choose to pursue a non-traditional, non-clinical career and find enjoyment and fulfillment in such a career path. There are plenty of job opportunities for MDs and DOs who did not do a residency.

Before you quit residency, consider these 3 questions

Every week, I seem to get a few emails from disgruntled residents who want to quit. They don't enjoy clinical medicine and they want to get out ASAP. Of course, many are burdened by significant loans and others feel that they would have nothing else they could do if they didn't pursue a career in medicine.

I always ask people to consider the following:

1. Financial stability: If you quit now, do you have a financial plan that will get you through the next 3, 6, 9, and 12 months? For most, it's resorting to family resources. For others, it's living off of a spouse's income or tapping into savings. Have you examined your budget?

2. Maybe you're in the wrong residency: Have you considered a different residency program or a different specialty? If you're currently dissatisfied or disgruntled, maybe you'll be happy at a different program. No 2 programs are alike. Maybe you're just in the wrong program, around the wrong people, in the wrong place in the country, in the wrong type of hospital...

3. Predicting the future: Will you regret the fact that you never completed your residency? Even if you never plan to practice clinical medicine, there are career benefits associated with being board-certified and by having an active medical license. Do you know what they are?

Of course, there are about 20 other questions you'll need to ask before you seriously think about quitting. Questions like: How will this impact my colleagues? What type of letter will my program director write? How will my family respond?

The Physician-MBA & Occupational Medicine

What does the MD/MBA have in common with the world of Occupational and Environmental Medicine (OEM)? Read this Harvard School of Public Health newsletter publication titled, "The Physician-MBA & Occupational Medicine." The Occupational and Environmental Medicine Residency Program at Harvard recognizes a number of MD/MBA graduates (they also have an MPH because you get an MPH as a part of the residency in preventive medicine) in this newsletter.

Operations Integration Administrative Residency

If you are a medical student, resident, or fellow, have you considered an Operations Integration Administrative Residency, Internship, or Fellowship? Johns Hopkins University has a unique program that may be of interest to you. Here are some of the details:

The residency experience at the Johns Hopkins Health System’s Department of Operations Integration is a matchless opportunity. The focus of the residency program includes projects to conceive and implement the healthcare delivery model of the future; designing and applying patient-centered best practices; and the integration of safety, quality improvement, and innovative technologies in hospital and health system design and administration.

The combination of four acute care hospitals, multiple ambulatory care programs, a homecare practice, a managed care contracting entity, and several physician/academic group practices offers qualified applicants an opportunity to gain valuable work experience in a variety of healthcare delivery and support settings. Residents work closely with executive leadership, senior clinical, non-clinical, and financial administrators, physicians and nurses to conceive and implement plans and procedures for patient care, business improvement, and program development.

2012 Residency Match: Scramble replaced with SOAP

Last Friday was Match Day.

The 2012 Main Residency Match was the largest in NRMP history. More than 38,000 applicants vied for 26,772 PGY-1 and PGY-2 positions. In addition, the NRMP debuted the Match Week Supplemental Offer and Acceptance Program (SOAP), a new system designed to automate, streamline and equalize the process for unmatched applicants seeking unfilled positions.

SOAP replaced the traditional "scramble" used in the past to help programs fill unfilled positions. Here's some more information:

For individuals who were not matched to a residency position, the NRMP debuted the Supplemental Offer and Acceptance ProgramSM (SOAPSM), a new process developed in partnership with the Association of American Medical Colleges (AAMC) and in consultation with student affairs deans, residency program directors, resident physicians, and medical students. Designed to help streamline, equalize, and automate the process for students who are not matched initially, SOAP replaces the “Scramble,” the unofficial name for the period of time during Match Week when unmatched applicants contact programs with unfilled positions. Under SOAP, the NRMP makes available the locations of unfilled positions so that unmatched students can submit applications for these positions through the AAMC’s Electronic Residency Application Service® (ERAS®). After receiving applications through ERAS, residency program directors create a list of candidates in order of preference and the NRMP offers positions in that order in a series of up to eight rounds. Applicants are able to receive multiple offers in a single round; if an offer is accepted, it is binding.

Quality of life, debt, and burnout among doctors-in-training (residency)

A recent JAMA article titled, "Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents," concludes:

In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores (Internal Medicine In-Training Examination (IM-ITE) scores).

Here's what the researchers found:

• Quality of life was rated “as bad as it can be” or “somewhat bad” by 2402 of 16 187 responding residents (14.8%). 
• Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16 192 (51.5%), 7394 of 16 154 (45.8%), and 4541 of 15 737 (28.9%) responding residents, respectively.
• In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >$200 000 relative to no debt).
• Residents reporting QOL “as bad as it can be” and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL “as good as it can be” and no emotional exhaustion symptoms, respectively.
• Residents reporting debt greater than $200 000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively.

So, what does this suggest? For one thing, residency is grueling and many people burn out or feel that life is terrible. Does this change once physicians complete their residency and enter the busy working world of high-volume patients and stressful working conditions? For some, their outlook improves because their salary has significantly gone up. For others, they battle with greater stress and anxiety because they now have more responsibilities to shoulder as an attending. They no longer have that backup or safety net they used to have during residency training. 

Jobs for doctors without residency

I continue to encounter countless physicians who are looking for jobs even though they have not completed a residency here in the United States. Some are US medical school grads who wish to drop out of residency. Others are foreign-trained physicians who have faced difficulty finding a residency position here in the United States.

I wrote an article back in 2008 titled, "Jobs for Physicians with No Residency Experience." This article continues to draw traffic from search engine users who are searching for "jobs for doctors without residency."

If you're a doctor looking for a non-clinical job, I encourage you to visit the NonClinicalJobs Job Board to find a variety of job opportunities for physicians who don't have residency experience. You can find a number of different employment opportunities in small and large companies where you won't need an active medical license, board certification, or post-graduate training.

Leadership and management skills in dual degree MD/MBA medical students

I recently had the opportunity to speak to medical students at the 9th Annual MD/MBA Conference hosted at Texas Tech University. One of the conversations focused around the value of the MBA for medical students who are preparing for residency applications. Is the MBA an asset or is it a hindrance when it comes to residency applications? Do residency program directors view the MBA as a positive characteristic? Are they indifferent?

Robert Wallace, MD, MBA, from the University of Southern California is currently conducting some research to answer these questions, so stay tuned. You can also read a current MD/MBA student's perspective on this issue here.

Residency Directors and Their Opinions of MD/MBA Applicants

Author: Brittany Chan

This weekend, Texas Tech hosted the 9th annual MD/MBA Conference. It was a great success and I’d like to thank everyone who came out to Lubbock.

One major topic discussed at the conference was the impact of the MD/MBA dual degree on one’s residency application. Back in January, I posted an article on the utility of the dual degree in the field. Based on anecdotes I had heard from other students, I mentioned marketability to residency programs as one of the advantages to the MD/MBA. However, I really had no empirical evidence for what residency directors truly think of the dual degree.

Dr. Robert Wallace, a clinical associate professor in ob/gyn at the Keck School of Medicine at USC, presented an eye-opening research study in which he surveyed residency directors on their opinions of MD/MBA applicants. Though he and his research team are still working, the preliminary data he shared shows that overall, 85% of the residency directors surveyed were aware that MD/MBA dual degree programs exist, and 65% of the residency directors viewed the MD/MBA as a positive aspect of a student’s application. According to his study, MD/MBA students were often perceived to have positive traits such as stronger communication skills, interpersonal skills, management skills, problem solving ability, and leadership potential. On the negative side, MD/MBA students were sometimes judged to have less clinical focus or seem "distracted". No significant differences were noted among specialties.

How to find open residency spots

Residency spots open up all the time. People drop out. People move. People switch programs. If you didn't match into a residency this year, you might still have a chance at post-graduate training by jumping into a residency during the fall or spring.

If you're looking for an open residency spot, here are some helpful resources:

https://services.aamc.org/findaresident
http://residentswap.org
http://www.openspots.com (website might be down)

You can also find discussions about open spots on these forums:

http://forums.studentdoctor.net/forumdisplay.php?f=290
http://www.scutwork.com/cgi-bin/links/page.cgi?page=position&d=1

Match Day: Did any of you choose to skip residency and go non-clinical?

Author: Riley Alexander, MD, MBA

St. Patrick's Day is also Match Day this year and for most senior medical students, it's the most important day of the year. It's one of those days that few outside of medicine have heard of and don't understand that, in many ways, it's much more important to medical students than graduation day. By the time you've gotten to 4th year, graduation seems like a "guarantee," but match seems very out of your control and because of that, finding out you matched in the specialty of your choice and where you'll be spending the next 3-7 years of your life is all the more important.

But, considering the nature of our blog, are there any of our readers out there who decided to forego the match and pursue a non-clinical path? Anyone go into consulting, pharma, biotech? Did you complete joint degree programs in medical school like an MD/MBA or MD/MPH?

Residency Match Day is Today. Didn't Match? Here Are Some Options

Today is Match Day. Congratulations to all the 4th year medical students who matched! If you didn't match, let's consider some options.

If you didn't match, here are a few suggestions:

1. Develop a clear, one-year plan where you will work in a non-clinical setting, volunteer, travel, etc. Make sure you stay productive. Find some non-clinical jobs on the NonClinicalJobs Job Board.

2. Residency spots will open up throughout the year. Do you want to jump into a position in the fall? As long as you're willing to live anywhere, you'll find open positions.

3. Spend the next 12 months strengthening your residency application for the next year.

4. Speak with a mentor/career coach/advisor who can guide you through this process.

Residency, board certification, or medical license not required for these non-clinical jobs

The other night during our NonClinicalJobs conference call with Dr. Steven Peskin, someone asked whether board certification was a requirement for non-clinical jobs within the pharmaceutical industry. Depending on the type of job, board certification, residency, or medical licenses are not required.

In general, an active medical license will not be required for most jobs where you are directly employed by a pharmaceutical company.  Some physicians who work for a pharma company may choose to moonlight once/month, so you'll need a medical license if you plan to do that.

Residency and/or board certification (active or previous) may be required for certain positions that require you to oversee certain areas of specialization. Keep in mind that some cardiovascular clinical studies may get managed by an internist who works within a pharmaceutical company. Or, a clinical study involving orthopedic surgery may be managed by a pharmaceutical VP of Medical Affairs who is a general pediatrician. Therefore, if you're a generalist, you may have the opportunity to expand into specialty areas. If you're already a specialist, then you may not have an easy time expanding into other specialty areas that don't specifically overlap with your specialty (eg, if you're a psychiatrist, you probably won't oversee oncology studies).

Take a look at some of these jobs:

• Medical Officer
• Drug Safety
• Medical Science Liaison  
• Clinical Research

Remember that many of these pharmaceutical jobs are filled by professionals who have a PharmD or PhD. Therefore, residency training is often not a requirement for many positions in the pharmaceutical industry.

Some Insights on being an MD/MBA Graduate Part 3: I've graduated and matched, now what?

Author: Riley Alexander, MD, MBA

I made sure and titled this "graduated and matched" because if you didn't go through the match, you've most likely made the decision to go the non-clinical route and this post will have much less relevance to you. (Dr. Kim has already addressed multiple pathways involved in that route so just peruse the blog for some great material on that, if you're interested).

As a first year resident, I think the initial time after graduation and starting residency has been one of the more difficult parts of being an MD/MBA grads--especially if you were like me and weighted most of your MBA courses towards the end of your MD/MBA training. Why is this? Well, I think the primary reason is that you've just completed this rather unique training and you're now faced with 3 or more years of residency/fellowship...3-more years where you have this fear that you will "lose everything" from your MBA training. Residency is, after all, a rigorous training environment that doesn't allow for a lot of extra-curricular activities and certainly not another full-time job.

So how have I addressed this? One of the best things I did was take advantage of the time I had off between graduation and residency. This will likely be the last time you have 2 months in a row off for the next 25 years so choosing to work during this time is not an easy one. But, if you're really interested in "getting your feet wet" in a non-clinical setting, this may be your best time. I was fortunate enough to get hired by a local healthcare consulting firm on a full-time basis during this time. This experience was invaluable. Working full-time allows you get a much better sense of how actually working in a non-clinical setting is and if you'll like it. It also allows you to learn how the business setting you're in much better than if you were just exposed on a part-time or after-hours basis. I know something like this may not be easy to find with the limited time-frame, but if you're really interested in doing it, try asking around and put some feelers out there and remember it will only be for two months--don't let what you get paid influence you too much. Many employers would be thrilled to have a recently minted MD/MBA on for a couple of months who is more interested in learning than making money. It may even provide for some part-time or non-clinical moonlighting opportunities during residency.

Dr. Robert Jarvik: a medical entrepreneur who skipped residency

This week's featured physician is Dr. Jarvik. We've all heard of the Jarvik Heart. Did you know that Dr. Jarvik did not do a residency? 

Robert Koffler Jarvik, M.D. (born May 11, 1946) is an American scientist, researcher and entrepreneur known for his role in developing the Jarvik-7 artificial heart.

He graduated with an M.D. from the University of Utah in 1976 and he never did an internship or residency. Instead, he pursued a non-clinical career as a medical scientist, inventor, researcher, and entrepreneur.

From 1978 to 1987, Dr. Jarvik ran the Salt Lake City company Symbion, Inc., a company formed to produce the Jarvik-7. In 1987, he moved to New York and founded Jarvik Research, Inc. where he began work on the Jarvik 2000 Left-Ventricular Assist System.

Today, Dr. Jarvik is President and CEO of Jarvik Heart, Inc. He holds numerous patents for medical device technology, and degrees from Syracuse University, New York University, and the University of Utah College of Medicine.

Medical students and residents don't know about the preventive medicine residency

Over the years, I've spoken with a number of medical students and residents who knew nothing about the preventive medicine residency.

These medical students and residents are not familiar with the ACPM - American College of Preventive Medicine or the American Board of Preventive Medicine (ABPM). You can become board certified in preventive medicine. Medical students and residents are also not familiar with the Preventive Medicine Residency & Fellowship programs offered by the CDC. They don't realize that they can get an MPH while they go through a preventive medicine residency.

The American Board of Medical Specialties (ABMS) recognizes preventive medicine as a specialty and here's a list of preventive medicine general and subspecialty certificates:

General Certificate(s)

• Aerospace Medicine*
• Occupational Medicine*
• Public Health and General Preventive Medicine*

Subspecialty Certificates

• Medical Toxicology
• Undersea and Hyperbaric Medicine

To learn more about preventive medicine, start with the American College of Preventive Medicine (ACPM) and the American Board of Preventive Medicine (ABPM).

From Residency to the Pharmaceutical Industry

The American College of Physician Executives (ACPE) offers some great resources that can help you transition from a clinical career to a non-clinical career.

Here's a "Career Stories" presentation featuring Michael Sokol, MD, MS titled, "From Residency to the Pharmaceutical Industry." His current title is Medical Director, Health Management Innovations at GlaxoSmithKline.  He talks about the first job that he had as an Associate Medical Director at Merck-Medco. He got that job straight out of a general preventive medicine residency. He stayed there for 8 years and moved his way up the corporate ladder.

So, how do you find a non-clinical job right out of residency? He was fortunate to have a mentor who was able to guide him through some of those steps. He also emphasizes the importance of building a social network so that you can get your foot into the door. One of his slides says:  "Great opportunities and jobs come from building and utilizing effective networking."

He ends his presentation by providing some tips to prospective physician executives who wish to enter the pharmaceutical industry. Click here to view this 16 minute presentation on the ACPE website.

I'm burned out... Should I quit residency?

I get questions like this all the time: "I'm burned out. Should I quit residency?"

Here's how I typically respond:I hear stories like this all the time. Burnout is very common during residency. It's important to explore all your options because it will be extremely difficult to return to clinical medicine in the future.

I find that many residents really don't have the proper perspective on post-residency life. There are so many different practice models that you'll never see during medical school or residency. You may also end up treating a patient population that is vastly different from the types of patients you've seen. Many physicians are able to find rewarding, satisfying jobs after they complete residency.

Are you absolutely certain that you don't want to practice medicine? Or, are you simply burning out, looking for a solution to your current situation? Perhaps you're in the wrong specialty. Maybe you'd be happy if you worked in preventive medicine.

If you're absolutely certain that you wish to exit residency to pursue a non-clinical career, then I could work with you to guide you along the way. Even if you lack business experience, the transition is possible. You don't need an MBA or an MPH to find a non-clinical job. In fact, I've personally helped many physicians make this transition successfully, so contact me if you're interested in speaking with me further.