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Nonclinical Physician Jobs & The Long Tail

By Mehul Sheth DO

As I read The Long Tail by Chris Anderson I could not help but draw parallels to the world of medicine.

In the same vein as seminal books such as The World is Flat and Connected, this book looks to make sense of the new world view introduced by the internet. The basic premise is that in a world of infinite options (movies, songs, books, etc) the blockbuster hits are no longer the only way to be profitable. With no cost to list an MP3 in iTunes, it is as profitable to sell 1 million copies of 100 blockbuster hits as it is to sell 100 copies of 1 million less popular songs. There are three main reasons the internet has helped with this shift, one of which is democratization of the tools of distribution.

This paradigm shift has affected medicine in at least two ways. One is witnessed by the super-specialization of clinical medicine. For example, within pediatrics you can sub-specialize in gastroenterology. From there you can further sub-sub specialize in nutrition and from there you can go one level deeper into feeding disorders. One of the reasons such a niche can exist is because individuals and institutions can promote these fields not only to recruit providers, but also patients who have a specific interest in that type of treatment. At the Children’s Hospital of Wisconsin there is not only a feeding disorders clinic, but also an intense 2 week inpatient program that draws patients from all over the world. This could not exist in the pre-internet world where the enchachement area for Children’s Hospital of Wisconsin would include, at best, the entire state of Wisconsin and some of northern Illinois. With the internet the cost of distribution (in this case information of their center) is not only essentially zero, but is also technically easy. You need only to look around at your colleagues to realize that the number of niches is incredible!

More interestingly, to me, is how this democratization has expanded not only clinical jobs, but non-clinical physician jobs. The contrast is exemplified by my father and I, both physicians. My father is an anesthesiologist working for 30 years at the same hospital in service of a small farming town. In stark contrast, I work as a physician executive for Allscripts, a health IT company, working from home and traveling on an almost weekly basis. As I think of physicians in my father’s cohort I find that most of them fulfilled this classic role of clinical physician. Those that went outside of clinical practice did so after years of 70+hour weeks solidifying their clinical prowess thus resulting in promotion to administrative roles that carried heavy titles. Although many of these physicians did their non-clinical role well, a number who were great clinicians did not perform so well outside of the examining room.

But a deeper dive into that generation reveals that many of them had great interest in things outside of medicine. An internist comes to mind who, like my father, has been practicing for many years in the same town, but who also regularly wins stock picking contests. The short term rate of return that he can extract from daily trading is in the triple digits. I can only think that if he had trained 30 years later he would have many more opportunities to take his avocation and turn it into his vocation, combining both medicine and financial analysis. In fact, there are numerous joint medical school programs that bestow not only and MD but also a JD, MPH, MBA, PhD at the time of graduation. And if you don’t complete your second degree before residency, many training programs allow you to get a second degree as part of their program. This has become possible with the increased distribution of information associated with non-clinic careers. There are websites, including conferences, such as Medical Fusion and SEAK, and list serves, such as the drop out club, to name a few that have taken advantage of the ease of distribution to cast a large net to help physician find satisfaction in their careers. The unhappy doctor of yesteryear who found his joy in his hobbies now can find a career that combines his medical knowledge to bring about greater job satisfaction.

The internet has profound effects on the career choices of physicians, only some of which I’ve named here. I’d love to hear about other ways the ease of information distribution has helped with physicians’ career choice.

About: Mehul Sheth DO is a physician executive with Allscripts and career coach. His expertise is at the intersection of medicine, technology and social media, having used Twitter, Facebook, and LinkedIn to effectively engage with a wide variety of nonclinical jobs and opportunities. Dr. Sheth is accessable via his LinkedIn profile and his blog at

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Reader Comments (1)

Thanks for the excellent post, Mehul. Very interesting perspective. It's true that we live in a time when clinical medicine is changing very rapidly (and probably not for the better). However, we also live in a time when, through the internet, physicians now have much more opportunity to learn new skills and apply these skills than at any previous time. We're entering a time when motivated physicians can and will begin tweaking their careers in unique ways to create opportunities that would have been unimaginable even a few years ago. Thanks for the reminder.

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