Should physicians stay in clinincal practice? | Joe Bormel | Healthcare Blogs Skip to content Skip to navigation

What Influences Physicians, Or You, To Change Career Paths?

November 7, 2012
| Reprints

In this blog I often address stories about improving healthcare delivery through the use of information technology from my standpoint as a physician and software vendor.  Although we always start with the intent to do something for the care provider to make their work 1) faster, 2) easier, 3) better, and 4) help keep them out of trouble; we also risk achieving the exact opposites.

The non-clinical hassles around caring for patients—administrative, technological and workload combined with compensation issues—are causing many physicians to re-examine their career paths.

The Challenge

Should physicians stay in clinical practice full-time, part-time, or not at all?  Those are the questions several hundred docs were asking during the October Skills, Education, Achievement, and Knowledge (SEAK) conference in Chicago, where I served once again as an official mentor.

Attendees spent more than $2,000 of their personal funds, and two or more days of their time, to sort out these important questions.  And, that figure doesn't include the potential lost income from not being able to provide patient care. 

I had the privilege to work with all of these physicians from the stage, as well as meet and work individually with about 70 of them.  Their stories were remarkably similar.  All said something along the lines of, “I love patient care.  It is everything around patient care that I don't like.”  Most added, “I don’t see clinical practice as desirable or sustainable over the next five to 10 years.”

The Causes of Physician Dissatisfaction

There was a broad, homogeneous sampling of physicians in attendance—men, women, all ages—including primary care, surgery, radiology, and all specialties.  Most were employed, although there were a significant number of independent physicians in solo or small group practices.  All had experience with electronic health records and, for the most part, that experience was very positive.

Of the docs I talked with, there was a universal sense that their incomes would be declining.  And that decline was set against a backdrop of longer hours, progressively less autonomy, and frustration with their reduced ability to ensure their patients receive the best care.  No surprises in this paragraph to anyone with friends or family in the practice of medicine.  On one hand, the economy is changing life for us all.  But on the other, the cheese actually has been moved.

Optimism Combined with Sadness

Every time I share these observations with colleagues, both non-clinical and clinical, the reaction is uniform.  No one wants to see their doctor or docs as a whole dissatisfied with their profession.  And we are angry, or at least disappointed, when the doctor we trust becomes unavailable to us.  This is happening even now as the shortage of physicians to replace them—along with a shortage of nurses and pharmacists compounding the dilemma—increases nationwide. 

The other dimension that everyone seems to pick up on is the profound apparent waste when physicians leave active clinical practice.  Most of us have, on a personal basis, seen the positive results that stem from the skills and experience of caring doctors.  It is uniquely transcendent.  I know this from personal experience. 

As a patient, I had long-term, intermittently excruciating stomach pain.  When my doctor Joanne identified it, and my surgeon Gil subsequently removed my gall bladder to end it, I've remained grateful for decades.  Emotionally, seeing doctors choose to leave clinical practice is indeed sad.  But in certain instances, as with other professions, this is sometimes a necessity.

My Advice

For all of us, periodic self-reassessment is essential.  So is receiving coaching and mentoring.  Taking an inventory of our options—including reading descriptions of positions available and talking with recruiters—are essential steps to grounding oneself.  This requires discipline to make sure we take a few hours to perform these tasks on a quarterly basis even when our “day jobs” are rewarding.  When they're not, I’m sure most of us can find time each week to work on improving our situation.

I assembled my specific guidance for physicians in a 2009 SEAK presentation, with an extended version specific to the software vendor positions for physicians I presented to AMIA here.  Note that in a general sense, the information therein may prove of value across a spectrum of career choices. 

Closing Thoughts

Health and healthcare delivery are changing, and that's happening in concert with broad payment reform.  This is happening with rapidly increasing transparency on quality, safety, and consumerism, characterized by a heightened focus on consumer convenience.  More on that last item in my next blog about self-service and the patient experience.    




Dr. Joe,
Several years ago, I was considering whether to alter my career path somewhat. Although I had experienced a great degree of satisfaction as a nurse executive and throughout my nursing career, I felt as though something was missing.

One area I was seriously considering was informatics, and I viewed your original SEAK presentation when it was first posted in 2009. It greatly influenced me, with the support of my employer, to add that skill set to my portfolio. I will be forever greatful to you for your help!

Today, I continue my role as a CNO, but have brought added value to my hospital as an informaticist as well. This has resulted in greater responsibility and recognition, and a significantly improved income.

I believe it's not necessary to completely change your career path in order to find greater satisfaction. That set me to wonder, in your experience, how many clinicians do you think have added skill sets and yet continued on their primary path as opposed to starting something completely new? It doesn't appear as though enough healthcare professionals think through this before jumping into the fire, so to speak. Do you agree?

Again, many thanks to you. And don't forget about nurses in your blog. We're in the same boat as the docs, and we do a lot of the rowing!

Rosemary Carlisle


Thanks for your comment.

I agree with the spirit of your comment, that I'll refer to as the Tapas approach ( In general, it can be far safer, more effective, and more powerful to combine clinical practice with management. There are many CMIOs who have made their transition into informatics as a combination of clinical practice and management. That said, it's not for everyone and probably cannot work without a strong, mature engagement partner. That can be via an effective CEO and CIO, and often with outside consultants.

In my experience, informatics management done well in medium to large, complex organizations will require many 60-80 hour weeks, just for the informatics change management and oversight. For folks with excellent character construction, executive function and knowledge base, combined with a strong clinical practice setting that can run independently, the Tapas approach can be sweet.

Thanks again for your thoughts.

thank you for writing about this important problem and for making yourself available to colleagues seeking advice and support. The reasons one might look for an alternative career are so varied. Some of us simply found our way into an alternative career by following our passions, others through disillusionment, or a combination of both. New payment models and empowered e-Patients can present physicians with an opportunity to remake primary care so that it is more rewarding and less encumbered, but it takes strong collaboration to redesign care, and letting go of how we were trained to practice medicine. We need both mentorship and effective sponsorship from the leaders in our community to drive change and remake our careers.

Thanks for your kind words. Thanks also for introducing the concept of sponsorship. Many of us implicitly and optimistically hope that a mentor will, somehow, sponsor us. For a variety of reasons, it never works that way.

Here are two resources for interested readers:

1) From: ---

The Difference between a Mentor and a Sponsor

... the idea that mentorship and sponsorship represent more than just a language change, and in fact fulfill very different roles.

In her book Knowing Your Value, author Mika Brzezinski describes

A mentor as someone who will offer advice, provide feedback, suggest strategy, and explain company culture.

A sponsor, on the other hand, she describes as someone who is willing to use his or her own social capital to help pull someone else up the corporate ladder.


2) From:

The Sponsor Effect: Breaking Through the Last Glass Ceiling
By Sylvia Ann Hewlett, with Kerrie Peraino, Laura Sherbin, and Karen Sumberg

Center for Work-Life Policy

Although the fascinating study looks at the challenge from the perspective of women's career growth and advancement, some of the principles strongly apply to men, and physicians of both genders.

I'm not sure about this, but I have a suspicion that the ability to offer sponsorship to a direct report or others is harder to do as the economy shrinks organizations and many companies can no longer fund training, development, and other programs to strengthen the social fabric.