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Entries in Nonclinical Career (29)


Leadership Attributes In Industry

Physicians in industry must be leaders—not just experts in their field.

What does it mean for a physician to be a leader in industry?  What attributes are companies looking for in physicians who are seeking careers in industry?

Physicians looking for non-clinical careers may find a good fit in the medical device or pharmaceutical industries.  Some will have no difficulty in demonstrating technical mastery of the job.  After all, they are domain experts.  Unfortunately, physicians in industry are expected to be strong leaders—not just experts in their field of medicine.

The good news is that the attributes of a good leader can be learned.  Contrary to what some believe, these qualities are not passed down through the DNA of well-known business leaders.  Physicians can develop or strengthen their leadership skills—and apply these skills in new career opportunities.  But they will need to be deliberate and intentional about this—and go into industry with their eyes open.  Top companies will have high expectations for leadership—perhaps more so than for the technical aspects of a job.     

Some companies simply display their mission and vision statements—and almost never refer to them.  For others, theses statements are very much a part of their culture or “social architecture.”  They constantly talk about why they exist, what they want to achieve in the future, what they value most—and what they consider to be the key attributes of leaders in their organization.  In these companies, management and staff continuously evaluate themselves and each other against these standards.  Technical know-how is necessary—but not sufficient.  Physicians will need to be proficient in medicine—but also true leaders in a dynamic business setting.   

Different companies may use different terms to describe leadership—but the key attributes are essentially the same.  These core qualities are vital to most businesses and certainly apply to companies in the medical device and pharmaceutical industries.   

Charts the Course (sets the direction and plan)

  • Translates the business strategy into challenging, actionable objectives and plans
  • Conveys a sense of purpose and mission that motivates others
  • Maintains direction, balancing big-picture concepts with day-to-day issues

Delivers Results

  • Consistently achieves results in line with company values
  • Establishes high performance standards, uses measurable goals to track progress, and   continually raises the bar on performance and expectations
  • Focuses their organization on high-impact activities by clearly communicating expectations, accountabilities, and responsibilities
  • Conducts periodic reality-based, results-focused operating reviews and drives quick corrective actions

 Develops Best Team

  • Recruits and retains high-performing individuals and develops successors for key positions
  • Builds diverse and empowered teams
  • Provides honest and constructive feedback on an ongoing basis.

 Role Model

  • Lives the company values and sets expectations for others to do so
  • Displays self-awareness and seeks self-improvement
  • Demonstrates technical mastery of the job
  • Develops insightful strategies based on deep knowledge of external and internal operating environments
  • Champions opportunities for change and innovation
  • Has the courage and judgment to take appropriate risks

For further reading on this topic, check out the following resources: The Leadership Challenge by Kouzes and Posner, Leading Change by John Kotter, Execution: The discipline of Getting Things Done by Larry Bossidy and Ram Charan, and High Flyers: Developing the Next Generation of Leaders by Morgan McCall.


Plan Your Non-Clinical Career Escape As A Physician: Building Your Team

Building your team to suport your non-clinical or non-traditional career moves.

I just finished reading a very interesting book entitled The Art of Non-Conformity by a guy named Chris Guillebeau.  I mentioned Chris' blog in a recent post on Lifestyle Design, and I thought I'd download his new book to see what I thought.

The book is an interesting read, mainly because Chris is an interesting guy and looks at things in a unique way.  The focus on the book is breaking free form our default patterns of living and stepping out into something more purposeful, more directed, and hopefully, more fulfilling.

At some point in the future I'd like to write an entire entry about Chris' book and give the Freelance MD crowd a rundown of my thoughts on this text, but suffice it to say I thought it was a good book and it helped refocus my energies on building Freelance MD.

If you've been reading much of Freelance MD, you know that we're offering various forms of career modification to physicians.  All life modifications-- regardless of their scope-- require a little risk, and it's this risk that holds many people back. The few individuals who do modify their careers or lives in some way often only do so when the pain of change is less than the pain of staying in the same place.  This push towards change is discussed in Chris' book and made me think some more about Freelance MD and what we could do to offer more practical goals so individuals who were considering change could begin stepping out in little steps.  Hopefully, these little steps would assuage their fear while at the same time help them make some forward progress with the hope that the inertia would eventually carry them through to something substantial.

It's in this spirit that I offer this post.  It's a sort of beginners guide to building a team that you will need once you launch out on your own.  You may see little need for the entire team right now, but once you go "over the wire" to a new life, these are the individuals you'll be tapping for expertise in a variety of crucial areas.

Team Member #1: Your Financial Advisor

The first person I suggest you recruit if you're going to move forward in your career is your financial manager.  A good financial manager is difficult to find since many are predators who do little to build wealth for you and lots to build wealth for themselves.  The unscrupulous in this field begin to salivate when they meet naive individuals with high incomes and little understanding of the financial industry (think, young newly graduated physicians).  However, a good financial manager can evaluate your financial situation and set you up with a plan to take you from where you are to where you want to be in 5, 10, or 30 years.

Freelance MD has recruited a great financial manager as an author in Dr. Setu Mazumdar who, in addition to being a board certified Emergency Medicine physician, also runs Lotus Wealth Solutions and specializes in helping physicians make good financial management decisions.  Another good outfit is Martin & Wight based in Hunt Valley, Maryland.  The folks at Martin & Wight have managed my finances for the past six years, and I've found them to be very approachable and honorable in their business dealings.  Both Setu at Lotus Wealth Solutions and the folks at Martin & Wight specialize in the financial management of physicians, something that is a huge help when discussing things such as disability insurance and other issues specific to physicans.

Please know that I am not a trained financial person and my experience with any financial management company is, at its core, anecdotal.  You need to use your own judgment when considering anyone to handle your finances, but these mentioned entities are a good place to begin. 

Red flags when meeting a financial manager that indicate you need to run screaming from the room?  Any sort of pressured sales job to sell you any products, especially in the beginning, or any requirement that you submit a large, up front cash payment to secure their services.  Either of these indicators are big warnings.  Maybe there are exceptions, but I would proceed with extreme caution and make sure I spoke to multiple references prior to signing anything binding.

Team Member #2:  Your Attorney

In medicine, when we think of attorneys we almost universally think of the profession in a negative light.  This is due to years of conditioning from hours upon hours of paperwork that we are required to fill out on every patient simply to make sure all the "legalese" is in its proper order, and the specter of a malpractice suit that colors every patient interaction.

However, once you begin to delve into business, you find that your attorney can be one of the most valuable members of your team.  You go to him (or her) for advice when you set up your company and when things need to be restructured as the company grows.  You also know that you have a dog in the fight if you ever do need to do legal battle, and in this day and age, this is a great comfort.

As you begin to broaden your career to do consulting, entrepreneurship, or even write a book, it's good to have an attorney around that you trust.  A good attorney can walk you through such issues as how you form your own company, writing or reviewing contracts, discussing ways to limit your exposure to lawsuits, and many other legal issues that might arise as your begin your new pursuits.

So how do you find a good attorney?

Well, you don't find one by asking your doctor buddies who they'd recommend.  They'll most likely end up recommending one of their golf buddies, or someone who they know who works in or around the medical field. 

The best way to find a good attorney (as well as the third member of your team that we'll be discussing very shortly) is by going to the best small business person you know and getting a recommendation.  A small businessman or businesswoman is an expert in the area you are just getting into, whether it's consulting, writing, or anything else-- small business.  These hardy individuals will recommend someone who also knows small business and can help you navigate through the mine fields of your new endeavor.

The culture these days is highly litigious and a good attorney is worth their weight in gold.  Get a good recommendation, build a relationship with an attorney, and listen to their advice as you begin to expand your career.

Team Member #3:  Your Accountant

This final team member is important because as a physician, your number one expense is your taxes.

As you begin to branch out from your current career into other areas, you should begin receiving income from entities other than your main source of income now.  When this happens, your tax situation can become very complex very quickly, and it is very important that you have a good accountant around to help you sort through the dos-and-don'ts of things like tax write-offs, expense accounts, savings plans, debt exposure, and the like.

A good accountant can give you advice on ways to invest your income into your business, and limit your exposure to unnecessary taxes.  Notice that I say unnecessary taxes since I want to be clear that I am not advocating for cheating on your taxes or not paying what you are legally bound to pay.  However, paying more than your share of taxes simply due to ignorance or laziness is not "patriotic" as some politicians have implied, but foolish and short-sighted.  If you believe you should be paying more taxes, fine, that's your prerogative.  I personally think it's wiser to pay what you owe and then take whatever savings your accountant can find and invest them into your company, or simply donate them to a charity of your choosing.

The point is that a good accountant is a huge help when you start expanding your career, and once you've found a good one (through recommendations from small business owners once again), listen to their advice.  Beginning a new endeavor is tough, and it would be incredibly unfortunate to take that first step towards freedom, only to have it dashed due to poor bookkeeping or foolish business practices.

So there you have a basic guide to building your team.  Start with a good financial advisor and as you get ready to branch out, find a good attorney and accountant. 

In future posts we'll be giving you some more specific tasks to take to your various team members, so you can continue to grow your competence little by little. 


You're a Physician. What Are You Worth?

You're a physician but what are you worth as a business asset? Here are 3 Ways to determine your price.

One of the key decisions every seller has to  make , whether it's a house, a business or any other asset for sale, is to detemine its value and price. I'm married to a residential real estate broker, one of the dwindling few left standing, it seems, in a business that's been in a tailspin for the last 3 years. Consequently, I hear lots of stories about how much people want for their houses and how they make the decision. Typically, sellers overprice, figuring that the largest drop in housing prices in 30 years does not apply to them, that they are entitled to recover every cent they spent on their gourmet kitchen renovation, and they need to build in some wiggle room in the price anyway since they know they will have to negotiate some away later. Then, of course, there is dreaded realtor's commission to factor into the equation.

When it comes to selling a business, there are three basic ways to value it.

The first approach is known as the Asset Based Approach. This approach derives an indication of value based on the costs to replace the tangible assets in depreciated or replacement cost condition. Some businesses for sale are generating negligible cash, so the assets are the only thing that has value. True, intangible assets, like intellectual property, and future market growth might have value, but let's keep this simple for now.

The Market Approach
derives indications of value using ratios or factors derived from the earnings, sales and/or assets of past transactions of similar businesses. This approach is like getting comparables for house, asking what a similar house in a similar location has sold for in the recent past. In the case of businesses, the value is determined by comparing it to the selling prices of similar businesses.
The Income Approach derives indications of value by converting some level of earnings into a value using a capitalization rate, discount rate or multiple. There are several ways to calculate this net present value, but basically it has to do with using historical revenue numbers and applying a discount rate to determine the value of the revenue streams.

If you are considering branching out from your medical practice or leaving it all together, suppose you were to apply the same technique to valuing yourself?

Using the asset method, the monetary value of the chemicals and proteins in the human body is $4.50.

Using the comparables method, you are probably worth what most others who do what you do are worth. The average salary of a realtor, for example,  is about $45K and it is all commission based. But, don't tell that to all the ex-realtors trading resumes at Starbucks or Ms. Bigbucks still selling the occaisional multi-million McMansion.

Using the NPV method, you are worth the discounted net present value of the future cash flows you can generate compared to what you make doing what you are doing now.

Inevitably, despite the self-actualization talk, docs and  their families want to know how much they'd be worth if Mommy or Daddy did something different. Go figure.



How Doctors Can Double Their Income

As a physician, you're trading time for money.

Most physicians are no doubt very adept when it comes time to academics and being “book smart”. We all had to get great MCAT scores and high grades to get into medical school. However when it comes down to financial planning or building wealth, it’s not overstating the case that our preparation was a bit lacking. Medical school didn’t prepare me very well for finances,entrepreneurship, let alone running my own practice.

As physicians, when it comes down to it, we are exchanging time for money. The amount of money a physician can make is generally in proportion to how much patients we see or procedures we do. This is no different then the majority of the population who earn wages for a living.

The unfortunate aspect is that for us to double income, we generally have to see double the amount of patients. And as reimbursement continues to dwindle, we are now having to see more and more patients to get the same amount of income, in comparison to five to ten years ago.

So what are our options? For physicians who want to maintain their current nest egg, they need to start building passive or residual income to work for them. Indeed, many physicians have resorted to passive income (in the form of investing, real estates, buying bonds, etc), or started “side careers” or investments (In fact, many of my ER doc friends have run anything from owning their own tavern, to daytrading, even starting your own winery! There’s a reason why Business Pitch section of the AMA news, a series that highlights physician side careers,  seems to be one of the most popular columns.

One great way to build residual income, is entering the domain of online health consulting and medical publishing.  No matter what you decided to do, building residual income to work for you will be more imperative for physicians in the near future. Starting early is the key.


Physician Leadership In Industry

Physicians in industry must be strong leaders and team players.

Do you consider yourself a leader or a team player or both? To succeed in industry, physicians will need to be strong leaders—but also team players.

Physicians looking for non-clinical careers may find a good fit in the medical device or pharmaceutical industries.  Some will readily adapt to the technical aspects of their new role. Others may be thought leaders in their field—but could fail if they cannot work effectively in teams. Still others may not fit, if they can’t or won’t follow leaders with less clinical knowledge or experience.

The culture of a company will vary depending on what is valued. For instance, some companies are science-based. Applying the scientific method in all parts of the organization is expected and highly valued. Other companies are very competitive. They compete intensely against time, past performance and industry rivals to rapidly achieve quality results. While companies may differ in their core values, most get things done by working in teams. Teams move scientific breakthroughs from the lab through the clinic to the marketplace—and support other aspects of the business. 

Most companies believe diverse teams working together generate the best decisions for their patients, staff, and shareholders. Their team structure provides opportunities for staff to impact the direction of the organization, gain broader perspective about other functions within the company, and reach their full potential. 

So, what does this mean to a physician who is considering a career move to the medical device or pharmaceutical industries?  t means the physician must be able to demonstrate strong leadership skills—but also work effectively in teams. It means that they will not always be the leader, even if they are experts in the area. It means they will need to flexible, adaptive to change. 

Leading companies in the medical device and pharmaceutical industries continuously evaluate staff on their performance.  But this is not just about getting things done or getting results. Staff members are also evaluated on (1) how they achieve results in line with company values and (2) how effectively they demonstrate the company’s leadership attributes. 

As you consider career opportunities in industry, imagine how you might be evaluated against the expectations of your new role. How would others describe your performance?   What would you include in your self-assessment about team work?  Here are some statements of effective performance:

Team Leader

  • Displays strong leadership in a team environment
  • Builds a strong sense of teamwork and purpose
  • Conveys a powerful influence in a team environment
  • Promotes cooperative behavior and team efforts
  • Excels in building teams for success

 Team Player

  • Excels in developing team momentum, enthusiasm, and pride
  • Resolves team conflicts with finesse
  • Participates effectively in team efforts  
  • Excels as a team player

3 Thoughts On Physicians & Career Modification

Non-clinical and non-traditional medical careers are a common theme on Freelance MD.

If you peruse the posts on Freelance MD you'll find articles on a variety of topics—writing and publishing, real estate investing, concierge medicine, medical device development, business skills, leadership, journalism, and many more.

The common theme of all these posts is the idea of career change, or as I like to call it, career modification. It's the idea that as a physician, you aren't forced to accept the status quo; you have options, and there are a variety of ways in which you can harness your skills and personality traits.

Having said this, however, I must say that it is very difficult for the typical physician to make any kind of career change.  It's been a long time since I've met a physician who wasn't significantly frustrated with their career, but I'd say maybe only one out of fifty, or even one out of a hundred, of these frustrated physicians are actively taking steps to modify their career in some meaningful way.  It's a strange phenomenon, but it does seem to be a cultural trait in our profession.

Look, I'm not a professional career counselor.  If you want professional guidance, I'd suggest Ashley Wendel, whose entire career is focused on helping physicians transition into more satisfying careers.  However, for those of you who can tolerate my amateurish anecdotes, here are my top three reasons why I believe physicians have a difficult time modifying their careers...

(drum roll please)

1. Physicians are Narrowly Trained

A typical physician is overall a very narrowly trained individual.  

The majority of us were science majors in college and then spent a minimum of seven years being crammed full of medical minutia.  When we finished our medical training, we had a fairly firm grasp of our area of clinical expertise, but not much else.  Few physicians have had any significant exposure to personal finance, the legal system, business transactions, popular writing, art, negotiations, investing, or anything of the like.  Many of the physicians who I know who do have a special area of expertise outside of medicine sort of fell into it, or were raised in it by their family upbringing, not necessarily because they sought it out.  

When you compare a physician to an attorney, for instance, and the diverse professional experience of the typical person in law or business, it's easy to see why attorneys and business-types seem to transition in and out of careers with a lot more ease than physicians.  We know the Krebs Cycle; they know contracts, and corporate structure, and business appropriateness.  It's not that we physicians are any more or less as professionals than our peers in other professions because of our narrow training, it's simply that what works in our narrowly defined world doesn't necessarily work elsewhere.  

Physicians who have decided to launch into business, or anything else for that matter, without sufficient prep time usually find just how lacking in knowledge they really are.  Our narrow training puts a premium on our clinical knowledge and skills-- it takes a high investment of time and resources to obtain a medical degree and become a licensed physician-- but it also condemns us to a narrow career path unless we actively seek out further training.  

The good news is that with further training, career transition is much easier.  Here at Freelance MD we're committed to exposing physicians to training in a multitude of diverse niches.   We don't want the "narrow training" issue to be an excuse anymore for any physician considering a career move.

2. Physicians have Difficulty with Ambiguity

This reason takes a little more to explain.

Think about your medical training and your current medical career.  How did you get where you are today?  

Few careers are more systematized for more years than a career in medicine.  Most physicians began thinking about medical school before college and worked towards medical school as a goal from the beginning of their undergrad education.

Take and excel at my core science classes...check.  Take MCAT...check.  Get letters of recommendation...check.  Send in applications and pray...check.

Once in medical school our lives are completely structured to the point of exhaustion.  We are routed into our various specialty tracks and move along the medical assembly-line like widgets, getting the final stamp of approval and then shipped to a place of employment where we dig into our clinical careers, join a medical society, buy a house, begin paying off our school loans, and well, not much else, really.  

When we finally take a look around-- years into our clinical careers-- we have no professional experience other than medicine from which to draw and no practical experience in how to transition into something that doesn't have a structure or system to it.  

Become an entrepreneur?  

Where's the fellowship for entrepreneurial medicine?  

Develop a medical device?

Isn't there a masters degree in medical device development somewhere?

Write a book?  

I'd love to, but I don't have time to go back and get a college degree in English.

Does this seem familiar?

Physicians are so trained in a systematic educational experience of structure and hierarchy that it is very difficult to imagine how an ambiguous career move might work.  The idea of setting sail without a predetermined path and system to plug into leaves many physicians completely flummoxed. 

Instead of taking a machete and beginning to forge our own path through the career jungle, we wait for someone to build a superhighway that we can follow, complete with rest areas and gourmet coffee shops.  Of course, this rarely (read, never) happens so many physicians sit around saturating in the magical thinking that someone will come along with a foolproof plan to save us, and getting more desperate and frustrated when that person doesn't show up.

I could go on and on about this point, but I will use this as an easy transition to my final reason physicians have a difficult time modifying their careers...

3. Physicians are not Risk-Takers

Alright, everybody calm down.  

I know you're brave and calm in tense situations.  I know you can thread an angiocath, or intubate during a code, or your steady hands can find the pulsating bleeder with the best of them, even when everyone around you is losing control.  I know you're good under pressure, but this is not the same as being a person who is comfortable accepting calculated risk.

What I've found in conversations with physicians is that their risk profile is extremely low.  Yes, they're frustrated with their careers, but leave their jobs, start a company, move to a different part of the country, invest actual cash in an endeavor? Are you out of your mind?  Greg, those things are so risky...

Look folks, here's the facts...

You will never grow, transition to a better career, get from where you are to some better place, move beyond your current boundaries, or do anything of significance without assuming some measure of risk.  It's impossible and if you're waiting for that risk-free career move to show up, well my friend, I hope you've got a lot of time on your hands.

Many physicians have a difficult time with this aspect of career modification, even sadly, when the only risk is of the potential damage it might do to their professional standing.  I know a number of physicians, for instance, who deep down do not like academic medicine, but who persist in academics because they simply can't bear the thought of what people might say if they left or how it might affect their standing with their peers.  They're afraid they'll be dropped from this committee or not invited to speak at that conference.  They persist in their academic positions not for the love of teaching or the stimulation of their research; they persist because of the fear that they might lose something in the transition.  Their positions have become shackles that confine them, and their peers have become juries whose approval they must have.

When I speak to a physician who is hung up on this aspect of risk, I council them to of course make sure the transition they're considering makes sense-- talk to mentors, read up on the area they're considering jumping into, spend considerable time planning the transition.  However, in the end most of these career decisions come down to taking a jump off a cliff, and when I get to this point in the conversation I always discuss with them the risk of the status quo.

You see, career modifications are not a discussion of risk versus no risk.  They're a discussion of risk versus risk-- the risk of a career change versus the risk of staying in the same place.

I ask them, "What is the risk of staying in your current position for another year, or two, or three?"

If they're honest, they begin to see that staying in the status quo also carries significant risk, and when this is realized, a potential jump doesn't seem as frightening.

The point is that for most physicians, being able to tolerate risk is not something that comes naturally.  We like systems.  We like order. We like knowing our next step and we like having safety nets.  We work in a culture that demands perfection each and every day and the idea of stepping out without a finalized gameplan is terrifying to most of us.  We're creatures of habit with a significant dose of OCD in us-- medical school selects for these traits-- but we have to realize that we'll never begin to grow past where we are if we don't begin stepping out.  The idea of growth without risk is ridiculous, and we need to recognize this fallacy and move beyond it.  Embracing calculated risk-taking isn't optional, it's mandatory for career modification, and the sooner we accept this the sooner we'll begin moving towards a more fulfilling career.  It's that simple.

So there you have it.  My three reasons why physicians have a difficult time with career modification.  

In future posts I'm going to explain more about what I mean by career modification and some unique perspectives on what is available to physicians in today's modern, fully-wired, world.

Until then, check out Ashley's posts here at Freelance MD or her website.  Her advice is excellent for those of you considering a career change, much better than the musings of physician blogger, and almost risk-free.



Zoo MD: Another Nontraditional Medical Career

It really is a jungle out there.

All of us have had cases we never forget. Mine was a 12 year old female who I was asked to see in consultation for noisy nasal breathing.

It seems the patient was unable to talk about her problems, so her caretaker, dressed in a loud green coat with bright white buttons, told me that for the past several months she had noticed the patient had left sided noisy nasal breathing, irritability, and a change in appetite. The patient, Sally,  had no previous history of surgery or similar complaints and was taking no medications.

The patient's past medical history was otherwise unremarkable.  She was not sociable, usually playing by herself. She had an extensive family history and review of symptoms was otherwise non-contributory.

Physical exam showed a hirsute, overweight, female with abnormally long fingers and toes. She had significant craniofacial dysmorphosis. On ENT exam, I could hear noises coming from her left nostril. The remainder of the exam was normal.

My initial clinical impression was some kind of symdromic abnormality or an intranasal cause of her problem.

Because the patient was uncooperative, we scheduled her for fiberoptic nasopharyngolaryngoscopy  under general anesthesia. Endoscopic exam was normal except for a shiny white object in her left nasal cavity that I extracted without difficulty. The object was a button that looked remarkably similar to one on the coat of her caretaker.

Follow up with Sally's primary care physician indicated complete resolution of Sally's nasal obstruction, but the foreign body removal did nothing to resolve her hirsutism or abormal facies.  But, then again, I wouldn't have expected it to. You see, Sally is a Pongo pygmaeus abelii, a Sumatran Orangutan at the Denver Zoo, where I am a consulting otolaryngologist in the primate division.

The convention wisdom has always been that 98% of the DNA between chimps and humans are the same. It turns out that is not true. It's only 95% similar and there are many other differences. For example, apes have 24 pairs of chromosomes, not the 23 pairs in humans.

Despite that, I am amazed at how similar the endoscopic anatomy of our forebearers is compared to humans.

Orangs are an endangered species with only 9200 left in the wild, so it is unlikely that I'll be reporting a case series.

I've provided a lot of uncompensated care in my career, as I'm sure almost all you have, and I've never regretted helping those who couldn't pay the freight. This was no exception. The patient seemed extremely grateful and , every now and then when I make a housecall to see her at the Zoo, I can't help think Sally remembers me and occaisionally gives me a smile. Every now and then she'll offer me a banana in exchange for her care.

My nontraditional medical career, consulting to the Zoo, has been a kick. And here you thought your last clinic day was a zoo.

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