What Can Doctors Do After Quitting Mainstream Medicine?
Labour statistics in the United States, United Kingdom, Australia and elsewhere have seen an alarming trend in physician burnout, suicides (attempted and completed) and a general dissatisfaction in the medical career. In this article I will be discussing the alternative career choices taken by doctors who wish to have more control and autonomy in their lives. Perhaps a virtual career in telemedicine may give that sense of career freedom that so many physicians are desperately searching for.
Many healthcare professionals who have been contemplating leaving their careers in medicine, have purposely taken the initiative to quit their jobs enmass.
Doctors and nurses feel left out from major healthcare policy making decisions, which have been unanimously decided by administrators and policymakers located thousands of miles away, and in many cases by regulatory bodies in other states or countries. Overburdened health systems, under-resourced facilities and in many cases, abuse at the hands of desperate populations have left many healthcare professionals to consider alternative methods in earning a decent living.
But Why Are Doctors Leaving Their Medical Career?
In the beginning of modern medicine there was a notion of service to serving the community and humanity in general. Gifted individuals sacrificed their productive stages of their lives in acquiring high grade professional skills to provide much-needed healthcare services to vulnerable populations.
To consider quality standards, competitiveness and to attract more talent in the short staffed healthcare sector, different financing models had to be sorted i.e. the way doctors should be reimbursed as a measure of the value they create for their employers (not the patient since they are not the actual payers of healthcare anymore)
Unfortunately reimbursement did not adapt with increasing inflation over the decades, quite simply doctors would have a lot less purchasing power over time compared to the amount of effort needed as the complexity of healthcare increases.
This means many doctors are facing the burden of increasing student debt, unsustainable mortgages and the rising pressures of their daily jobs. Many consider leaving the profession in total just so as to be on par with achievements of their non-medical peers, atleast in enjoying some form of life satisfaction.
Many doctors who have dedicated decades of their lives to the profession have come to the realisation of sudden changes in reimbursement policies and increasing institutional burdens on their workflow. Especially greater time spent on EHR notes which are non-income generating activities.
How Did the Current Pandemic and the Work From Home Movement Affect the Career Choices for Doctors?
Skilled professionals in the non-medical service industry, and the legal profession, creative sector or any task that can be adequately performed remotely and digitally have realised the value and comfort of remote work. Work from home paradigm, has become the main choice of career for many specialised professionals who have also been seeking greater freedom and quality of life.
In the healthcare space, telemedicine is the ideal method in providing value personalised and direct communication based services by certain specialities which do not require a hands-on interaction as part of the treatment. This is particularly effective for follow up cases with known patients, mental health support, expert second opinions and other forms of personalised care reviews.
Follow-up appointments by zoom are the most convenient and impactful ways to communicate with your family medicine, palliative care provider, certain internal medicine specialties, mental health specialist and other subspecialties which rely on a more direct doctor-to-patient communication, prescription refills orders and other non-acute non-interventional activities
So why are Doctors quitting their jobs even if there are so many healthcare career options?
Health tech innovation was a welcome move for patients and doctors alike, unfortunately certain parties have not realised his full potential as part of a much larger revenue cycle for the organisation.
Major hospitals rely on elective procedures as their primary reimbursement model for their insurance provider or by out-of-pocket players, therefore remote decentralised hospital staff will not be able to increase patient turnover and hence may affect the hospital’s financial sustainability.
Policymakers who may or may not be aligned with the business model strategy of medical insurance companies due to the decentralised issues, meaning the telemedicine reimbursement model depends heavily on providers to cover the cost in exchange for patient health data.
Many doctors who had a dream of having their own private practice have contemplated telemedicine to be their ticket to financial freedom, however running a private clinic is a lot like running a small business, in a volatile economy can be quite challenging if one does not have the necessary business acumen.
Some doctors feel that their options are limited in spite of greater investment in excessive specialisation and continuing medical education. The question arises where else can I work?
The Public sector
The public sector is overburdened with Covid surges, rising cases of complex chronic diseases and lower pay as usual. Doctors assigned to telehealth duties do not receive any additional remuneration in many cases.
The nonprofit sector, which is often a beacon of affordable quality healthcare in developing countries, now has suffered a donor cash crunch as the world is suffering a recession due to the stoppage of mass consumer economic activities.. This means medical staff working in NGOs will now have precarious income in the coming years, unless donor sustainability can be assured.
The Private Sector
The private sector is an ideal method to earn a profitable income, have better choices in workload and other benefits. However, providing a sustainable reimbursement to the actual healthcare providers of the healthcare business is a complex issue not openly addressed in stakeholder meetings, compared to fund raising investment in other company verticals.
What can a doctor do outside of medicine if the healthcare system does not adapt?
Many healthcare professionals are forced to reassess their difficult financial situation, hard questions need to be pondered on whether to leave the profession.
However there is still the burden of medical student loans, mortgages, children’s education and other incurred costs.
Some healthcare professionals who are financially literate, may have invested and diversified their portfolio beforehand, with sustainable savings and perhaps a side hustle which allows them to make such decisions without major disruptions to their daily lives.
Some female doctors have decided to give up their busy professional life in order to raise their children, either as a measurement of a better quality of life or to save on expensive childcare facilities.
However the majority of doctors are not financially literate enough to contemplate an alternative income source. Classic side income sources are also unstable such as the real estate market which is highly volatile, many businesses have shut down due to labor shortages and the opportunity cost of acquiring a new trade or skills may seem daunting for most.
After all, when a doctor has invested ⅓ of their adult lives to perfect their clinical skills, it is not an easy feat to just learn something new and start off.
Some physicians have pivoted to non-clinical work such as:
- Online teaching courses (teaching English, craft, yoga, functional medicine or mental health support)
- Digital marketing i.e. medical writing, publications which can be done from home for some positions
- Tried their luck in the entertainment industry, especially online.
- Many clinicians have started their own business from their savings or other funds which they had considered for a long time.
But the reality is not so easy, when a skilled professional is used to a certain way of living, with a certain income and of course financial obligations.
Once a doctor, always a doctor.
Can a doctor leave their hospital jobs but still practice medicine on their own?
Many doctors who have dreamed of opening a private practice may not realise the massive capital investment needed in private practice, much like starting a small business. Opening a clinic, or even a group, requires massive investment in physical infrastructure, employer contracts and individual regulatory procedures.
Before the pandemic the number of private practices have been steadily decreasing, due to the unwillingness of younger physicians to take on the burden of a fledgling practice, merger and acquisition by large healthcare organisations and in some cases being acquired by private equity firms.
A small practice cannot have the same economies of scale of a massive healthcare corporation in order to be adequately reimbursed with the correct coding and billing procedures.
Even cash based practices are not that financially stable to high administration costs, employee turnover, or a static pricing model for their services or memberships. Similarly some practices may not be ideally placed due to a low population in their catchment area, or the general lack of competitiveness with a large established organisation in the same community.
Are there opportunities for independent doctors in digital health?
Digital clinics do not require physical infrastructure as a starter, there is no need for a brick-and-mortar clinic to be built in order to service the patient community.
A telemedicine physician just needs a decent device for the video conference, good connectivity and the right business model to afford the necessary malpractice insurance.
Nonetheless there are other challenges and costs in a private direct-to-patient virtual practice, namely:
- Affordable indemnity coverage for the actual virtual interaction. Specifically in errors and omissions and of course cybersecurity coverage.
- Digital marketing strategy and its budget
- Restricted state licenses will restrict the population that the doctor may serve, multiple state licenses may be required in this case, which is not that affordable in many cases and not all states in America are participating in the Inter-State Medical Licensing Compact (imlcc.org)
- Population coverage is limited by geography and regulations i.e. if the population that you serve is quite small, their purchasing power for private care is also limited, there will be significant effects on the sustainability of your digital health practice
- Administrative burden of running your own telemedicine practice as a small business is not easy as a solo practitioner. You must maintain the administrative and managerial tasks to keep the business running, paying your taxes, creating a marketing strategy to generate enough leads, dealing with complaints or special requests, affording malpractice coverage and managing chargebacks and other business related tasks which are often not the forte of the doctor in question
How can a doctor have a sustainable private practice in Telemedicine?
To be sustainable as a telemedicine provider you must consider the practices of a successful small business in a remote setting, the most successful models in this case are in online education courses, freelancer gig work and other specialized service providers in a remote setting.
This analogy can be extended to the concept of strip malls, a non-retail entity is in charge of lean leases, parking security, sanitation, insurance and maintenance of a property whereas the small business owners merely occupy a location based on their budget and carry out their retail business as required. Multiple businesses occupy a retail location that can attract and manage potential customers without the added burdens of ancillary administrative tasks.
This model is applicable in the examples above, where independent contractors or agencies occupy the platform related to their business and leave the costly and cumbersome administrative work to the platform providers, in return for a membership or commission (rent).
Are telemedicine platforms a suitable model for cost-effective healthcare services?
In theory it is possible and is the most common model of digital health services. A specific database of service providers are provided to manage a specific illness on demand. Just like the ‘Uber of Healthcare’.
Physicians occupy a niche in their platform specifically designed for patients in need of their specialized skills eg. Pediatrics or Mental Health support and can be easily contracted and contracted to carry out their services, under the supervision of the platform.
The benefit of a platform-based telemedicine solution are:
- Established business entity
- Administrative tasks are handled by them
- Digital marketing and other lead generation tasks are their responsibilities
- Many platforms provide umbrella coverage for malpractice claims
- They may already have a brand image with significant patient leads
- They have a network of outsourced specialists and consultants to handle business tasks such as legal support, bookkeeping, IT support.
- Many patients prefer to interact with a peer agency rather than a solo virtual practitioner i.e. a business entity rather than an individual
- The calibre of the existing physician pool may add to your own i.e. respect by association
- Commissions for services rendered are more cost-effective than starting from scratch
Can The VIOS Clinic be a Suitable Solution for Physicians in Need of a Career Change?
It is certainly the vision of ViOS, Inc. to create a truly decentralised and adaptive network of specialists, who do indeed control their careers and are able to safely practice their medical craft as they see fit – to a patient population in need of their personalized approach.
The VIOS Clinic is an International Database of highly trained and motivated healthcare specialists, who were seeking the same career independence and ‘adventure’ as the reader of this publication.
We provide the necessary foundation for an automated patient interaction such that the patient and provider are in total control of their health choices from the moment they enter the platform, and when they are adequately satisfied.
In our remote digital health platform, we have discrete sections populated by specialists who are trained to manage specific disease states eg. Diabetes management, where any website visitor is free to interact, view their credentials, join our flexible membership plans and almost immediately start their private online consultations – free from the hassles of prior insurance authorizations and the complexities of long-distance medical travel.
If you are a physician desperately seeking a better choice in the healthcare industry without having to quit your medical career, reach out to us here and we can see if there is an opportunity for someone with your clinical skills.
Dr. Ismail Sayeed
Dr. Sayeed is the Medical Director of ViOS, Inc. He is a deeply committed physician entrepreneur & medical blog writer. While building the global infrastructure of the VIOS Clinic, he is dedicated to educate people on the potential of specialist telemedicine for managing chronic diseases.
Read more about him in his author bio