June 26, 2017

Leaving Medicine and Reentry – Know Before You Go!

doctor thinking

Hold onto that medical license and keep your stethoscope handy!

If you’re thinking about leaving clinical practice, don’t retire that license too fast or stay out of practice too long – unless you‘re lock, stock and barrel sure you’re not going back. Even then, it’s wise to keep everything current.

You may be burned out, wanting more time with your children, or needing to care for elderly parents. Perhaps you’re shifting into administrative work or have been enticed away to a start-up company. You might only intend to be away from practice for a year, but then before you know it, 5 years or 10 years have passed, or more. Maybe your financial situation has changed. Is it too late to return?

What is required to return to practice?

Depending on how long you’ve been out, your specialty, and other factors, it could be as simple as making a few phone calls, or it could be harder than climbing a double Mount Everest to return. And as with summiting Everest, no one guarantees your success.

Dr. Christine Stone, an internal medicine physician was gone for 14 years before she decided to return to practice. In her blog, Reentry Physician, she chronicles her return to primary care, which took 27 months and cost $40,000. To begin practicing again, Dr. Stone had to get her license back, pass her board certification, find a preceptor willing to supervise her, and then find a job. Every step took longer and was more difficult than she anticipated, but she made it and offers her blog as a way to help other reentering doctors.

What are the challenges to reentry?

Where do I start? First of all, each state sets their own policy on reentry, and close to 50% of the medical boards do not have a formal reentry policy (AMA fact sheet on reentry). Per the AMA’s 2011 medical board survey, 2.8 years is the average length of time out of practice after which some type of reentry program is required.

Second, the programs for reentry are few and far between, and they are not inexpensive. Each program has different features, but at a minimum, they involve some type of assessment to determine the physician’s knowledge base and clinical competence. The assessment phase on average runs around $10,000.  If there is a patient care component offered, it may be more of an observership or involve direct hands-on patient care.  The fees for this phase can be $10 – $20,000+, not including living expenses.

Dr. Stone did the CPEP Program (Center for Personalized Education for Physicians). CPEP is for physicians from any specialty who left medicine in good standing and involves two phases. Phase 1 is an assessment of clinical skills and knowledge base. Phase 2 involves practice-based learning which is usually done in the physician’s home community. It’s the physician’s responsibility to find a preceptor (supervisor), and this can be daunting.

After getting a lot of “No’s” when trying to find a preceptor, and even wondering if after coming so far, she was going to fail to meet her goal, Dr. Stone finally found a preceptor through a personal connection and was able to fulfill her reentry requirements. She is now working again in primary care.

Dr. Gould, a psychiatrist who had been out of practice for years filling several executive roles in healthcare, did the CPEP program as well. He also had an incredibly hard time trying to find a preceptor for the necessary supervision. About his reentry process, Dr. Gould recounted,

“Prior to starting the process I requested a meeting with the Minnesota Board of Medical Practice, having submitted my basic credentials to them, and asked them outright if, with the proper re-training, would they be willing to license me. If not, I wouldn’t waste my or their time. They were generous in being willing to preview my application and told me if I worked with a company they knew and had confidence in, like CPEP, they would. So, I immediately contacted CPEP and did whatever they wanted me to do, so when I returned to the Board, I had their approval.  Finding a clinical supervisor turned out to be the biggest problem in the whole process. I had my own malpractice insurance and was willing to pay a supervisor their hourly rate for supervisory time, but I needed some program that would let me see their patients as a mature trainee.”

After months of trying to find a supervisor, Dr. Gould’s persistence paid off and a connection from 20 years ago came through for him.

“All in all, Dr. Gould said, “the whole process took about 18 months and cost about $20,000.”

How About a Mini-Residency?

A reentry program in Texas has a solution to the challenges of finding a willing preceptor. The KSTAR/UTMB Reentry Program (A partnership of Texas A&M and The University of Texas Medical Branch) offers a mini onsite residency at UTMB in Galveston.

Physicians need to do a two-day assessment first to see if they qualify for the 3-month mini-residency. Most specialty and subspecialty programs will be possible for those who are eligible. Reentry physicians function as part of the medical team and have access to performing procedures. Liability insurance is available.

Another option is The Drexel Reentry Program in Philadelphia

Eligible specialties for the Drexel Program are internal medicine and subspecialties, pediatrics, OB/GYN, radiology, and anesthesia (other specialties may be possible). While there is no direct hands-on patient care, there is an extensive assessment followed by clinical rotations on the wards, simulated patient encounters, instruction, and feedback.

Lifeguard is a program in Harrisburg, PA open to physicians seeking reentry, including those who have been involved in disciplinary action or may not have finished a residency (depends on the state).

In an interesting twist on reentry, the Physician Retraining and Reentry Program (PRR) in California offers an online program for physicians wanting to reenter or transition into adult primary care. Physicians do not need to be from primary care to be eligible, and doctors from a variety of specialties, including surgery, have enrolled in this program. As a case in point, former urologist Dr. Michael LaRocque became restless in retirement and decided to do the PRR program. He now works as a primary care physician seeing patients at a federally qualified health center in California.

Is a formal reentry program necessary?

Every physician’s situation is different, depending on specialty, time away, state licensure, CME hours, etc. My recommendation is to find out what your state board requires.

One of my clients who left internal medicine for over a decade to raise her children just landed a great job at a progressive primary care clinic. She had kept her license active, and took an intensive Harvard Review Course to prepare for her boards, which she happily passed. She shared this information about her reentry for the blog,

“When I was starting my process, before I took my boards, I contacted Drexel, because I wanted to enroll. They told me to apply for jobs first, and if the employer required me to do a refresher program, to call them back. My current employer did not require me to do a refresher program. Before I started I did some shadowing of one of the primary care physicians. They are starting me slowly, seeing about 10 patients a day. So far, it’s been like riding a bike. My main questions are related to the EMR, and not clinical.”

If I’m transitioning to a non-clinical job, do I need an active license?

Many doctors are surprised to learn that a good number of non-clinical positions require an active license and even board-certification.

Do I need to keep clinically active to some degree?

If you are in a nonclinical job and are able to do some intermittent patient care (locums, volunteering, urgent care shifts, teaching, etc.) you could have a much easier time returning to medicine if you so choose. While this can be impractical for some jobs and specialties, it is worth considering and seeing what’s possible.

Does this mean I can’t take a break?

Absolutely not. I’ve seen doctors take significant time away and return without missing a beat.  Obviously, this depends on your particular situation, but for a reasonable time period, there is more latitude than you might think. Giving yourself time to recover from burnout, flex some different muscles, or devote time to family, can give you an entirely new perspective. Do your due diligence before you go, and if you plan to be out for a while, you might want to set aside some money in a “reentry jar,” just in case.

 

Do I Need to Leave Medicine? One Physician’s Story

yes no pixabay

Dear readers, I am honored to share with you an inciteful and powerful story by one of my awesome clients.  

When you tell people you are changing jobs, they want to know why. Many people will even ask, “Are you going to make more money?” or “Is this a promotion for you?” They don’t know how to react when the answer is, “No.” I make less money than I did two years ago. I am not the boss. I don’t have a title. Yet I am happier.

This concept would be so foreign to the younger me. Since high school, it has always been about the next step – college, medical school, internship, residency, that first job, that better job, more responsibility, more money, more prestige. At each step I was unhappy, yet I struggled through because I just knew that happiness would come when I reached the next level.

Two years ago, I had everything the world had taught me that I should have: more money than my parents ever did; freedom to run my practice the way I wanted; a directorship position and a chief of staff position. But I wasn’t happy. How could that be? I had checked off all the boxes in life, delayed gratification for years and found emptiness at the end of it all. Since my usual way of handling dissatisfaction was to force my way through to the next better thing, I just assumed that I needed to progress to a new level. Without realizing it, I was looking for more ladders to climb. I was so used to the constant “what’s next?” that I could not enjoy the now.

I enlisted the help of Heather Fork with the idea that I would find this great new career path. Certain that she would steer me into administration, medical writing, or some exciting new field, I jumped in with both feet and worked hard on the process. I was excited about the idea of developing new skills and succeeding in a new area. What I found instead was that I was in the right career but had lost sight of what I liked about it. With a little thinking about who I am and what I like, I could see the times in my career that I did enjoy what I was doing.

It turns out that I didn’t need to keep climbing; I needed to go back down! I have always enjoyed the basic work of my specialty, but my current position did not allow much of it. I was isolated, I was not working on interesting cases, and I felt as if I was not really making a difference. I knew I needed a new practice setting. So I set about looking for a new job.

The best thing I ever did was let go. I put in the work – got on LinkedIn, built a network (or rather, discovered that I actually had a network), bought a new suit, buffed up my CV, and applied to at least two dozen positions. Then I let go. Spending my life forcing the next step and searching for the perfect position had brought me nothing. This time I would let the process flow, and I would flow along with it.

The second best thing I ever did was to change my standard of living. All my chasing after more and trying to live the American dream had boxed me into a lifestyle that kept me reliant on my current job. It is easy to look back now and see that the level of joy in my life has never correlated with my income level. So I made some major lifestyle changes in anticipation of up to a 30% pay cut. Incredible freedom comes from living below your means and it opens you up to many new career opportunities.

I went on three interviews. Interestingly, of all the positions I applied to, all the fantastic letters I wrote, and calls I made, the only interviews I got came through someone in my network.

My first offer came through a nearby group. I would not have to move and it seemed the perfect opportunity. But as I looked it over and thought about this group, I found myself saying things like, “Well I guess I could live with that” or “I would just have to learn to do without this.” It dawned on me that I was forcing it. It didn’t feel right – it didn’t flow. So I turned the job down.

Then I was offered an interview in the “perfect” city, with the “perfect” group. I interviewed and thought this is it; this is where I will be. But I was not offered the job. I briefly thought that this flow business may not be working.

My next interview came from a friend of mine from residency. The thought of working for him was intriguing but I only took the interview out of respect for him. This job was very far from home, in a very different part of the country. The city didn’t exactly sound exciting either.

The interview went very well. I can’t explain it, but it felt right – I felt the flow. This would be a job with a good friend of mine and other, like-minded colleagues. The workload would be heavy, but interesting and worthwhile with a lot of support. After two weeks of sleeping on it, I called and accepted the job. Not two hours later, the second place I interviewed with (the “perfect” one) called me again. I was told that now they wanted me. They offered me a better package than my friend’s group. I really thought about it. I hadn’t signed anything, I could easily accept the new offer; but that would have been forcing it. I was resolved to let the process flow, so I told them no thanks.

So here I am, no longer in charge, just another guy doing work that I enjoy with people I like. I look back now at the whole process and think that had I not taken the time (with Heather’s help) to learn about what I really like and why I was unhappy, I would have forced a solution that was not in line with my true self. The biggest change I made was not changing my job, moving 1200 miles away or getting back to the basics of my specialty. It was a change in my attitude. I have learned to stop and enjoy the now. I am also starting to look for ways to incorporate some of my other interests into my job. I have had a desire to do something creative and to teach. So over the past year I have experimented with a couple of writing and speaking projects and have had the opportunity to do some mentoring. It is nice to know that I can do these things without completely changing careers. This new job is great but not perfect. No job is, so there is no need to always think about it and look for it. I may not be here forever, but I am here now and that’s what counts. At some point, the flow of life may take me somewhere else: but I’m going to let it be a surprise.

 

 

Melissa’s Story Part I – The Journey of an Ob/Gyn Physician

Melissa with dog

In medical school and residency, wild horses could not have torn me away from a medical career. Sure, I was exhausted and overworked but I was learning to deliver babies, to operate, to help people navigate some of the best and worst moments of their lives and I loved it! Not once did I feel I had chosen the wrong career path or wish to be elsewhere. I knew with great certainty medicine was where I belonged forever, and even went so far as to harshly judge my colleagues when they made negative comments about our chosen field.

I trained prior to implementation of the resident work hour restrictions and upon graduation entered a solo practice in a rural community. After three years there, I felt the inklings of career frustration but pegged it entirely on the cumulative exhaustion of ob/gyn solo practice and perpetual call responsibilities. To remedy my situation, I joined a group practice with partners and shared call thinking this would crush the perplexing thoughts tickling the back of my mind. I felt better for a short time but as years passed, my frustration grew and I began to feel like a caged animal alternating somewhere between numbness and rage. I cared for patients every day; however, I did not feel like a physician anymore.

My day to day energy was seemingly consumed by clicking computer boxes to create charts that satisfied billing requirements, by nursing protocols that had no relevance to actual patient care, by compliance meetings and safety mnemonics, and an ever expanding set of meaningless initiatives. My choices about what tests to order and what treatments to initiate seemed dictated by the threat of possible lawsuits more than their clinical relevance. In the delivery room, the actual childbirth seemed far less important than the nursing charting process, and in the operating room the actual surgery took second stage to being in compliance with the OR rules and stating the “fire risk” before each case. Where had the medicine in medicine gone, and what the heck was I actually doing every day?

For a while I forged ahead despite my feelings because I felt I needed the money. Let’s face it, the income was good and I could make purchases or travel without much regard for cost while still saving for retirement. Was my daily work so taxing that I couldn’t continue simply for the money? Ultimately, my answer was yes. I realized that somewhere in the prior ten years I had lost my compassion. I had absolutely no desire to continue on that path indefinitely no matter what the cost. My humanity was not for sale.

Then came the big question, what would I possibly do if I were not a working physician? I examined this situation from all angles, as giving up medicine felt like chopping off my own arm. Being an MD consumed most of my time and much of my identity. Imagining a life without it was almost impossible. Despite my apprehension, I decided to take the plunge. In order to fairly investigate what this type of change would realistically mean for me, I saved up some money ($40,000 to be exact) and took a six month personal leave of absence from my job. I had no real plan other than to feel what my life would be like without eating, breathing, sleeping (or not sleeping) medicine.

I spent the first month catching up on sleep and on all the life chores that had been sitting indefinitely on my to-do list. Lightbulbs got changed, the garage was cleaned, the dog got washed, the carpets shampooed, the planters weeded, and I visited the dentist. The next few weeks involved visiting family and friends that I had neglected and taking long walks with the dog. Then, of course the inevitable struck, now what? I was forced to face the reality of my situation: my existing medical practice was intolerable yet I could not live on $40,000 forever and I only had 4 months left to craft a plan. I searched my soul and came to realize three critical truths.

First, the lack of compassion in my daily work was unacceptable. I felt robotic in my practice responding more to outside system pressures than to the individual human in front of me. Second, I felt trapped by my income. I had not been careful with my spending and while I had no serious debt, I was still living in such a way that I required my inflated paycheck to sustain my lifestyle. I calculated that had I lived on $50,000 per year and saved the rest, I could have been set for life by now instead of feeling trapped. It was time to curb my spending. Third, despite my frustrations, I was not prepared to part entirely with patient care. Not only was my personal identity inextricably wrapped up in it, but I truly enjoyed the part of medicine where I actually cared for the patient. I did not miss charting, computers, or protocols, but with time away, some of my original interest in the field began to reemerge.

In light of the above three factors, I decided to explore some alternatives. In my remaining time off, I tried a locums assignment in an underserved area, became a licensed massage therapist, took a real vacation, and looked into international medical opportunities. Determined to liberate myself from my salary, I moved out of my house and into an apartment and cut my spending dramatically until I required well under $50,000 annually. With some new skills and reduced cost of living, I now knew, if worst came to worst and I truly wanted out, I could quit my job anytime and work as a massage therapist or do a few locums assignments and be absolutely fine. Surprisingly, the mental freedom that came with this realization actually created the space for me to consider returning to work without the same animosity that I previously held.

Research into international opportunities eventually led me to a seven-week assignment in South Sudan with MSF (Doctors Without Borders). While there was limited access to laboratory tests, medications, and procedures, there was also minimal charting, no insurance companies, no computers, no lawsuits, and no nonsense. The entire experience involved 100% clinical assessment and direct patient care. Overnight I wasn’t called unless a patient was literally dying (compared to hourly calls for Colace or Tylenol orders in the States). For the first time in years, I felt like an actual physician. I was using my brain and my skills in truly life-threatening situations. I celebrated with patients and families when things went well and felt genuine tears of sadness (versus fear of lawsuits) when things did not.

At one point, in South Sudan, when I was visibly distressed over the impending death of a hemorrhage patient with DIC, her husband actually consoled me stating “It’s okay doctor, you have done your best, now we will wait here with her.” What just happened? The situation was incomprehensible. The family of a dying woman was comforting me, the doctor, who was supposed to save her life and was not succeeding. Ultimately, by some miracle, that patient ended up surviving and the family was no more and no less thankful. We were just all there together doing what we could for her. At that moment, I realized that somewhere in my 6 months away from work, I had found my compassion and oddly enough it had manifested in the context of medical care, the very same practice that had originally stolen it.

So, what does my life look like now? I work some days in ob/gyn clinic and take some night and weekend call. I do a bit of massage therapy in a local spa. My schedule is flexible on both fronts and I am in the active pool for possible international assignments with MSF meaning that I will likely spend one to four months per year in maternity hospitals in third world countries. I also have active credentials with a locums company and can take assignments that suit me if and when they are offered.

If you are thinking to yourself, that’s good for you but my employer would never let me keep that kind of schedule, think again. In retrospect, my biggest issue was that I felt trapped in the current system and I kept comparing working in what traditional medicine had become to not working in medicine at all. My linear brain couldn’t see alternatives outside the norm in terms of work schedule or lifestyle. Once I took my blinders off, I was able to see that my happiness hinged on flexibility and I took steps to ensure that freedom. The most frightening part was asking my employer and my partners if I could work a non-traditional, flexible schedule of my own creation knowing that if they said “no,” I would be faced with quitting completely or returning to work. By cutting my expenses, I was able to enter into that conversation with confidence and I was prepared to walk away if needed. Surprisingly, they simply agreed to the modified schedule with no fanfare and here I am.

Now, when I show up to work, not only do I feel more compassion in my day to day patient interactions despite the persistence of bothersome health care system problems, but I have reclaimed a passion for medicine. My day job funds my ability to participate in international missions with MSF, and participation in MSF keeps me in touch with hands-on patient care enough to participate wholeheartedly in my day job. Offering relaxation massage therapy on the side reminds me that I can walk away from medicine altogether anytime and, oddly enough, in that freedom I have found an inherent desire to continue with medical practice. I no longer feel trapped and having reinvented my life once, I also no longer fear the process of making dramatic change again should the need arise.

A big, “Thank you!” to Dr. Melissa Wolf for sharing her story. Please stay tuned next month for Part II, where she takes us to the South Sudan on her adventure with Doctors Without Borders (MSF).

 

Addicted To Perfection: A Surgeon’s Story

wisdom not perfection pixabay

I was sure that we had cut the ureter. Every time we looked and found it intact, I became even more certain that we had cut it. Finally, my exasperated chief resident told me to stop. I was emergently operating on my next door neighbor for what turned out to be cancer, and that’s how I excused my paranoia. (She’s now cancer free, and yes, her ureter is fine). That kind of worrying had taken over my practice of surgery, though. The joy of operating, teaching residents, watching patients heal and recover from major and minor illness had been replaced by a constant vigilance for the next complication, unexpected finding, or patient that I was unable to help. Every decision, every operation, whether straightforward or difficult had become agonizing. I was consumed with trying to make sure everything was perfect. I stopped believing in chance, uncertainty, and incurable disease. Unfortunately, that was all in my subconscious. Consciously, I felt like I was being diligent and holding myself accountable in an admittedly high stress career. After all, I was responsible for people’s lives, right? Though I didn’t see it at the time, I had lost focus on my patients because I was completely focused on making sure I didn’t make a mistake. At the same time, I was winning teaching awards from residents and medical students. I had the trust of colleagues who asked me to operate on their loved ones. By all accounts, I was a well-respected and competent surgeon, yet I was having chest pain on my drive in to take out an appendix. I desperately wanted the pain to stop, so I started looking for ways to quit surgery.

It had started during my third year pediatric surgery rotation. A 3-year-old girl died following a simple procedure, and I felt the soul-crushing reality that even the small things we do have major consequences. From there it was double thinking every decision, replaying each operation in my mind sometimes dozens of times, lying sleepless, staring at my pager and dreading the next call.

When I reached the point where I was having chest pain and suicidal ideation, I got into counseling. At the first session, I spilled all of my angst. The counselor looked at me and said “You’re an asshole.” That was a bit less support than I was expecting, but he continued. “Look at how you’re treating yourself, is this how you treat your patients? Your family? Why have you put up with this abuse for so long?” He also pointed out (to my horror) that I had a God complex – I had convinced myself that if I did my job perfectly, I would get perfect results. I had thought I was rooted in reality, but I really wasn’t.

Opening myself up to counseling (which required swallowing a lot of pride) honestly may have saved my life. Like any other recovery, the first step was realizing that I needed help. The next step (and the hardest for me) was asking for help. I had to trust someone else the way my patients trusted me. I had to be open to things I didn’t really believe in at the time. I had to accept that things could get better, but that there was no quick fix to my pain, like finding a new job or career. At first, it was simple relaxation techniques. I’ve since learned about the power of mindfulness, meditation, and practicing gratitude. I’ve found a peaceful bliss in yoga. Yeah, picture your favorite (or least favorite) surgeon quietly meditating or posed in a downward facing dog. Trust me, it’s funny. I’ve gradually learned to quiet the storm that had taken over my consciousness. It was hard work. Harder than anything I’ve ever done. No joke.

The next thing I needed to do was to take an honest look at what was going on in my head. What I found was that I had lost track of reality. I was spending so much time ruminating in my head that I had become unaware and not accepting of what was really going on in the world. I was caught up thinking about how things should be rather than accepting how things actually are. I was addicted to perfection and would accept nothing less. Accepting reality meant accepting imperfection – my own, and that of the world around me. I had to realize that I have a lot less control over reality than I want. What I do have control of, though, is how I react to and interact with reality. I’ve learned that striving for perfection is different than expecting perfection. Perfection is not an outcome measure. Reality is the outcome. Perfection is doing the best I can with the situation presented to me, accepting the reality of the outcome, and realistically assessing if I can do better the next time.

It’s been a long road, but I’m better now. I’m eight years into practice, and I like being a surgeon. I can schedule a major case without chest pain. I can deal with a major complication without falling into depression. I can separate myself from the pain and suffering I see every day so that I can be fully present with my family. Despite that separation, I feel even more compassion and have more satisfying relationships with my patients and colleagues. The energy I was putting into angst can now go to my family and to myself without the guilty feeling that maybe I’m not doing enough for my patients. I think my complication rate has actually gone down, too.

Am I cured? No. I’m in recovery, just like any other addict. And just like any other addiction, it has gotten easier with time, but I know it will never go away. I slip. I pick myself up. I ask for help. The trick is to have the awareness to realize when I am slipping. I’ve moved from counseling to career coaching, but this is still the foundation I have to keep coming back to as I work to shape my career. I strive for the strength to change what I can, the serenity to accept what I cannot, and the wisdom to know the difference. The world is not perfect. It never will be. And that’s okay. I’m not here to make it perfect, I’m here to make it better.

A big “Thank you!” to one of my great clients for sharing his story.  I talk with many doctors who think they may have to leave medicine. In many cases, this is not true. If you are questioning your career choice, it is worth the time and effort to find out what is possible for you. There is a right answer for you, and it can be found. 

Physician Transition Story: Carla Hightower

 

carla hightower

Dear Readers, in this blog, one of my clients shares her career transition story. As you will see, the non-clinical path does not follow an orderly set of steps, unlike becoming a physician. In these less predictable waters, there is uncertainty of course, but there is also opportunity and adventure. Take it away Carla.

Shining the Light on a Non-Clinical Career Path

Recently, I left medicine and became a physician advisor and now a freelance medical writer. I am experiencing a tour along a unique, winding road of possibilities. My years working in anesthesiology prepared me for very different challenges, so leaving clinical practice was not a simple matter. Unlike the trajectory for becoming a doctor, a non-clinical path is rarely straight; however, I am discovering that there are plenty of people to help guide the way. My story is about making choices and how networking with other people has positively influenced my direction.

While still practicing anesthesiology, I attended business school and gave serious thought to working in the pharmaceutical or biotech industries, but I did not feel much desire to climb the corporate ladder. Therefore, after graduation, I stayed in my clinical career. However, around my 20th year, the stress, declining compensation and dwindling resources could no longer be ignored.  Finally, when a hospital administrator did away with critical supplies in the operating rooms, I was absolutely certain it was time for a change.

While exploring my options, a friend introduced me to a physician advisor at a revenue cycle, health care consulting firm that helps hospitals comply with Medicare regulations and improve their reimbursements.The company was growing and recruiting physicians for on-the-job training; I applied and was immediately hired. In this position,my job was to determine whether particular patients met medical necessity criteria to be treated as inpatients or outpatients. I learned to review medical records and write consults providing evidence-based support for the level of care recommended. Primarily because of this job, I determined that becoming a better writer was something I really wanted to pursue.After working with the company for one year, a ruling for the Medicare inpatient prospective payment systems profoundly impacted the industry, and I started looking for something different.

Briefly, I considered starting from scratch in a wholly unrelated industry. Real estate, perhaps? This time, I recognized that speaking with a number of people in the field was the most effective way to demystify any new industry. I called several friends working in the real estate business and got a sense of the necessary skills and challenges involved. Next, I arranged a meeting with a seasoned real estate broker. His unforgettable, first question was an emphatic “WHY-Y-Y?” that made me wince internally. Despite the awkwardness of that introduction, the broker was very gracious and helped me explore all the pros and cons of the business. He cautioned, “this business is more about luck than skill,” and “don’t go into this business if you need to make money!” I took these remarks as cues to expand my search.

In the meantime, a credentialing application for a locum tenens anesthesiology opportunity sat lurking on my desk at home. I dreaded the thought of completing the paperwork and the sinking feeling of caring for patients in a remote facility. I just could not make myself do it. Finally, I called the recruiter, declined the opportunity, and felt a massive weight lifted from my shoulders. In that moment, I firmly committed to doing something I enjoyed rather than settling for something that was not a good fit.

My thoughts kept circling back to becoming a writer. In fact, I was already enrolled in medical writing classes at a nearby university. Given my additional interest in starting a business, I participated in a 6-week freelance medical writing program. This opportunity was a gigantic step in the right direction. The instructors and other students shared their stories and advice, which gave me a real sense that I could make it in this field.

My first medical writing client was a well-respected consumer health education website. The client needed fresh, comprehensive articles on various diseases, and my writing instructor generously recommended me for the opportunity. I provided an initial sample pieced that was very well-received, and I was asked to write more articles! Upon the momentous arrival of my first paycheck as a writer, I affirmed my capacity to succeed in this business.

To refine and shape my direction, I continued gathering information and advice from other writers. So far, I have interviewed several freelance writers whom I found in the American Medical Writers Association directory. With their guidance, I have identified the kinds of writing opportunities that are right for me. For instance, when I was curious about regulatory writing, I interviewed several experienced regulatory writers. I was told that working with cutting edge research is really cool, as long you don’t mind digging through thousands of pages of clinical data and working under extremely tight deadlines.

Today, I am still evolving, making choices, and getting even more comfortable with uncertainty. It is impossible to see the precise ending, because a curvy path connects to such a wealth of possibilities. On this journey, there’s no room for old baggage, such as worrying what other people think I SHOULD be doing. When navigating detours and forks in the road, I am recognizing the warning signs of ill-suited options while patiently searching for the right choice for me. Fortunately, there is never a need to stumble in confusion when others are so willing to share stories, offer candid advice, and shine the light.

Carla Hightower, MD, MBA