It's Okay to Not Want to be a Clinician - Alternative Pathways in Medicine

It’s Okay to Not Want to be a Clinician – Alternative Pathways in Medicine

Jan 12, 2021

Written by Michael Tanner

Michael Tanner is completing a Doctor of Medicine/Doctor of Philosophy. His writing explores the intersection of economics, the media and public health. You can follow him on twitter @MichaelTanner_

While medicine is a wonderful field in which to work there are plenty of reasons to want to walk a different path.

So a career in clinical medicine no longer excites you? That’s OK. Maybe it never did. Maybe you chose to study medicine because you were 17 or 18 and you had watched one too many seasons of Scrubs. Or maybe you chose it to please your parents. Or maybe you chose it because you got really high marks in Year 12 and bought into the “I can’t waste my high marks” idea. And now the simple joy of excising a skin lesion no longer outweighs the pressure of being an intern and the stressful nights no longer overshadow the pleasure of seeing the older woman with congestive heart failure regain the ability to walk. Maybe it’s the unpaid overtime. Maybe you just didn’t know what to expect. Maybe... 

As burnout rates and drop-out rates rise among junior doctors and the path towards specialist training programs require ever more years of unaccredited service as well as PhDs, exams and more qualifications, it is natural to wonder: is this what I want? 

If this feels familiar, you are not alone. While medicine truly is a special field in which to work, there are plenty of reasons to want to walk a different path – both personal and systemic. The number of people opening their eyes to this idea is increasing. 

In 2017, just 43% of doctors completing their foundational training in the NHS in England continued on to specialist or general practice training in 2018 – a huge drop from the 71.3% who did so in 2011. In Australia, there was a 20% drop in the number of applicants applying for general practice training positions between 2015 – 2019, despite ever-increasing numbers of medical graduates. This trend is not restricted to junior doctors. In America in 2011, flagship medical schools Stanford and the University of California San Francisco, saw just 68% and 79%, respectively, of graduating medical students continue to postgraduate medical training. 

There is a conspicuous absence of data on why people leave medicine. We can speculate, though. 

You might be a big-picture thinker – acutely aware of the societal contributors to health and disease: growing inequality, insecure work, climate change, obesogenic environments. 

You might be a risk-taker: being a doctor is a stable and comfortable, if stressful life, but the scope of practice can be narrow, and the often inhospitable hours can be a barrier to a work-life balance. 

There are a myriad careers, too – careers that take you far from the white linoleum floors and brown brick buildings and the flashing lights and beeps of hospital life.  

Systemic issues abound. The rigid, inflexible nature of medical training, sometimes with requirements to spend extended periods in far-flung lands, sometimes with no say as to where or when. The overworked and underpaid nature of training in England or the United States. The ever-worsening training program bottleneck in Australia, which has doctors thinking about back up career options: there remains little hope in sight of a resolution to the crisis.  You might blame it on burnout – many do. However,  an opinion piece in the British Medical Journal points out that many doctors leaving the NHS enter equally or more intensive fields. Perhaps it is not always burnout; often it might be a lack of support, inspiration, motivation or a feeling of being valued. 

I hadn’t finished medical school before I began exploring other options. I was disheartened by the societal and political issues that underpin the onset of health issues from depression to diabetes to dementia. However, I still saw some beauty in healthcare. The natural sidestep from medicine is into research, which is where I found myself after my penultimate year. Perhaps it is a strange decision that someone feeling ambivalent towards medicine would embrace further year(s) as a “medical student”. But the day-to-day life of research is profoundly different from the practice of medicine. Always asking and reasoning: why? Questioning, not accepting, evidence. Learning to think. To analyse. To write. To look at the big picture, the wider implications, to become an expert in an area. My honours year turned into a PhD, offering the time to further develop other skills – such as writing. It’s also a source of humour, when people ask what I want to do when I grow up, while working towards a PhD in women’s health, “freelance journalist” is not the expected answer. 

Whether research is lab-based, epidemiological and data-driven, clinical or qualitative, there is something for everyone (sometimes clichés are clichés for a reason). Each kind has its unique challenges and skill sets to develop, but has one thing in common: the experience will be immensely different from  clinical medicine. 

There are a myriad careers, too – careers that take you far from the white linoleum floors and brown brick buildings and the flashing lights and beeps of hospital life. 

It is easy for medical trainees looking for careers outside medicine to overstate the importance of their lack of formal education in other fields, and understate the on-the-job skills they have developed: working in high pressure situations; efficient time management; optimising workflow (aka Getting. Shit. Done.); managing a team; working in a team; attention to detail; problem solving skills; and countless others I hope to develop when I actually become a junior doctor. 

So what are some of these other careers?

Management consulting

Consulting has emerged as a popular exit strategy for doctors, particularly those going straight from medical school or early in their careers. Professional development across a diverse range of industries is the number one priority in such a job, often on high-level, strategic issues - the sort of experience that is an incredible asset for a career in any industry, from the smallest start-up to the largest corporation.

As Jama Network reports, high-profile consulting companies – particularly the so-called “big three” of McKinsey, Bain & Co, and the Boston Consulting Group – recruit medical students and physicians, recognising their diverse skill set. Mckinsey, for example, recruits for an "MD Fellowship" in the United States, a two-year contract for work while still a medical student.  

Most who turn down this path end up staying fewer than three years. Endless opportunities await following a stint at these firms – from global health to finance to working on the higher-level, systemic issues in health systems.

Digital health, biotechnology and the pharmaceutical industry

These are huge and interlinked fields. 

In the year leading up to 2020, digital health was a rapidly growing field. But the Covid-19 pandemic has turbocharged the long-awaited digital revolution in health care. Investment is pouring in and start-ups abound, with the sector expected to nearly double in size between 2019 – 2024. 

Beyond digital health, the biotechnology industry – think medical devices – is also poised to grow dramatically over the next decade. The pharmaceutical industry is another where innovation is constantly happening. Research and development is not limited to universities. A recent report (PDF) In the United States between 2013 – 2017, the private sector invested triple the amount the federal government put into medical and health research. 

Doctors are a key part of the design, evaluation, testing and implementation of new products. 

Non-Government Organisations

Countless non-government organisations, from global (think the World Health Organisation) to local (think The Australia Institute or the Grattan Institute), consult, research and write reports on issues facing the public health of the world, the nation or local communities. 

Writing

Life as a doctor gives one perhaps the closest and most intimate exploration and understanding of humanity. Plenty of doctors have translated these experiences into best-selling books and/or powerful journalism such as,Atul Gawande writing Being Mortal and Better, or Ranjana Srivastava, a regular contributor to The Guardian. 

These are just a handful of the more popular paths out of medicine or that can be combined with a medical practice. One need only look at prominent doctors in the public eye to be inspired: from the GP/magician Dr Vyom Sharma to public health advocate Dr Sandro Demaio to Drs Kerryn Phelps and Richard Di Natale, who took their skills to public service as politicians. 

A common question facing businesses and individuals alike is whether to explore or exploit. You can exploit your current skill set and the investment you have put into training as a medical student or doctor – a safe but challenging option which comes with many benefits. But if you want to step off the conveyor belt of training you can explore other options, where the risk is greater, but so are the potential rewards.

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