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.

Almost.

What Do Seed Investors Look For In A Medical Startup?

Investors look for ideas that are big, doable and profitable.

When it comes to looking for money, keep in mind that different strokes attract different folks. Most investors, be they private equity groups, venture capitalists or angels, have different approaches, styles or sweet spots when it comes to parting with their money. At a minimum, they will look for :

• An investment that is comfortable for them and fits their risk and domain profile
• A project that satisfies a large, growing unmet need
• A solution that works
• Something that is different
• A good story
• Something that has the potential to make a lot of money in the shortest time
• Good management
• Other sources of cash

A related article on About.com

During my work with www.headwatersmb.com , I"ve identified some others characteristics of growing companies that are not as obvious.

The structure of the capitalization table.

The "cap table" describes how the company has been funded to date, who owns what and how much do they own or owe? For example, it is not uncommon for early stage company management to get money from many small investor family and friends. Multiple people owning relatively small amounts of the company in stock or other claims complicates the cap table and makes subsequent investments by large investors more complicated , though certainly not impossible. You are better attracting a few large investors than a lot of small ones.

Scalability of the business

Congratulations. You've made a workable prototype or sold and shipped an item on the internet. Now you have to make and sell a thousand a month. Does your plan describe how you intend to do that?

People are messy. The fewer the better.

If your business plan calls for hiring a lot of people that adds costs, re-think the model. Internet companies are easy to grow and scale with a few people. Just ask Jeff and Greg, the cofounders of this site and others like it. Craig's list has 8 employees.

Finding early stage investors is never easy, particularly in this economic environment. Put your business plan together so that it pushes the right buttons. If you do, the cash-meisters won't be able to resist.

Steps To Surviving the First 100 Days In Your New, Non-Clinical Career

The biggest question from physicians in the process of transition to their first non-clinical role? How can I best prepare?

From my last post on docs moving on to the corporate world, we know that leaving clinical practice and making your way within the business environment has a unique, and sometimes steep, learning curve. This curve, made up of both the new career training, as well as the unspoken expectations for business skills and acumen, has been a stumbling point for many a physician who is venturing into the non-clinical world for the first time.

The importance is on being prepared for the learning curve, and doing what you need to do ahead of time, as well as during the first few weeks of your transition, to ensure that those critical first few months position you for success as you continue on your new career path.

So how do you do that? What are the steps you can take to make sure that you have the most successful “First 100 Days” on your new job as possible?

Here are some ideas:

Step 1: Get Ready - Optimize the Period on to Your Transition

One of the most important things to recognize is that your first day on a new job better not be “day one” where you’re getting up to speed on the company and your new role. It is critical that you’ve spent time preparing yourself for the transition prior to the actual change, so that when you do arrive on the job you are ready to hit the ground running and make your initial days a value-added time for all involved. It is critical that you’ve thought of, and planned for, all of the elements that will start you off in the best way possible. These should include:

• Doing your “homework” on the company, the industry, the competitors, financials, etc.
•  Meeting with initial management, employees, alumni, customers, etc. to lay the groundwork for strong relationships and to gather valuable input up-front
• Preparing your family or personal support base for the intense time (and hours) ahead, in order to minimize personal disruptions and allow you to immerse yourself in your new role for the first months
• Assessing your own knowledge, skill or experience gaps, to determine what functional expertise or specialized training you will need to succeed in your new job – particularly where it comes to the “unspoken expectations” of business skill / acumen that are a given in the non-clinical world 

Step 2: Starting Off Right

When starting a new position within a new environment, you have a unique “window of opportunity” to establish yourself and to mold peoples’ expectations of you as well as your own foundation for the work ahead. You want to ensure that you are as successful as possible as you begin this new professional phase. During those early days it is critical to establish yourself as a learner, an active listener, and someone who is prepared and organized as they enter into this new space. Things to consider as you make your way:

• How you introduce yourself – to colleagues, team members, clients – and how you set expectations of yourself, your working style, your ability to partner
  
• Spending time to learn about, understand and shape your team
  
• Crafting your own “personal strategic plan” for the first three months, including your goals, milestones and your desired outcomes (see resources below)
  
• Spending time to understand your new company’s culture, and your place in it
  
• Establishing a productive relationship with your colleagues and boss
• Making sure you listen more than talk, and using effective communication as questions / issues arise

Step 3: Thriving in Your New Role

Once you’ve gotten yourself well-entrenched in your new position and are feeling comfortable that the initial learning curve is behind you, you will still need to make sure you are mastering the critical success factors that drive non-clinical environments. Pay attention to how well you are:

• Avoiding Common “New Team Member” Pitfalls - things such as talking more than listening, trying to impress by having all the answers (often before getting all the facts), stubbornly relying on what has made you successful in the past, setting unrealistic expectations of yourself, etc.
• Being an Effective Team Player - e.g., knowing how/when to defer to others, knowing how/when to delegate, taking leadership when appropriate, being accountable, sharing credit, knowing how to utilize complimentary skills for a common goal / outcome, etc.
• Knowing What To Do When You Don’t Have the Answer - not an easy one for physicians who are used to being required to have the answer! - this includes, avoiding the temptation to think you must have immediate answers and/or over-promising on things you may not be able to deliver, knowing how to create a process for reviewing the issue and inviting others to participate in getting the answer
• Running Effective and Impactful Meetings - things as simple as crafting an effective agenda, keeping discussion on-track, guiding and tracking feedback, and starting and ending the meeting on time
• Staying Accountable - knowing how to take criticism without deflecting blame, "owning" your work and any dependencies that others may have on it, delivering things on-time or appropriately escalating issues that impede progress
• Being an Expert Facilitator and Presenter - knowing how to engage your audience and deliver impactful presentations, being able to communicate complex clinical data and information in a way that your audience understands, being able to facilitate other peoples' process to a common end
• Delegating and Trusting Your Colleagues - being a true team player not only in words but in action, trusting others' follow-through, having a highly honed sense of collegiality
• Being a Highly Effective Communicator - having strong interpersonal skills, being able to mediate conflict, being clear and unambiguous in your words, being highly effective in both written (i.e., email) and spoken communication

A couple of great resources for you to consider:

“The First 90 Days: Critical Success Strategies for New Leaders at All Levels”  (2003)  by Michael Watkins (thanks to Dr. Arlen Meyers for the reference)

“You’re in Charge - Now What?: The 8 Point Plan”  (2007)  by Thomas J. Jeff & James M. Citrin

Publishing Contracts & What To Expect From Your Publisher

Answers to physician publishing questions.

In a previous blog post, 5 Reasons Your Book Isn't Published Yet (And The Cure For Each), Arlen had asked about negotiating points in a publishing contract, as well as what publishers are responsible for and what they expect their authors to do. It seemed a big enough group of questions (he had 10) to warrant a separate post. I'll get us started with Arlen's questions and feel free to add your own as a comment. 

I will say, as a book coach, I almost always recommend authors sign with a reputable literary agent rather than negotiate their contracts themselves. Even when you're signing with a small publisher, the advantages of having a qualified agent far outweigh the cost (typically 15% of your royalties, but can often be negotiated to 10% if you already have a publisher and they are just negotiating the contract).

Here are answers to the questions about some of the main negotiating points:

Royalties: While a typical royalty percentage is 10%, I have recently seen several authors earning and even 20% in unusual cases.

Royalties are typically paid quarterly and authors should receive quarterly reports. If you have an agent, your royalty is actually paid to the agent, who then pays you.

Copies of the book: Publishers tend to provide from 20-100 free copies of the book to the author. This is often an item that can be negotiated, especially if you have a solid marketing/pr plan for additional copies. Authors can usually buy additional copies at a discounted price.

Due dates and turnaround times: I've also seen agents negotiate dates that chapters are due or turnaround time for revisions.

And here are my answers to questions about what a publisher will do and what they expect from the author:

What tasks are the author's responsibility and what will the publisher do in terms of rights and permissions? In my experiences, the author would be responsible to get permissions, waivers and copyright releases. One of my clients had to pay to use the lyrics to a song. He hired an attorney to find out who owned the rights and make arrangements (he did not have a literary agent).

Design and art: Generally, the publisher provides graphics, art and layout. However, there are times that an author may provide a cover design--one of my recent clients liked an image and suggested it to his publisher who accepted it. The publisher often shows from 1-3 different cover designs and gets the author's (and agent's) input. However, the publisher almost always has the right to final decisions on cover and title.

Marketing and promotion: Generally, as an author, you are expected to market and promote your book. The publisher may pitch your book to the media along with other books, during meetings with national producers, but the lion's share of publicity is yours to develop and implement. This is a really critical point. If you are writing a book proposal for a trade book, be sure to include a robust promotion plan (that includes online promotion) and demonstrate that you have a following and/or reach a good-sized segment of your audience (we call this author platform in the industry).

Pricing: This is determined by the publisher.

And, to answer Arlen's last question, if only a few books sell, your publisher may sell the books at a discount to resellers. Sometimes you can negotiate to buy back the rights to your book.

Arlen, thanks for these great questions. Let's hear from other authors about your experiences with publishing contracts and responsibilities. And do post additional questions here, too.

Business Plans Are Like Treating Patients Clinically

Recommend a treatment and see if works.

Laryngopharyngeal reflux is a controversial entity. Patients complain of hoarseness, throat clearing, globus symptoms,cough and sore throat. Some have coexistent symptoms of gastroesophageal reflux disease (GERD), some don't. Some have abnormal physical findings on laryngeal examination, some don't. Most doctors treat such patients clinically with proton- pump inhibitors for several weeks to see if things improve. We doctors call it treating someone on a clinical basis or treating clinically. Business people call it a business plan.

When treating someone clinically, you are never sure the treatment will work and are prepared to reconsider the diagnosis and the underlying assumptions you made when you made the diagnosis and recommended treatment. Likewise when you write a business plan, you are never sure the plan will work and should be ready to make frequent adjustments...getting to Plan B.

John Mullins, Professor of Entrepreneurship at the London Business School, and Randy Komisar, a partner at Kleiner Perkins Caufield &  Byers , explain all of this in their book, "Getting to Plan B".

The basic thesis is that no battle plan. or business plan,  survives the first shot and you need to be prepared to make changes quickly. Just like you monitor patients for response to treatment, you monitor your business to see if things are working. If they are not, then make changes.

Mullins and Komisar recommend using dashboards to monitor your business. The numbers will tell you whether your leaps of faith, beliefs you hold about the answers to your questions despite having no real evidence that these beliefs are actually true, are valid or not.

In addition, just like you use history, physical exam and testing to monitor a patient's progress, you should use metrics and dashboards to monitor the vital signs of your business. Those vital signs are your revenue model, your gross margin model, your operating model, your working capital model and your investment model.

You can count on the fingers of one hand the number of businesses that have succeeded based on Plan A. None of them are mine. Be prepared to monitor your business's clinical progress, challenge your initial diagnosis,  and, if the patient is not responding to treatment , change your therapy before things go terribly south.

Check Out Book Biz Radio

Recently I did an interview with Drew Nederpelt on BookBizRadio.com

Check out Drew's interviews with authors for more information on book publishing. You'll see that he has interviewed a variety of authors who write in different genres. If you scroll down to the bottom of the provided link, you'll be able to listen to the interview that I did with Drew. Another good resource for authors! 

Physician, Build Your Own Ship

Looking back over the past month it's been very rewarding to see the growth of Freelance MD.

It was interesting to read Jeff's recent blog post about Freelance MD's first 30 days and the resonance this site has had with physicians. Freelance MD was created to offer physicians objective, credible information on a variety of topics that are important to modern physicians. We knew going in to this project that there was no other place on the web like this, and we felt that the topics that we would be discussing would fill an important void.  Based on our numbers, it appears others agree with us. Jeff and I sincerely hope you're finding the site to be informative and encouraging.

In thinking about the growth of Freelance MD and the beginning of the Medical Fusion Conference, I began to think more about physicians and their careers. I'm in a rather unique place when it comes to the issue of physicians and their career issues. First, I'm a physician. Second, I come from a family of medical people (my cousin is a medical student, my father and brother are surgeons, my sister is a medical malpractice defense attorney, and my mom is an elected official who sponsored medical malpractice tort reform in my home state). Third, I run two national conferences and come into contact with physicians from multiple specialties who practice all over the country. All of this exposure to many types of physicians allows me a lot of opportunity to discuss the idea of physician career modification and what physicians can be doing to improve their situation.

When the issue of career modification comes up in conversation with my physician friends, it seems that many are frustrated with their clinical practices, but they seem completely overwhelmed by the thought of making a change. These friends are like the survivors of a plane crash on a deserted island who are sitting on the beach in stunned shock realizing they're now marooned. They're so overwhelmed with the shock and horror of the crash that they haven't moved past the shock to the point of working towards their survival and, hopefully, escape from the island. They're still sitting in the sand, wailing, "We've crashed! We've crashed! We're all alone!  How will we survive? What are we going to do!??!!!"

Look, I'm not saying things are rosy and we shouldn't have concerns. I think it's obvious to everyone that the medical profession has crashed. Gone are the days when being an excellent clinician is the only worry of a physician. Today's physicians have to balance clinical excellence with billing codes, patient satisfaction scores, duplicitous administrators, underhanded trial lawyers, and a government bureaucracy seemingly intent on driving the entire healthcare industry into the dirt. It's not a great situation to be in and if there ever was a time when one would be justified a little despair, now is that time.

However, what I've found amazing about Freelance MD and the Medical Fusion Conference is that in spite of all this doom and gloom in medicine, there are a number of talented individuals who are not just surviving the current environment, they're thriving. These people aren't sitting in the sand weeping over their losses, they've moved off the beach and have taken active, deliberate steps to improve their situation.  

I'm reminded of the quip from the author G.K. Chesterton who, when asked by a journalist what book he would most want to have with him if he was ever marooned on a deserted island, said, "Why, A Practical Guide to Shipbuilding, of course..." 

The leaders I've met—many of whom are authors on this website—are inspirational because they aren't just moaning about how horrible the crash has been on them or waiting passively on the beach for someone to rescue them. No, these leaders are out in the jungle, foraging for food, building shelter, scouting out the island for opportunities and, most importantly, building a vessel to get them off the island when the timing is right.

If these individuals have been so successful in making the transition, why then are so many physicians still moribund, stewing in despair and learned helplessness? Why is making the change so difficult for many physicians?

There are a lot of theories about this and there are many individuals writing on Freelance MD who have been addressing this very issue, but it's important to note what appears to be a universal truth:  many physicians are having a difficult time adjusting their careers to the current reality around them.

As we build Freelance MD, one of my personal goals is to build this site in a way that offers very practical, systematic steps for physicians to begin taking control of their careers, shaking off the learned helplessness in which they've been festering, and begin working on their "ship" to get them off their deserted island and back on the road to adventure and a more fulfilling career.

Are you interested?  

If so, join our motley crew and learn from the experts on this site. Get involved and ask questions. Contribute to the community and teach others what you're learning. In short, get started, right now, making the transition for yourself.

The time for sand-wallowing is over.  

It's time to build your own ship.