HealthMay 19, 2020

When should you change medical practice settings?

By: Edwin Leap, MD

Physicians have long been seen as cornerstones of their communities. The thing is, cornerstones don’t move around. Medical practice, for a very long time, meant going to medical school and residency, starting a practice and staying in it for 20, 30, even 50 years. Regardless of specialty or type of medical practice, doctors stayed put.

However, times have changed. Where once there were two main medical practice settings—office or hospital—the varieties of practice have changed dramatically. Physicians can work in so many types of medical practices that it would surprise our medical forebears. We can still, of course, practice only in outpatient offices or clinics. Physicians can also admit their private patients and care for them in the hospital. Hospital work may involve being a hospitalist, anesthesiologist, pathologist, radiologist or emergency physician.

Physicians can also work as educators in medical schools or residencies. They can be directors of medical groups, pain clinics, nursing homes or prisons. Some review charts for insurance companies; others work as industry consultants. Increasing numbers work from home doing telemedicine. Many physicians are engaged as government workers in active duty or reserve military practices or public health. The list is long. And the list means we have options.

How change empowers physicians

The option to change either medical practice settings or types of medical practice is a powerful tool for your happiness and professional success. Furthermore, it gives physicians a kind of collective power. The more freedom we possess, the more valuable we are to employers who struggle to recruit quality physicians.

However, change is often difficult for physicians. We tend to be highly dedicated to projects or jobs. We also have a lot of inertia. It kept us moving forward during the long march of medical education. Unfortunately, inertia means not only motion but a tendency to stay still. Learning to overcome that inertia can be liberating.

5 times to change medical practice settings

All that said, how do you when know it’s time for a change or that the change you make will empower you? Consider these five scenarios:

1. When it gets personal

First and foremost, a change may be in order when your personal health and well-being—or that of your family—require it. I left a job of 20 years because I was unhappy and I wasn’t making the money I desired. The emergency department where I was working also held memories of the severe illnesses and deaths of people dear to me.

Changing your medical practice setting might also be necessary when a family member in another area is ill or when a spouse or child has health or social problems that demand more time. Perhaps most important of all, there are times when a change will simply allow you to enjoy more time with your spouse, children and other loved ones.

2. When you want to pursue a passion

Sometimes changes in medical practice settings or types of medical practice have to do with professional fulfillment and satisfaction. A rural physician who has a deep desire to teach may be better served to find a teaching opportunity in an urban location in order to enjoy the challenges of educating students.

That said, it flows both ways. The academic who desires more involvement in community health and outreach may have to walk away from committee meetings and lecture preparations in order to work in a medical practice setting in an underserved area.

3. When you can’t do it anymore … or you can do it better

A change in medical practice setting can also be inevitable when, for instance, a physician has an injury or illness that limits their ability to do procedures or when age reduces their stamina or makes those night shifts unbearable.

But it isn’t always because one “can’t” do the same thing. Sometimes it’s because a physician has a unique set of experiences and skills that they can bring to their new type of medical practice. A seasoned physician might desire to practice clinical medicine part time while working as a consultant or as an administrator in a hospital or healthcare corporation. An experienced obstetrician could bring great value as an obstetric hospitalist and might benefit from the somewhat more regular schedule.

4. When the money matters

Although we learned years ago not to say that we practice “for the money,” there’s no question that financial reward is part of why we go through medical education and tolerate the difficulties of practice. As such, there are times when a change in medical practice setting or type of medical practice can be accomplished for greater financial gain.

A move to a busier practice or a more lucrative type of practice within one’s specialty may result in more money for less work. There’s no crime in working “smarter, not harder.”

5. When your wellness is at stake

Unfortunately, sometimes a change in medical practice setting or type of medical practice is needed to avoid a toxic workplace. When a physician feels disrespected, ignored, bullied, underpaid, over-regulated or otherwise considers their situation unsustainable, then it’s time to walk away. It’s easy to fall victim to the “sunken cost fallacy,” in which we continue to engage in a behavior that’s no longer worthwhile, simply because we’ve already invested money or time in it.

I tell residents this simple bit of advice: “When your job no longer works for you or your family, find another job.” Physicians have a remarkable degree of flexibility enjoyed by few other professions. Although we can be constrained by debt, it’s still possible to make significant changes that result in work that’s more rewarding personally, professionally and financially.

It isn’t easy to change either medical practice setting or type of medical practice. But once a physician embarks on a new path, the potential rewards are incredible. So don’t let fear—or inertia—keep you down. Exercise your options for your good, the good of your loved ones and for the good of the people who will benefit from your presence and skills.

There’s no time like now to make a change!

Edwin Leap, MD