Plan B Doctors

Most people want to be doctors so they can take care of patients. Not so much anymore. Several, for numerous reasons, are jumping ship and doing Plan B i.e pursuing non-clinical alternatives, like authoring novels or investing in real estate, or, more commonly, following alternative clinical pathways, where they get to apply their clinical expertise and experience in ways other than seeing 20 patients a day.

Nearly 334,000 physicians, nurse practitioners, physician assistants and other clinicians left the workforce in 2021 due to retirement, burnout, and pandemic-related stressors, according to new data.

According to the AMA, there is an impending physician shortage in the U.S. that has clear repercussions for patients and the health system at large. The Association of American Medical Colleges projects that there will be a shortage of up to 124,000 physicians by 2034. Beyond the impending shortage is the urgent need to address physician burnout. That is because without a mentally and physically healthy workforce, doctors will continue to leave practice before retirement age.

Physicians experienced the largest loss, with 117,000 professionals leaving the workforce in 2021, followed by nurse practitioners, with 53,295 departures, and physician assistants, with 22,704 departures. About 22,000 physical therapists also left the healthcare workforce and 15,500 licensed clinical social workers, according to a report from commercial intelligence company Definitive Healthcare.

Although Devangi Patel, 33, has been working as a cardiothoracic anesthesiologist at a large medical center outside Atlanta for only two years, her goal is to afford to walk away from her job at 50.

Dr. Patel is not alone in her quest to become financially independent — and at an early age. A generational shift is well underway: Many millennial workers don’t aspire to retire in their mid- or late 60s, like their parents. Instead, many with professional careers are seeking to leave their jobs by 50 and work for themselves or take a lower-paying role that is more aligned with their interests, studies are showing, and financial advisers are finding.

 Plan B is about mixing boxes, not stacking them. Instead of a sequence of education, work and retirement, the approach means blending the three during your life and creating a portfolio career. In addition, if your interest is some kind of alternative career using your skills as an experienced physician, then you need to plan sufficiently ahead of time, with areas of overlap and transition, instead of just jumping off the cliff one you decide to shove the white coat.

Following Plan B involves three basic steps:

1. Getting your head screwed on about the decision to leave clinical medicine. The most difficult of the three, it is essential that you "divorce the corporation" and deal with the emotional baggage that goes with leaving your doctor persona, the clinical culture and all that goes with it, including the raised eyebrows and disappointed family members and parents. In addition, the financial opportunity and switching costs are high and depend on strong internal motivation to go after the next brass ring.

2. Becoming aware of alternative clinical career options. There are many, but most doctors are unaware of them, don't believe they are the right fit or that they don't have the knowledge, skills, or abilities to be successful. They need role models and success stories to be convinced.

3. A plan to execute the next steps. Creating a career development ladder is a lot like seeing yourself as a personal start up. You'll need to develop the right product-market mix and deal with all the business model and validation issues that Newco's must face.

 Revenue spirals, industry shifts, and legislative changes can have unexpected ripple effects on your career advancement. Developing a predetermined fallback plan allows you to proceed with a clear head if you’re faced with a career setback. Importantly, fallback plans are not a marker of failure. Considering your options is an essential part of career exploration, adaptation to sudden transitions, and commitment to growth. This author, a career coach, presents six steps for creating a fallback plan so you’ll be ready in case you’re faced with a career setback.

1. Identify the worst-case scenario.

2. Clarify your non-negotiables.

3. Identify the obstacles you could face.

4. Assess your options and consider the support you may need.

5. File your plan away.

6. Make your well-being a priority.

Here is a more granular breakdown of the 6Rs of career transition planning.

Behavior change models typically follow a pattern of unfreezing old behaviors, changing to new behaviors, and refreezing the new behaviors or habits to prevent relapse. Changing to Plan B is not different.

However, the likelihood that a physician entrepreneur will fail is more likely than they will succeed. That reality means that you might be considering re-entering medicine sometime in the future. There are many reasons why:

1. You found out the grass is not greener.

2 You realized you missed it more than you thought you would

3. You can get a job and a paycheck

4. You didn't know what you didn't know when you left

5. You are getting flack from your spouse or family

6. You don't have Plan B and are unlikely to have one

7. Things have changed and now you can work part time and, in many roles, like a teledoc, that didn't exist when you left.

8. You fixed what was making you so unhappy that it had nothing to do with medicine when you left in the first place. You were a grumpy person, not a grumpy doctor

9. Somebody thinks the lessons you learned as a failed entrepreneur might be valuable to them

10. You think you can go home again.

Re-entering clinical practice after even a short time can be difficult if not impossible, despite the need for doctors.

One study found that among 2010 law school graduates, 20 percent hold jobs that don’t require a law degree. We may be seeing the same in medicine as medical school graduates increasingly pursue non-clinical careers.

The American workers who have had their careers upended by automation in recent decades have been less educated, especially men working in manufacturing.

But the new kind of automation — artificial intelligence systems called large language models, like ChatGPT and Google’s Bard — is changing that. These tools can rapidly process and synthesize information and generate updated content. The jobs most exposed to automation now are office jobs, those that require more cognitive skills, creativity, and high levels of education. The workers affected are likelier to be highly paid, and slightly likelier to be women, a variety of research has found

A lot of people think that doctors who don't see patients aren't "real" doctors, including several physician peers. It's not true. A doctor who creates a biotech company is just as real as someone who treats your high blood pressure or takes out your spleen. The fact is, some may have done both at some time in their careers.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship