A definite smugness comes over me whenever I have the opportunity to say "I don't practice anymore." The words escape my mouth easily, automatic as a reflex.
It's been several years since I've seen patients. I even question whether I could practice again, and I pray the decision is not forced upon me one day.
Unlike many of my peers, I didn't feel the need to escape clinical care because of burnout or the hassles of managed care. I don't harbor fantasies of starting a dot-com or buying a Napa Valley vineyard. I would still recommend medicine as a career for my children.
In fact, I never intended to give up practicing. I just gradually phased out of the clinical arena and into the administrative realm because that is where my interests led me.
The most recent chance to say "I don't practice anymore" came when I turned down a request to become a hot line consultant for a not-for-profit healthcare organization, the Neuroleptic Malignant Syndrome Information Service.
There's no question about the value of this organization and its counterpart, the Malignant Hyperthermia Association of the United States. NMSIS and MHAUS are dedicated to reducing morbidity and mortality of neuroleptic malignant syndrome and malignant hyperthermia, respectively, by gathering case-specific data; disseminating information to medical professionals, patients and their families; and improving the scientific understanding and research related to these lethal, drug-induced disorders.
I co-wrote a book on neuroleptic malignant syndrome when I was a passionate clinician, and I currently serve on the NMSIS Professional Advisory Council. So why would I pass up the opportunity to educate and counsel fellow physicians about this condition?
All along, I had used the excuse that NMSIS did not have proper insurance for its hot line consultants. And since I no longer retain malpractice insurance (because I don't practice anymore), taking on the role of clinical consultant would leave me exposed, however minimal the risk.
Now NMSIS was writing with "good news!" They had obtained liability insurance coverage, and I could join their cadre of consultants.
Unmasked, I wrote back: "I don't practice anymore, but I would like to continue serving in an advisory capacity."
Why did I offer my services at all? For the same reason, I suppose, that I gravitated toward medical management. Call me whatever you like--a "recovering" physician, a hypocrite or even a turncoat--I've been called worse. The point is that I really still enjoy medicine. I'd just rather talk about it than practice it.
The grass is not greener in management, but it's certainly different.
There are many others like me and organizations that represent us. We're medical directors, vice presidents of medical affairs and physician executives, about 15,000 strong. We may wear sport coats instead of white coats or have spreadsheets instead of stethoscopes in our pockets. Some of us have journeyed from the patient's room to the boardroom and perhaps from the bedside to business school. We practice on the inside and rub elbows with the "suits." And we have the audacity to yearn for recognition!
But we don't hold our collective breath waiting for the American Board of Medical Specialties to anoint us. We may be "certifiable," perhaps, or bored, but not board certified. We've turned to other accrediting bodies for certification.
What else do medical directors have in common? We share similar beliefs. We believe, for example, that we can improve the quality of care for entire populations--not only individuals--while holding down unnecessary, costly treatment. We believe there is too much unexplained variation in clinical care and too little prevention.
We believe practicing physicians should be helped by giving them accurate feedback about their performance relative to their peers. We believe in e-healthcare and patient enablement strategies. We want to get out of the business of saying "no." And above all, we want to work for an organization whose vision is to become the most trusted name in health solutions.
How do we know this to be true? This is what the research tells us about medical directors. Oh yes, we still read the medical literature and contribute articles, but our portfolio is more diverse than it ever was. It now includes Physician Executive, Modern Physician and the Harvard Business Review. We may have left academic medicine, but academia never left us; its blood still courses through our veins.
Actually, our intellectual curiosity is what led us down the management path in the first place, except some of us didn't develop a taste for management until well into our practice years.
To aspiring physician executives, I say try out for the role of chief resident and see if management whets your appetite.
Many prominent physicians have given up practicing and have risen to prominence in government and business. Despite evil portrayals in the mass media, who administers really does matter. Would the public rather entrust its care to a clerk sitting in front of a bottom-line oriented, computerized algorithm?
It's telling that when American Medical News published a commentary about physicians with MBAs, it generated more letters than any other column in recent history. Not surprisingly, most of the letters were critical and were authored by M.D./MBAs and physicians pursuing an MBA degree.
The funny thing is that, as physicians in important leadership roles, we tend to undervalue ourselves. Nonphysician executives give us more credit for contributing to our employers' effectiveness than we give ourselves.
Apparently medical school damaged our egos. No wonder business schools advertise to physicians that they can build confidence and self-esteem and impart persuasive written, presentation and negotiation skills.
This ego defect shouldn't be taken lightly. It has been rumored that medical directors' psychopathology manifests in grandiosity--they believe they can protect the public from harmful procedures and business practices and that this is part of their "mission."
We certainly didn't choose management for the money or security. (Okay, so I lied about the Napa Valley vineyard fantasy.)
But we do believe ours is as noble a calling as the one of the practicing physician.
Paradoxically, to really excel at medical management requires a full-time commitment. And that is why I don't practice anymore.