Home Commentary Leaving clinical medicine

Leaving clinical medicine

October 2013
clinical medicine

Published in the October 2013 issue of Today’s Hospitalist

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 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.

A different side of medicine
I now work for a health analytics company, sitting at a desk and helping my company’s clients in evidence-based pursuits to improve quality outcomes. 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. 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.

I don’t put a stethoscope on anyone’s chest anymore. But I think about how to improve medication adherence and 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.

And I think about how doctors leave medical practice because they are frustrated, overwhelmed or frightened, or all three.

A better understanding
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, all while seeing 15 to 20 hospitalized, complicated patients and educating three or four budding medical students and interns.

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? 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 would be covered in medical school, but of course they weren’t.

I’ve also left clinical medicine 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.

Ruben J. Nazario, MD, who is now medical director at Inovalon, a health care data analytics company, is a veteran of both community and academic pediatric hospitalist programs.