Concerns Grow as Top Clinicians Choose Nonclinical Roles

On a spring day a couple of years ago, I met with some internal medicine residents in a “Healthcare Systems Immersion” elective. I was to provide thoughts about the nonclinical portion of my work that I spend consulting with other hospitalist groups.

Nelson

I asked for their thoughts about whether the ranks of doctors providing direct bedside care were losing too many of the most talented clinicians to nonclinical roles. The most vocal resident was confident that was not the case; these doctors would ultimately have a positive impact on the care of larger numbers of patients through administrative work than through direct patient care.

I wonder if she is right.

Numerous Hospitalists Opt for Nonnclinical Work

It seems like lots of hospitalists are transitioning to nonclinical work. My experience is that most who have administrative or other nonclinical roles continue—for part of their time—to provide direct patient care. But some leave clinical work behind altogether. Some of them are very prominent people in our field, like the top physician at CMS, the current U.S. Surgeon General, and this year’s most influential physician executive as judged by Modern Healthcare. I think it is pretty cool that these people come from our specialty.

I couldn’t find published survey data on the portion of hospitalists, or doctors in any specialty, who have entirely (or almost entirely) nonclinical roles. My impression is that this was a vanishingly small number across all specialties 30 or 40 years ago, but it seems to have increased pretty dramatically in the last 10 years. At the start of my career, few hospitals had a physician in an administrative position. Now it is common.

Physician leadership roles now include information technology (CMIO), quality (CQO), leader of the employed physician group, and hospital CEO (at least two hospitalists I know are in this role). And there are lots of nonclinical roles for doctors outside of hospitals.

Pros, Cons for Healthcare

I’ve had mixed feelings watching many people leave clinical practice. Most of them, like those mentioned above, continue to make important contributions to our healthcare system; they improve the services and care patients receive. Yet it seems like some of the best clinicians are taken from active practice and are difficult to replace.

At the start of my career, the few doctors who left clinical practice for nonclinical work tended to do so late in their careers. Now many make this choice very early in their careers. Of the six or seven residents I met with above, several planned to pursue entirely nonclinical work either immediately upon completing residency or after just a few years of clinical practice. They were at one of the top internal medicine programs in the country and will, presumably, provide direct clinical care to a really small number of patients over their careers.

Comments

  1. says

    Great article!

    I think there are many factors that go into this decision. I’ve transitioned from FT hospitalist work to PT, with the majority of my time now as CMO of Medptus (a software company). I find that my choice had several dimensions.

    I have interests other than clinical medicine. Nowadays, there are options to include these interests in my career path. Back in the day, there just weren’t the same options to explore and grow beyond your clinical practice.

    I think healthcare is better off when we have everyone working in a field that finds them fulfilled. Maybe we just need to train more hospitalists so we can all do the amount of clinical work that is right for us.

    I can multiply the effect of my efforts in non-clinical roles. As a hospitalist I help one patient at a time. As CMO of a company, I can have an impact (though less direct) on many patients by improving the lives of their physicians. Look at any of the well known physician leaders and you can see the larger impact they can have.

    I enjoy medicine more (and am better with my patients and their families) when medicine is not something I fill every waking (and some sleeping) hour with.

    And finally, our current hospitalist scheduling model leave a lot to be desired. There’s only so long that people want to work weekends, holidays, evenings, and nights. How long do people want to work 85 hours one week and none the next? Hospitalist medicine has started to move down the path to more humane scheduling, but we have a long way to go.

  2. Charles L Carter, MD says

    This article is disheartening in many ways. Certainly there does seem to have been explosive growth in paid nonclinical positions for doctors of all stripes. I can see the appeal- no call, no weekends, excellent salaries; and I’d prefer MD’s with some clinical experience in these roles rather than MBA’s. But all in all those I must come in contact with are serving their masters first, patients second and me least of all. The assertions in the article and in Ryan’s comment that there is benefit to the system as a whole by these people is unfounded in my mind.
    I also question the title referring to ‘top clinicians’. Is there any basis for this?
    Like many other articles in The Hospitalist repeated references are made to leaders and leadership. These have become buzzwords with very flexible meaning. You mention Osler in your article. Unless he rose high in SHM, ACP, etc, or worked as VP or CMO somewhere I don’t think he’d make the cut for that appellation. The terms are almost always applied to some nonclinical activity done by someone that happens to have graduated from a medical school; even though nothing in medical school prepares them for said activity. But I’d bet an article has a 4- or 5- fold chance of being published in SHM if leaders and leadership are mentioned. It relegates those of us that find fulfillment in clinical practice as followers.
    Good leaders in medicine would be addressing just those issues that make clinical practice unnecessarily stressful.

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