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June 10, 2013

Leaving clinical medicine

I’ve left clinical medicine.

There. I said it. Now I can be at peace with my ancestors and the ghosts of Hippocrates and Galen.

But the question remains: Is a doctor who is not a doctor still a doctor?

But I digress. First things first.

I left clinical medicine because I could. Because I have opportunities in health policy, evidence-based medicine and medical editing.

People ask me, did it hurt? No, I pulled the Band-Aid rather slowly. Over two years, I slowly decreased my clinical time for a position in health IT, then in medical editing. At the same time, a government program allowed me to pursue graduate studies in medical informatics.

The die was cast.

So what do I do now? I work for a health analytics company. What’s that? I sit at a desk and help my company’s clients in evidence-based pursuits to improve quality outcomes. Yes, I help them make money, which they use to care for patients.

I tell everyone the same thing: I’ve discovered a completely different side of medicine I didn’t think about before. Yes, I knew about Medicare and Medicaid, about insurance companies and outcomes measures. But I did not know that there are companies and organizations that participate in health care in other ways, indirectly taking care of patients.

No, I don’t put a stethoscope on anyone’s chest anymore. But I think about ways to improve patients' medication adherence and how to streamline preventive measures to make them more relevant to patients.

I think about how our health system is so complicated and about how doctors don’t have a voice in the deliberations that hamper our progress. About how lawyers, lobbyists and business people have turned health care into this complicated, unsustainable regime that benefits them financially but fails to improve infant mortality or prevent diabetes complications.

About how doctors leave medical practice because they are frustrated, overwhelmed or frightened, or all three.

Of course, I did not predict my career arc into nonclinical medicine. But there were signs. Mostly, it was the everyday frustration of trying to find the time and space to think, observe, analyze and comment—space and time that seeing 15 to 20 hospitalized, complicated patients and having to educate three or four budding medical students and interns did not provide.

In other words, I had to leave clinical medicine to understand clinical medicine better.

So, if I am not practicing clinical medicine, am I still a doctor? But of course! It says so right here on my diploma.

The term “doctor” comes from the Latin verb docēre, “to teach”. But before teaching, one must learn. And so I'm learning about systematic reviews, evidence-based grading strategies, outcomes research and health policy. You’d think all these areas would be covered in medical school but of course they aren’t.

So I've left clinical medicine to learn about all this and to see if I can have an impact on the course of our health care system, not one patient at a time but across populations.

And who knows? Maybe, when I do a clinical shift here and there, I’ll understand what I’m doing a little bit better. I'll understand that having a comprehensive view of health care is as valuable as being “in the trenches.” And that I can help my colleagues provide the best care they can, under the best possible circumstances.
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7 Comment(s)

Robert Dabrow MD wrote:
Your choice was well thought out and you are well prepared. But have you thought of running for office? If only we had more dedicated physicians elected to political office (and therefore fewer lawyers,) we could really improve our system of excellent care that they are tearing apart!
Orlando, FL | Mon, Jun 10 2013 12:52 PM

Ben wrote:
Frustration is the primary reason you stated above that led you down this path....would be great if you could elaborate, maybe I need to follow you?
Fairfax, Va. | Fri, Jun 21 2013 09:15 AM

Ruben Nazario wrote:
To answer both comments: Frustration was partly the reason, but not necessarily frustration with medicine. Instead, it was frustration with the way we practice medicine.

My father was a doctor and the way he described being a physician in the 70s and 80s was completely different. We have lost something of the luster of being a doctor, and it’s mostly our fault. A profession that is supposed to be a vocation has been turned into a business. Don’t get me wrong: I like my paycheck as much has anyone else (and someday I would love to finish paying off my student loans). But when everything in medicine becomes part of a business plan or needs an enterprise solution, it depersonalizes one of the most intimate relationships of our lives.

But it’s not all our fault. Government, insurance companies, even patients have turned the tide. So rather than continue fighting that battle without having the time because of clinical obligations, I’ve chosen to continue the fight on a more macro level. Will I make a difference? I don’t know. But at least I can try. Thanks to both of you for your comments! Mon, Jun 24 2013 09:34 AM

Veena wrote:
I understand both what drove you to find other opportunities outside of clinical medicine and also how you feel about leaving it. Although I am still in my early years of my career as a hospitalist, I see that I need to branch out and I have recently started trying to learn more about medical informatics.

What would be your advice for someone trying to make the same change you did? Changing careers is very stressful but it seems not feasible to think I can keep up the complete hospitalist lifestyle as well. Would appreciate any words of wisdom.
New York, New York | Mon, Aug 5 2013 12:46 PM

Nicole H. wrote:
I have been a practicing PA for only 4 years and can easily understand some of the frustration all clinicians face. During the last six months, I have come to the conclusion that I am not cut out for clinical medicine.

I love teaching and working with patients to improve their health and well-being; but recently, I have been made aware that hospital politics and my innate interest in innovative process improvement do not play well together. Your post has shown me that the world of patient care is larger than I had previously considered. Thank you!
Newport News, VA | Wed, Aug 7 2013 20:14 PM

Michael Hein wrote:
My personal journey is similar to yours. It was a 5-year slow pull of the band-aid. I get the same questions and have nearly the same answers. I would also add that it wasn't frustration with clinical medicine because of the external realities of health care in the US, but internal frustrations as a result of my own personal growth, development, needs and desires. We are all on a journey, some of us physicians end up in places we hadn't initially envisioned, but find where we are rewarding, exhiliarating and challenging.
Grand Island, Nebraska | Fri, Sep 27 2013 10:40 AM

Mitchel Schwindt wrote:
Well stated. The opportunities for physicians outside the hallowed halls of the hospital have never been better. Many of my colleagues refuse to accept that there are attractive options that can lead to happiness and fulfillment and don't involve carrying a pager or stethoscope.
Minneapolis, MN | Wed, Apr 16 2014 13:41 PM

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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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