The Ex-Doctor’s Diary: No Longer a Real Doctor?

Last night I spoke with a man who had just attended an investment bankers conference. He gave me advice on a hedge fund and referred me to a colleague who could help me with a money market account. This man and his friend both work long hours in the financial world, helping people with their investment portfolios. They love their jobs. They are also both doctors.

Is a physician who works on Wall Street still a doctor?

In past columns, I have described my lack of interest in direct patient care. But not every doctor who leaves the hospital or a practice is trying to avoid seeing patients. Some leave medicine for reasons such as lack of intellectual stimulation, lifestyle incompatibilities, or opportunities to make more money.

Recently I spoke with several physicians who have left medicine and begun new careers. One went back to school for his MBA. Another dabbles in the financial world but continues to see patients one day a week. Still another has started a family and is working at the Food and Drug Administration. While they all shared excitement in the pursuit of what was important to them, they also shared feelings of unease and guilt. Peers and nonphysicians have questioned all of them about why anyone would want to leave the world of medicine.

Dan Johnson (not his real name) completed college and medical school in a total of seven years through an accelerated program. He was only 20 when he began his second year of medical school. “I found that people really change in their 20s,” he told me. “I had no idea what I really wanted to do when I started the program. In medical school, I found I enjoyed patient care but couldn’t imagine the idea of setting up a practice. During my fourth year, I started to hear rumors and legends of doctors getting jobs outside of medicine. However, that year I matched at a Yale hospital for my internship, and I thought, ‘How can I turn down the Ivy League?’” Johnson thought he would just put in his time in residency and go into cardiology. But between his second and third year of residency, as he saw the demanding work life of a cardiologist, he realized that the potential of the profession wasn’t enough for him.

“I often wondered, ‘Why am I not happy? This is supposed to be the best thing since sliced bread.’ At the time, I had 100 percent support from my family and friends in being a doctor. They kept telling me there is time and effort associated with the pursuit of any career.”

But Johnson decided to get an MBA when he finished his residency. After a summer on Wall Street, he began a job at Goldman Sachs as a product specialist. Currently, he evaluates drug pipelines and analyzes indications and market demand for new pharmaceuticals. He applies this directly to the company’s financial projections to demonstrate possible future business scenarios.

Steve Handel (again, not his real name) chose medical school despite coming from a family of bankers.

“I hated the first two years,” he told me. “I hated the environment, the unfriendliness of the students, and the competitive nature of the people. I met people who had no social skills and by their own admission didn’t work well with other people. They’d lock themselves in a study room and not come out for days. There was a guy who would point to the highest score on a grade histogram and announce that was his score on the biochemistry test. I thought about leaving more than once, but you get into a mode, look into the mirror, and say, ‘What if I regret leaving? What will I tell my family and friends?’ So I stayed. Once I got into residency, I found I liked seeing patients and I found the people were friendlier. I also began to take over administrative duties and found I really liked the business side; I was the one asking questions regarding the kind of technology we could implement to improve patient flow. No one else was asking questions.”

Through a series of small decisions, Handel decided to go to business school. He loved it. “I met smart, interesting people who thought the world was big. Every day I was learning something new.”

Both physicians told me how a medical degree didn’t mean anything outside clinical medicine. Headhunters couldn’t figure out where to place them; each was a round peg in a square hole. Johnson said, “You’ve got an entire career under your belt, but it doesn’t mean anything. Some of your experience is appreciated, but you still have to prove yourself all over again. You have to start over. [Having an] MD can be a credibility factor, but you are an unproven quantity with no work experience outside of patient care.”

For doctors deciding to leave, success seems more forthcoming if they are pursuing other interests rather than just escaping medicine. Handel says when you consider leaving, you need to take a look at yourself and figure out what is important to you. Many people leave for the wrong reasons. Is money the reason you want to leave? Do you want a lifestyle change? Do you like a large or small work environment? Are the people you work with important to you? How much financial risk are you willing to accept?

The physicians I continue to speak with who have left medicine are pursuing individual interests and making individual choices that may be complementary to medicine - or may have nothing to do with medicine. I have discovered that most doctors who seek careers outside healthcare (or within healthcare but with less direct patient contact) face circumstances similar to those I encountered. They are questioned by both physicians and nonphysicians on the wisdom of their decision. They also experience the difficulties of leaving a career that required so much personal investment.

Whether any of these physicians works on Wall Street, at a pharmaceutical company, within hospital administration, or as a stay-at-home parent, each is still a doctor.

Michelle Mudge-Riley, DO, is currently a student in the Master’s of Health Administration program at Virginia Commonwealth University in Richmond. She graduated from Des Moines University Osteopathic Medical School in 2003. She can be reached via editor@physicianspractice.com.

This article originally appeared in the July/August 2006 issue of Physicians Practice.