Early into my career as an emergency physician, I was seated in the department with a colleague when I inquired about one of our co-workers I had not seen in a while. “Oh, she’s on the mommy track,” my colleague said and picked up another chart. To me, selecting a career path that sacrificed traditional professional advancement for more time to raise children was legitimate. My colleague’s pejorative “mommy track” made it clear that to him, it was not.
At that moment, I resolved to pursue a non-clinical supplement to my emergency department work, colloquially known as an “exit strategy.” Here, I’d like to offer my path for the benefit of other physicians — whether burned out, seeking more family time or looking for creative outlets — as an example of what is possible outside of clinical medicine.
Emergency medicine is a fantastic field in many ways: Daily work includes critical thinking, procedures, interpersonal interactions, and the ability to make a positive impact when a patient is most vulnerable. But the field also has one of the highest burnout rates, likely secondary to erratic hours that can both interrupt family time and adversely affect health. It also suffers from a lack of autonomy: Usually, an emergency physician does not get to pick her schedule, whom she works with, how heavy her workload is or how burdensome the emotional toll of her workday might be.
Those inconsistent hours and lack of autonomy became relevant when I married another emergency physician and had two children. Raising toddlers plus the scheduling conflicts caused by two working emergency physicians rendered clinical hours less attractive. Doctors in specialties outside of emergency medicine may recognize this situation: Many otherwise great medical fields have onerous disadvantages that also limit flexibility, autonomy, creativity, and family time.
I had not possessed this lifestyle insight as a medical student. But, back then, I did know that medical school was making me feel unidimensional, so I availed myself of Harvard’s “five-year plan,” allowing me to graduate one year later with a nominal tuition difference. I spent time backpacking through Thailand, Mexico, Guatemala and Honduras and — fortunately — discovered the American Association for the Advancement of Science Mass Media Science and Engineering Fellowship. Through this program, while working at The Oregonian newspaper in Portland, I learned the fundamentals of writing about science for the lay press. I loved journalism but opted to complete my clinical training and matriculated into my residency program the next year.
After completing training, I was asked to stay on as faculty and was later selected as the assistant residency director of the Harvard Affiliated Emergency Medicine Program. My favorite part of being on faculty was the residents. I liked supporting them and, simultaneously, in my assistant residency director role, I learned invaluable information about the residency admissions process, reviewing ERAS documents, interviewing candidates, and selecting future classes of incoming trainees.
When I met my husband, we happily relocated to California. As I mentioned previously, we realized rather quickly that we were not achieving our shared vision of prioritizing family life. My husband’s practice did not allow part-timers, so I cut down my clinical hours a bit and started to consider what I wanted and what my skill set was:
I missed mentoring residents and medical students, as I had done before I left academia.
I also really loved the work I had done as a journalist and missed focusing on words and their impact.
I had a lot of experience interviewing applicants and understood what went on behind the closed doors of the residency application process.
I wanted to work virtually, so I had the flexibility to spend maximum time with my husband and family.
Consequently, over 12 years ago, I founded a consulting company that helps pre-meds and medical students improve their candidacies for medical school and residency, respectively. Throughout the company’s growth, I have continued to work clinically part-time, a strategy I would recommend to any physician considering a non-clinical track unless or until she is certain she will never see another patient. Years ago, I was given good advice to “keep an oar in the water” of clinical practice, and I would offer that recommendation to others seeking an exit strategy.
While my consulting company works very well for me, it has required thousands of hours of my time. My husband jokingly refers to my company as our third child for all the attention it has demanded.
So, before committing yourself to an alternative to traditional medical practice, it’s critical to remember that non-clinical pathways offer imperfect solutions. Also, while clinical work can be exhausting and lack flexibility, it is usually geographically and financially secure in ways a non-clinical exit strategy may not be, especially at first.
By creating a clinical alternative tailored to my situation, I am able to enjoy many of the aspects that replenished me as a Harvard assistant residency director without the drawbacks or politics of an academic career. Thinking outside the box as an entrepreneur allowed me to renegotiate the impositions I was willing to accept from my clinical work. It’s liberating when you no longer face the constraints that entrap many colleagues in clinical medicine. It’s also empowering to find that, thanks to a supplemental income stream, you can reduce or eliminate the more depleting aspects of your job like nights and weekends.
My advice for the physician seeking options outside of clinical medicine is to create a list of your skills and decide which ones confer an “unfair” advantage that you might use to create an opportunity to generate a supplemental revenue stream. If you can’t identify your niche skill, invest in developing additional talents, and expand your network. Volunteer on hospital committees that allow you to become a known and respected quantity to the administration. Alternately, developing research or financial skills may allow you to branch out into pharmaceutical work or venture capital.
A golden parachute is woven over the years slowly and deliberately, one stitch at a time. Create yours now and gift yourself a graceful path out of medicine from the comfortable height of your career. Ignore your golden parachute, and you risk an ill-conceived exit from a career that no longer keeps you aloft.
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