Pursue your passions with a portfolio career

Changes are a constant in the healthcare industry. From shifting reimbursement models to a growing paperwork burden, the longstanding approach to practicing medicine is often unrecognizable in this new environment. In response, the traditional physician job path is also evolving.

Sixty-nine percent of respondents in the 9th annual Physicians Practice Great American Physician Survey reported that they would consider going part time. And while about two-thirds (64 percent) of respondents don’t want to change workplaces, 29 percent said the main reason why they would prefer to work somewhere else is to work better hours or achieve greater work-life balance.

 A growing number of respondents (46 percent) said they would consider becoming a locum tenens physician, suggesting the traditional work environment is no longer as appealing to the 91 percent of respondents who have been practicing at least 11 years.

Today, physicians are increasingly open to the idea that they no longer need to be-or perhaps even want to be-tied to a single employer. Portfolio careers, where physicians have the flexibility to pursue multiple areas of focus and manage multiple revenue streams, are gaining traction. This strategy can provide high levels of job satisfaction, some much-desired mental stimulation, and a good income, too.

Building a portfolio around passion

It often begins with a desire to make learning a lifelong endeavor and to keep things fresh. “There are so many things I’m interested in, so if you told me I could only do one thing I’d struggle with that,” says Heath A. Jolliff, DO, FACMT, an emergency medicine physician in Columbus, Ohio. Multiple passions are a common thread among doctors who pursue portfolio careers.

Jolliff noticed that working in the ER brought challenges that fascinated him, and it didn’t take long for him to realize there weren’t many others focusing on them. This gap in expertise provided Jolliff an opportunity to pursue something new and interesting. He’s dedicated himself to emergency medicine for 25 years, and for the past 18 years he has also worked in the subspecialty of medical toxicology.

Today, he satisfies his passion through clinical teaching jobs at two different hospitals, Ohio University’s Heritage College of Osteopathic Medicine and OhioHealth Doctors Hospital. These roles give Jolliff a way to share his vast knowledge in the areas of emergency medicine and medical toxicology (and to promote a similar passion) with medical students.

In addition, Jolliff owns his own company, Mid-Ohio Toxicology Services, a firm that provides consulting to a variety of clients-patients, physicians, and legal teams-on toxicology issues such as evaluation of potential poisonings, forensic reviews, risk assessments, and similar expert analysis.

Pairing opportunities and interests

Heidi Moawad, MD, didn’t set out to have a portfolio career. Like many doctors who find themselves taking on new or additional responsibilities, she started by pursuing areas of interest. Along the way, she sought out a schedule and workload that best fit her growing family’s changing needs.  

While practicing neurology, she began talking with fellow physicians about ways to shape a career that suited her preferences. A number of her colleagues expressed similar desires, but during these conversations Moawad discovered there was very little information available about nonclinical jobs. She decided to write a book on the subject, a move that brought her into the publishing world.

As Moawad worked to finish her book, Careers Beyond Clinical Medicine, she also taught at a nearby college. Both of these roles were part time, a structure that offered her the flexibility she needed to care for her young children. Additional writing work, mostly small contracts in the early years, followed as she developed the right relationships.

These linked but disparate roles didn’t replace Moawad’s income from her neurology work right away, but she gathered more work in the following years. She now holds faculty positions at Case Western Reserve University and John Carroll University, both in Cleveland, Ohio. Today, her time commitment and reimbursement, plus teaching, writing and consulting work, are on par with a full-time clinical neurologist position.

When one path just won’t do

Trained in emergency medicine, John Shufeldt, MD, FACEP, has created a portfolio career that embodies his strong entrepreneurial spirit. Shufeldt’s work in emergency medicine afforded him flexibility, and he scheduled shifts that allowed him to continue his education in other areas. He obtained a Master of Business Administration, a juris degree, and an airline transport pilot rating-all while practicing medicine.

In addition to practicing emergency medicine, Shufeldt is the medical director of the Phoenix Police Special Assignments Unit, where he goes on high-risk calls with the SWAT team. He’s also the founder and CEO of MeMD, Inc., a telemedicine services company that fits well into the mobile device-heavy culture of today’s patients. In 2015, Shufeldt launched Tribal Emergency Medicine, a firm that partners with the federal Indian Health Service agency to provide emergency department staff for reservations’ hospitals. This latest endeavor came about as a result of Shufeldt’s Six Sigma certification and process improvement work.

A prolific author, Shufeldt has written a number of books, including urgent care textbooks that draw on his nearly 30 years of experience and a series of Outliers books that delve into being-and becoming-a high achiever. Along with mentoring medical and pre-med students, sharing what he’s learned to help them prepare for their medical training, he helps them get published. Shufeldt is quick to point out that mistakes are part of the growth process, but adds, “A lot of what has come together to make my career is learning from those mistakes.”

Pitfalls, payoffs, and getting it right

Simply making the decision to have a portfolio career isn’t enough. When doctors finally decide they want to take action, determining the logistics can be daunting. Can I do this while my family is still young? Am I too old to make such a big change? How will I make ends meet in the interim?

It’s not uncommon for doctors to take several different approaches and a bit of trial and error before discovering the mix of jobs that works best for them.  A position as a writer or editor appealed to Moawad, but she was uncertain about such a move at the time. Market and economic pressures may also play a role in finding just the right blend.

Moawad says a pay gap should be a realistic expectation for many doctors as they transition from full-time practice into a portfolio career. They should also be prepared for changes along the way. For example, Moawad spent some time working in telemedicine for a small company that later went out of business. Whether it’s the end of a company or just the end of a contract, a portfolio career means that doors will occasionally close. The trick is keeping an eye out for new ones to open.

Jolliff knew he wanted to deepen his expertise in medical toxicology during residency, but the prospect of spending even more time as a student when he could be making money caused him to put the idea aside. “It was a huge challenge because I finally felt I was done with school, and I needed to pay off those loans,” he recalls.

The money side of the equation often looms large in the overall picture. Jolliff’s passion was ultimately enough of a driver and, after spending a couple of years stashing funds away, he moved to Denver for a fellowship. He admits it was financially difficult, but says, “I’ll never regret it. I learned so much. It was absolutely worth it.”

Moawad still occasionally conducts independent medical exams but, by and large, she’s no longer practicing medicine. “Medical malpractice insurance is expensive and it’s hard to get it prorated if you want to work a very small amount of time,” she says. Until a few years ago, Moawad volunteered at a free clinic, a position that provided free malpractice insurance as part of the deal.

Malpractice insurance is something physicians may find difficult to navigate. Cutting back on direct care hours could mean the income won’t cover the insurance costs. In some cases, the insurance could make it difficult to practice clinical medicine on a part-time basis.

Finding the time to cultivate additional knowledge or skills-whether they take the shape of formal training or on-the-job learning-is often an early hurdle for doctors looking to develop a portfolio career.

At its core, medicine is a dynamic, ever-changing field. Taking an active role in advancing where physicians can contribute their skills and expand their knowledge can be hugely rewarding. If juggling everything seems overwhelming now and then, Shufeldt says the end result can be well worth it. “I think you have to realize that you need to be multidimensional to really have a successful practice and a balanced life.”

Julie Knudson is a Seattle-based freelance writer specializing in healthcare and technology.