Non-Clinical Opportunities After Medical School
This is a guest post from Dr. Kim, who writes for Non Clinical Jobs.
If you hate medical school, but you don’t want to quit, then maybe you should consider a non-clinical career after you graduate. I get asked about this all the time. Over the years, I’ve had a chance to meet different people working in various companies and industries.
First, ask yourself what you enjoy. After all, if you don’t enjoy clinical medicine, you don’t want to end up doing something else you’re not going to enjoy. Then, start networking like crazy. Leverage all the online social networking sites (like LinkedIn, Facebook, Plaxo, etc.) and get reconnected with old colleagues, classmates, and friends. Find out what people are doing. They may help you get connected to some key people. You may find some of the best opportunities this way. If you’re a woman, you may want to check out MomMD (www.mommd.com) and join a community of women who are seeking non-clinical opportunities ranging from part-time to full-time work.
The following list of opportunities is clearly non-exhaustive and many of these areas have significant overlap. This list is based on my personal interactions with people in these roles and as I meet more people, this list grows.
Here is my growing list of non-clinical opportunities for medical school graduates (not in any particular order).
1. Healthcare administration, medical management, hospital administration, managed care – Are you a seasoned healthcare executive? Do you enjoy making administrative decisions? Then join the American College of Physician Executives (ACPE) and run a hospital or a managed care organization. If you have a strong interest in managed care, then check out the NAMCP (National Association of Managed Care Physicians). You may want to get an MBA or an MMM (masters in medical management) if you don’t already have one. An active US medical license is required for most (if not all) of these positions, so plan to do your residency.
2. VC (venture capital), finance, Wall Street, market research, etc.- Got an MBA? If not, are you thinking of getting one? Some will argue that once you have an “M.D.” after your name, it may not matter as much where you get your MBA. However, I would argue that your MBA is your path to networking opportunities, so where you get your MBA is critical if you want to have a solid network. Once you get your MBA, you can work for venture capital (VC) firms, dig into market research companies, or work for Wall Street. Heard of the Gerson Lehrman Group (www.glgroup.com)? No clinical experience necessary for many of these opportunities, but it’s always helpful so that you can effectively communicate with KOLs (key opinion leaders) in the field. Many joint MD/MBA students have ventured directly into very successful careers this way. Also, an MBA is not necessary if you have some good business skills and understand the healthcare industry. You will need strong people skills and a willingness to work long hours.
3. Writing and medical communications (includes promotional education, certified CME/CE, consumer health education, and much more) – Do you enjoy writing? Many physicians and non-physicians have very successful careers as medical writers. The field is open to people who enjoy fiction writing, publications, research, or other types of writing. You can get involved working on journal publications, developing promotional content for marketing campaigns, or developing CME programs. Join the AMWA (American Medical Writers Association) and look for opportunities. You can work from home as a freelance writer and have a very flexible schedule. Or, you can work for a publisher or another type of healthcare communications company. You can find a list of some companies by looking at the North American Association of Medical Education and Communication Companies, Inc., (NAAMECC) website. No clinical experience / residency necessary for many of these types of opportunities.
4. Technology and Informatics (health information technology, healthcare informatics, EHR/EMR, PHR) – Want to develop or improve an electronic health record (EHR) system? Do you love informatics? Then join the CCHIT (Certification Commission for Healthcare Information Technology), the AMIA (American Medical Informatics Association), and the AHIMA (American Health Information Management Association). Clinicians use EHRs and patients (or consumers) use PHRs (Personal Health Records). There are many companies attempting to integrate the data between PHRs and EHRs. There is a national initiative to improve and standardize public health informatics, so now is a great time to enter this industry. No clinical experience necessary (but is always helpful), and you should be familiar with ICD, CPT, and other billing codes used in this industry.
5. Disease management, Personal health record (PHR) – Managed care organizations (MCOs) are always looking for better disease management (DM) programs for their plans. Some MCOs develop their own DM plans and others outsource them to external companies. These companies create and deliver various services to managed care organizations, including DM, wellness programs, personal health record (PHR) services, etc. Do you ever get educational pamphlets from your own health plan? Who puts them together? Who designs and develops these wellness and preventive health programs? It’s not always WebMD. There are other companies that provide similar services.
6. Pharmaceutical/Biotechnology/Medical Device- If you’re a medical specialist, there are many opportunities to do research for these companies. If you don’t enjoy research, then you can develop marketing strategies. Direct-to-consumer (DTC) advertisements have become very popular these days. See all those ads in the medical journals? Get ready for that “corporate America” lifestyle if you plan to venture into industry. You may be working even more hours and carrying a Blackberry instead of a pager, but if you climb that “corporate ladder” and play the corporate game, you may qualify for an early retirement. Young people who are fast learners may be very aggressive and advance rapidly. Be prepared to have a younger boss if you’re a seasoned clinician.
7. Independent medical examiner (IME), Expert witnessing, and Legal medicine – Personal injury, medical malpractice, nursing home care, etc. There are firms that specialize in specific areas (like nursing home cases). Want more information? Join the American College of Legal Medicine (ACLM). You can also become board certified by the American Board of Legal Medicine (ABLM). You’ll need an active medical license.
8. Public health, population health, health policy, and government health – Get an MPH, join the APHA (American Public Health Association), and find a local health department. Or, join the CDC and travel the world. Develop strategies to improve population health. Some pharmaceutical companies also have public health sections and are very devoted to public health and international health (Pfizer in particular comes to mind). Bridge gaps in healthcare disparities. Work for the FDA or a state or local health agency.
9. Consulting – The world is open. Want to work for yourself or for a company? Many healthcare companies are looking for experts to help them develop, refine, and improve their products and services. It may be hard to get started unless you’ve already established connections. Once again, social networking becomes critical. Your initial success will depend more on who you know.
10. Research – Academia vs. private vs. industry vs. CRO. You don’t have to go into industry to do research. Look for a Contract Research Organization (CRO) in your area. Join the ACRO (Association of Clinical Research Organizations). You may want to look at PPD (no, this is not the TB skin test). PPD is a large global CRO. Of course, there are also many other CROs.
11. Executive recruiting, search firm, headhunting, human resources – Physicians can work as an executive recruiter to hire and place other physicians. You can also work your way up and manage other recruiters who do the hiring. Remember, these ‘head hunters’ get paid a commission based on the salary of the person they place. The $ earning potential can be tremendous if you’re successful.
12. Start a company – Have an innovative idea? Start a company! New companies seem to be sprouting all the time. Stay connected with people and keep your eyes open for new ideas. Get an MBA and meet people who can help you get a concept off the ground.
Not sure where to start? As I mentioned above, start building your social and professional network. Reconnect with people and ask many questions. Find people who are in various positions and ask them what they like/dislike. Join some associations to build your network and to find companies. Note that some associations are specifically for physicians, but many are open to all types of healthcare professionals. Also, even those that are specifically for physicians (such as the ACPE) offer affiliate memberships for certain non-physicians.
Third Year
The following is contributed by Cousin Throckmorton.
When will it end?
Between the boredom
And bourbon
I haven’t much left
Empty
Hours
And hours
Of dry books and disappointed looks
Of diabetic feet and discharge sheets
Wading through patients
And patience
Knock kneed and faceless
From hackneyed cases
A doctor
Of guile
Hiding behind false smiles
Sweating away my soul
Into a day old shirt
I’m sinking
Gradually
Then suddenly
I haven’t much left
Fuck Surgery
So I’m not sure who the original author is, but apparently this was found on a 3×5 card in a resident room in some hospital. The person must have been bored during his/her surgery rotation. Enjoy!
Fuck Surgery – By: Anonymous
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Fuck surgery.
The hours murder me.
No one here’s concerned with me,
and no one says a word to me.
And all I do here is waste my time.
I stand around and don’t say shit like a motherfuckin’ mime.
I get up all early for no fucking reason.
When it comes to my will to live, it’s like it’s open season.
Cause I wanna die like every fucking day.
Please someone shoot my ass to take the pain away.
But that thought makes me nervous,
cause I’d hate to end up a patient on my own fucking service.
Cause don’t I already spend enough time here?
Damn, I need a beer.
And how come these guys never wanna go home to fuck their wife?
Please Lord, don’t let me be a surgeon and waste my whole fuckin’ life.
I ask why I am here, but I never get an answer.
That shit gives me visceral pain like pancreatic cancer.
I look for good reasons, but I can never find ‘em.
That shit is about to kill me like a widened mediastinum.
Here we go again, rushing to the OR quick.
This has got to be some kinda trick.
Cause doing nothing makes me sick.
And I’ve been standing in this surgery 10 hours now, holding my dick.
And does it get any worse,
than that bitchy scrub nurse?
Yes, bitch, I got the fucking gown.
And I got my gloves too, you need to settle down.
And don’t tell me shit about no sterile technique,
I’ll look in your direction if I want you to speak.
I don’t know why you think this job really rocks,
but talk shit and I’ll slap you back to your old job at Jack-In-The-Box.
And these residents, they got me trippin’ too.
Just let me go home, man, you act like I got nothing better to do.
If it’s past 6:30, and I am still here, you are not my homey.
And I’m telling you right now: I have seen my last lap chole.
If you want me to scrub, you can blow me,
and if you think I give a shit, clearly you don’t know me.
And the way you’re acting like you’re the boss,
that shit’s got me at a loss.
Cause you’re just a resident.
You musta forgot what that meant.
That means you’re not the attending,
so stop pretending.
You talk a lotta shit, always running your mouth,
but I can see you don’t know what the fuck you’re talking about.
And if you try to pimp me again on stupid surgical devices,
I’ll put yo’ fuckin’ lights out like an energy crisis.
But the chiefs have got to be the worst.
I’m down to get outta here even if it’s in the back of a hearse.
One guy goes as far as to even salt my game.
Tells me to stop chatting with the cute nurses when I’m working a
number and a name,
The other chief ain’t seen something he didn’t think was edible.
And I swear that fat motherfucker looks like the villain from The Incredibles.
On surgery, why is every day the worst day of my life?
Why do I feel this rotation has become my wife?
Why am I so full of strife?
Why do I have sick fantasies of stabbing y’all in the neck with a knife?
Oh, I know why: cause you took my Thanksgiving.
For that, when it comes to beating your ass, I will have no misgivings.
For this, there will be no forgiving.
Now my Thanksgiving dinner will be McDonalds and a six-pack of beer.
I’ll be laying back drunk and alone, asking how the fuck I ended up here.
Isn’t that pathetic?
I’m pissed off like I was on three different diuretics.
I don’t know what I’m gonna do with myself.
But ah, fuck it man, I gotta quit this bullshit and study for my shelf.
The Nine Circles of Medical School
The following is a guest post by getunconscious. Thanks for the submission!
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This is just a little something I wrote based on my experiences; I’m at the end of my third year and going into Pathology. I love your blog and just thought you might like it, I wrote it with your theory that medical school is hell in mind.
The Nine Circles of Medical School (read: Hell)
The Circles of Hell
Third Year introduces the medical student to the nine circles of Hell. The circles in third year occur for each individual in no particular order but it is easily determined that some are far worse than others, though they all represent varying degrees of torment and misery for medical students, house officers, and patients alike. Each circle’s house staff are punished in a fashion fitting their personality, and mean-spirited personalities predominate more and more as one descends through the circles. People who were foolish enough to enroll in medical school but realized before it was too late how punishing clinical medicine is end up in Purgatory, this is to say, Pathology and Radiology. Those in Hell are the M.D. graduates who cling to the notion that patient care is a rewarding endeavor.
“Abandon all hope, ye who enter here.”
LIMBO
First Circle: Outpatient Clinic
Here reside the well patients, who need only a brief check-up. Here also reside the not so sick. These patients are ambulatory and one only has to spend 20 minutes to diagnose and treat a simple problem, or follow up on management of one or more chronic conditions. Thus, the medical students are not punished in an active sense, but rather grieve only the occasional walking personality disorder patient. This is the most benign of the 9 circles, and very frequently is even rewarding.
Beyond the first circle, all the others involve overt punishment of the medical student. They may be grouped into 3 categories (similar to Dante’s incontinence, violence and fraud). The first involves basic care of the inpatient and is the least punishing. The second involves care of the very ill, and the third and lowest level of hell involves active interventions that require one to scrub in.
UPPER HELL
Second Circle: Psychiatric Hospital
The psychiatric hospital represents the most benign form of inpatient rotation. Though students may be occasionally screamed at by the mentally ill, there is usually no physical exam required and rounds move quickly. A good assessment and plan is something like, “Assessment: patient still crazy. Plan: go up on the anti-psychotic du jour.” Psych attendings are rarely if ever mean and tend to have entertaining and wacky personalities. Best of all, one can be done for the day in less than 6 hours.
Third Circle: Consult Service
The consult service is usually a subspecialty like infectious disease, cardiology, rheumatology, neurology, etc. This is the highest level of hell that involves being in a regular hospital. While consult services are plagued by a relatively unpredictable schedule (primary teams can call whenever), they are not burdened with overall responsibility for the patient. They deal only in one specific area, and while they may follow up, they do not take call and often do not accept consults after 5 pm. As they are almost always a specialty service, they do not have to deal directly with management of the patient’s comorbidities, a definite added advantage.
Fourth Circle: Pediatric Floor
In the fourth circle, one is part of the “primary team,” meaning that this team bears the ultimate responsibility for the patient and must deal with the patient’s multiple problems. In pediatrics, the patients frequently only have one diagnosis, which is an acute diagnosis, and little past medical history. In addition, the attendings and house staff are considerably nicer than those on medicine. The patients, being mostly cute little kids, are intrinsically more likeable. For these reasons, if one must be on a primary team and suffer the scourge of overnight call, pediatric floor is the least punishing.
Fifth Circle: Medical Floor
In theory, this is the same as pediatric floor, only for adults. However, there are several reasons why the medical floor is a lower level of hell. The patients often have many, many medical problems that must all be managed in concert. The history and physical is thus quite a burdensome endeavor and includes a significant amount of past medical history. In addition, the patients themselves may be combative and non-compliant. Not infrequently they are demented and cannot give a good history. While pediatric patients may not be able to give a history, the parent can give a very detailed history in 90% of cases. In addition to the patients, the culture of internal medicine is not near as friendly and welcoming as that of pediatrics. Though medicine attendings may not be overtly mean and yelling at people, they often have a giant stick up the butt and are never satisfied with anyone’s presentations or fund of knowledge. Add to this the 4 hours of rounding each day and it is self-evident that medicine floor is truly the 5th circle of hell.
MIDDLE HELL
Sixth Circle: Emergency Room
In the emergency room, one is constantly assaulted by an unending barrage of patients, ranging from the scarily critically ill to the very frustrating patient who just wants to ask for Vicodin or has a cold and didn’t feel like waiting until the next day to be seen by primary care. Thus, one is condemned to feeling either panicked or irritated 100% of the time. With ER patients, there is no winning. In addition, ER nurses are famously mean to everyone, not just students, but residents and attendings as well. Then there are the services to which ER tries to admit patients. When ER calls a service to admit a patient to their floor, the intern on call WILL be pissed, no matter how legitimate the admission. ER house staff have to burn off this frustration somehow, and will often take it out on the defenseless medical student.
Seventh Circle: Intensive Care Unit
The intensive care unit houses the sickest patients in the hospital, and many will expire here. In order to even be admitted to an ICU one has to be more or less trying to die. Thus the first thing that you will notice upon entering the ICU is an eerie stillness. Patients are all obtunded and hooked up to many, many machines and tubes. Here the medical student will often rapidly spiral into depression. Withdrawal of care occurs on a regular basis. When the ICU is not depressing, it is anxiety provoking, as patients code on a daily basis here. The ICU is the lowest level of hell that does not involve the torture of scrubbing in.
LOWER HELL
Eighth Circle: Operating Room
The operating room punishes the medical student in a very ritualistic, unforgiving fashion. First, the student engages in a ritual reminiscent of Lady MacBeth—scrubbing in. This involves rubbing each side of each finger 10-15 times with harsh iodine soap. One must wash in a precise fashion from distal to proximal and rinse in the same fashion. Then entering the OR without touching anything the towel is used to dry the hands in a similar regimented way (careful! The air above your shoulders is “contaminated” so don’t put your hands up too high!). Afterwards, the gown and gloves are donned and the student is hereafter confined in his own little prison, unable to touch anything except the operating table. Once (s)he is standing in the proper location (usually one where the operation is difficult or impossible to see), the student must remain motionless for the duration of the operation, often more than 4 hours. In some cases the student may have to retract this whole time. Thus the main form of punishment in this level of hell is immobility and inability to eat, drink, pee, or itch. One often sees only through a fog, as splash guarded masks are employed to add to the punishment, despite the fact that in non-trauma cases there is virtually no risk of any splash. The student is usually interrogated at some point by the attending and/or house staff on medical facts, most commonly anatomy, but this is a much less severe form of punishment than the complete imprisonment of being scrubbed in.
Ninth Circle: Labor
Family medicine really burns me
The following is contributed by Half M.D., the author of www.halfmd.com
The two things that piss me off quicker than anything else are inefficiency and ignorance. So far, the people who run my family medicine rotation have shown both. I’ve had one setback after another in the months leading up to this clerkship. Back in January, I wrote the course director to tell him that I would be going out of town for a special conference during his rotation. He never wrote back.
So I wrote the co-director of the course and told her the same thing. She never wrote back.
Then I wrote to the secretary for this clerkship. It turns out that she had been fired and replaced. I then wrote the new secretary of the clerkship. She never wrote back.
I went to the third year coordinator for my university to ask what was going on. I should have known something was wrong when she suggested that I make a physical appearance to the family medicine office. At that time, I couldn’t figure out why no one in the department could reply to my e-mails.
I then tried calling… multiple times.
I finally got through and confirmed all the information I provided in my original e-mail. Heeding the advice of the third year coordinator, I went to the family medicine office last week to make sure that everything was intact for my clerkship. You can imagine my surprise when I discovered that the secretary denied having ever received any information from me about my absences or where I wanted to practice family med. I had saved the e-mails and pleaded, “Here’s all the information right here.” To which she replied, “You should have e-mailed me more than one time.”
Through talking to the secretary of the course coordinator, I had hoped that everything would have been figured out for this week when I finally started the clerkship. I was given the wrong phone number to my preceptor’s office. And then when I finally managed to get through to his nurse, I was given the wrong location of his office.
I showed up bright and early Monday morning ready to see patients, but found out that he had a second practice located across town. I tried calling him at his other office multiple times that morning until I finally reached him at 10:00a.m. Keep in mind that he was supposed to have arrived by 8:30. I had to drive like a madman across town to this other office just so that I could be two hours late to my first day of my clerkship.
If things continue like this for the next month, I think I’m going to punch someone before it’s all over. Today is Wednesday.
Just in case any attendings are reading this, if you ever happen to be in a position to lead medical students—especially as a clerkship director—make sure that you have a good support staff and that everything in your clerkship is well organized. There should be no reason why students are given the incorrect telephone number and address of their clerkship location. We are paying for that education after all.