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What does a physician in their 40s feel after a busy but ordinary workday?

How often have you found yourself during a busy day in the clinic checking the clock repeatedly, not just to make sure you’re on time with your patient appointment slots, but also just to see how much of the day has elapsed? You peek at the clock icon in the lower right hand corner of your computer screen - 2 p.m. - and the thought pops into your mind before you can suppress it: I still have a handful of hours left to go … how many more of these days can I string together? What’s going to break up this routine? Although there are some spikes of satisfaction and meaning during the workday and the workweek, you can’t shake the question that surfaces from time to time:

Is this going to be the repeated pattern for the next 10, 15 or 20 years? And then you allow yourself to be distracted from that thought by the patient that is in front of you that requires your attention and expertise.

Those thoughts - the ones you quiet and suppress before they fully form - is where this essay begins. There is an increasingly common regret that many physicians have as they enter their 40s. It isn’t a regret about being a physician or the impact they have on patients. Rather, it’s a regret about how little of themselves they were able to put into their career.

Let’s break down a little more about what this regret is and what it isn’t.

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What the regret is NOT about:

The regret is not about being a doctor. It’s not about burnout. It’s not about being ungrateful for your position and all the benefits that you have. It’s not a desire to have gone down a different professional path.

What the regret IS about:

The regret isn’t about medicine; it is about what traditional medical practice crowded out.

The regret is about realizing that you could have expressed yourself professionally in different ways; you could have explored different opportunities and run different experiments, but for different reasons, you chose not to. It’s the sense that your career is somehow narrower than your capabilities, skills, and interests should really allow.

You didn’t cultivate external relationships that you could have, you could have taken more risks, you could have made your skills and expertise more visible to the broader world.

That version of your professional self - the one that represents who you really are - never fully manifested because the default physician career script didn’t allow it room to grow.

WHY THE 40s?

Interestingly, the 40s tends to surface this feeling because it stands at the crux of several converging factors. The first is that your natural career arc can potentially plateau at this point. You are past the initial training phase, and generally you have integrated yourself into your practice, potentially having formed partnership or some leadership roles. There’s a sense of some stability for how you practice and your place in the practice. And as these things are complete, the novelty and the ascension has worn off and the horizon for the remaining years becomes more visible.

Time becomes more palpable. In your 30s, your career feels wide open. In your 40s, you can actually start to project out the latter third of your career in your mind. You also tend to have some more bandwidth as some of the demands of training in early practice have dissipated. And with that increased bandwidth you can reflect on where you are, where you’ve come, and where you’re going.

When you’re in your 40s, your peers start to demonstrate their career trajectory. You’ll see concrete examples of what other people are capable of and you start to think about the different versions of yourself that were possible. This sharpens the question of why you didn’t pursue some of those same paths. Could you have done that too? Should you have taken that risk, that step?

Turning 40 is also a meaningful milestone for anyone, physician or not. It’s a concrete reminder that time is finite, that you’re getting older. Around this time you may have had a significant event happen to a family member or someone you’re close to - perhaps the loss of a parent, or an unexpected illness befalls someone close to you, or the ending of a close relationship. All of these things make you pause and introspect - and how you spend the majority of your time - your career - will definitely fall under the microscope.

Yet, your 40s are still a time period in which you have agency to design a significant portion of your remaining career. You still have a decent amount of runway and this potential regret arrives at a time when it can still be acted on. In a positive way, it serves as an early warning sign rather than a final verdict.

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WHY THIS REGRET CAN STAY HIDDEN

This regret, however, can stay silently below the surface, and this repression makes its effects worse. Firstly, regret can appear to some as ingratitude. It’s reflexive for some to think, “why does this physician who has so many good things going for him feel any sort of regret whatsoever? Who’s this person to complain; what right do they have?” So physicians tend to stay quiet to avoid seeming unappreciative.

Additionally, this sentiment is hardly ever voiced by other physicians, and when you don’t see anyone else around you talking about this, and your peers appear either content - or have a sense of resigned acceptance - then the silence becomes self-reinforcing. Each physician might assume that they’re the only one that feels this way, and think ‘other doctors seem fine’. They’re not. This is one of the most common experiences in mid-career, and one of the ones least vocalized. The silence around it is not evidence of absence.

We’re also trained to endure situations and not to necessarily push back against them or question them. Medicine requires a degree of sacrifice and stoicism, and questioning the arc of your career can feel like a weakness, a chink in the armor that you don’t want to expose.

Finally, there isn’t a specific language for this feeling. And without that precise language and definition, it becomes more of a vague sense of unease and restlessness that you experience at 2 p.m. in the clinic. And if it’s not concrete and nameable, it’s hard to fix it. Part of what this essay series hopes to do is to actually name that feeling - because unnamed things are hard to address, and this one deserves to be acted on.

The positive aspect of this is that regret experienced early enough becomes data. It becomes information, a compass. It points you in the direction of where you should go and what the next layer of your career should include.

Regret surfaces your values because you only regret things that you legitimately care about.

It nudges you to unearth your values and bring out those pieces of you that you’ve left unexpressed.

Also, regret about the future is still editable. The better question to ask yourself is not, what do I regret about the choices I made in the past, but rather, what will I regret at age 65 if I don’t make the changes that I’m thinking about now? That second regret hasn’t occurred yet and is within your control. Again, the 40s are a decent starting line and there is still a large enough time horizon for a physician to create something significant. So this regret, if acted upon early, serves as a launching pad for bigger things to come for the physician’s career.

WHAT TO DO WITH THIS SIGNAL

The first thing is an honest acknowledgement that an element of this regret exists, and to name it for what it is. This brings it out in the open and removes some of its power and control over your trajectory.

The second is to understand that regret serves as a map and a compass that will guide you. Ask yourself what specifically has gone unexpressed in your professional life up to this point in time: is it the part of you that could be the builder, the part that could be the innovator, the writer, the investor, the leader … these answers will guide you towards where to begin.

Next, take this signal and let it nudge you towards one small step. Start with one small bounded experiment or action that begins expressing the unexpressed part of you. Maybe this is exploring AI leadership, maybe it’s interviewing 3 people, maybe it’s joining a cross-institutional collaborative project. Maybe it’s mapping opportunities or assets. Finally, appreciate that this signal indicates that the next 10, 20, or 30 years do not have to be a static continuation of the path that you’re currently on. Those years are unwritten - a design space, with you as the physician architect.

Keep in mind that most physicians spend their 40s suppressing this feeling, but the ones who truly listen to it design a different next 20 years.

The physicians I’ve observed who are least burdened by this regret in their 50s and 60s tend to have one thing in common: at some point in their 40s, they made a deliberate choice to design their career rather than inherit it. They don’t mistake stability for design. And they realize that they don’t have to blow up their career with a big leap - a small, deliberate, judicious experiment is enough to start. In the next essay, I want to give that choice a name - and show you what it looks like in practice.

If this names something you’ve felt before but haven’t vocalized out loud, I’d love to hear from you. You’re not the only one. Comment and tell me what part resonated.

- Scott F. Cameron, MD. Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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What would you say if I told you that your most valuable professional assets aren’t your clinical skills, aren’t listed as line items on your CV, and weren’t taught to you in medical school or residency?

Your most valuable assets are your different forms of leverage.

There are five discrete forms. You may not be aware that they exist or be aware of how to activate them. But before we dive in, let’s first define what leverage is and what leverage isn’t.

Leverage is the ability to amplify your output per unit of input. It’s about getting disproportionate results - whether in income, impact, or opportunity - with the same level of effort. When you’re activating leverage, it compounds over time and accumulates even when you’re not actively working.

It’s important to contrast this with what leverage is not. Leverage does not mean increasing linear inputs such as hours spent at work, RVUs, or productivity. That model is not sustainable from an energetic perspective, and is also fragile in the age of increasing pressures from AI, reimbursement challenges, and consolidation. Physicians that have intentionally activated different forms of leverage will be hedged against some of these pressures.

THE FIVE FORMS

Form 1 - Knowledge Leverage

Using your clinical knowledge and expertise to create value outside of the clinical setting - expertise that extends beyond the clinical encounter.

Examples: My participation in the AI Advisory Board at Atrius/Optum, where I help evaluate AI software and platforms for integration into our practice. Quality and Safety Workshop creation in tandem with the insurer Coverys, to help practices across the country learn how to better manage incidental findings discovered on imaging exams.

Form 2 - Credibility Leverage

Using your physician credential itself to open doors, access opportunities, and create trust above and beyond the clinical setting.

Examples: Advocating for healthcare reform in Washington DC alongside hundreds of other physicians wearing their white coats in the halls of Congress. The MD credential signaling trust, status, and judgement in conversations with healthcare founders and investors.

Form 3 - Network Leverage

Utilizing relationships built over time through either your practice, professional societies, or your training to create access to opportunities, people, ideas, and introductions.

Examples: 15+ years of relationships in professional societies, such as The Massachusetts Radiological Society, and the American College of Radiology, leading to leadership opportunities in both organizations. Deep investor networks built through my time spent with the Launchpad Venture Group, AngelMD, and various other physician investor circles, leading to investment opportunities such as in the Series A investment round for RadAI. Gaining an invitation to speak at a national conference (RSNA) through reaching out to a fellow physician that I know through my network.

Form 4 - Platform Leverage

Using your public presence - whether through your social media channels, your reputation in your specialty or across the conference circuit, or through your writing or a newsletter - to amplify your visibility and transform it into opportunity.

Examples: MRS and RSNA conference speaking. Physician Vantage Studio creating opportunities for collaboration and discovery, such as a guest-podcast invitation I received recently to be interviewed on the Let Care Speak podcast. LinkedIn presence now approaching 1000+ followers and growing.

Form 5 - Capital Leverage

Using financial resources to create investment positioning, ownership interests, and business interests that create returns either disproportionate to - or independent of - hours worked.

Examples: Equity shares in multiple healthcare startup investments, some of which are positioned very well (and some of which have not been successful), and real estate investments. Using financial stability to buy back time which is then invested in other ventures, such as building Physician Vantage Studio. This could also include ownership of medical office space, or equity in clinical practice ownership or ASC ownership.

HOW THE FIVE FORMS COMPOUND

The important thing to understand is that these five forms of leverage are not independent of each other, but rather work together as a flywheel. Each part of the flywheel amplifies the effect of the others.

The flywheel works like this:

The Physician Leverage Flywheel: Knowledge creates Credibility. Credibility expands Network. Network expands Platform. Platform generates Capital. Capital funds the next investment or experiment. Each rotation of the flywheel is stronger and faster than the one that preceded it.

Knowledge opens the door for you and credibility makes you trusted once you’re there.

The network amplifies as your work permeates and compounds, which leads to a platform that magnifies your visibility.

Then capital follows as the flywheel turns.

Let’s run through a specific example from my life. My radiology expertise (Knowledge) combined with my AI interests and expertise (such as those gained through my RSNA AI certificate) gave me credibility as an AI implementation leader in my practice (Credibility) which connected me to other physician leaders and AI experts through my participation in my practice’s AI advisory board (Network). This informs my writing through LinkedIn, Substack, and Physician Vantage Studio, which then surfaces investment or collaboration opportunities (Capital) through outreach from investors and innovators I connect with in-person and online.

Once again it’s important to note how these forms compound. Each form of leverage makes the others easier to activate.

So, a physician with a rich network and platform leverage tends to learn about advisory opportunities (that they may not have discovered otherwise)… which can then be executed with knowledge leverage. These forms of leverage end up multiplying each other instead of being additive.

The gap between having leverage and using it is mostly a matter of awareness.

Here’s the honest baseline analysis for where most physicians stand across all five forms:

Knowledge Leverage: Already formed and available, but generally underutilized outside of the clinical domain.

Credibility leverage: Already intrinsically there by definition, but generally underutilized in the non-clinical context.

Network leverage: Partially formed, strongest within medicine and typically within one’s specialty, but weaker outside of it. Large potential to be amplified and grown over time through intentional strategic relationship building in adjacent contexts.

Platform leverage: Generally underdeveloped. Most physicians have a relatively minimal public presence. This leverage form can generate a strong return on investment because it compounds over a long time horizon.

Capital leverage: Depends on the state of the other four, and most physicians don’t activate this until forms 1 through 4 have been activated to a certain degree.

So the good news is that as a physician you have at least three of these five forms of leverage available to you right now, although you may have never activated them fully. The five categories of opportunity listed in the prior essay are the destinations, and these five forms of leverage are the ways to get there.

In the next essay, I’ll dive into the specific regret that builds when physicians reach their 40s with leverage they never activated - and why that regret tends to be more common, and more preventable, than most physicians realize.

Which of the five forms of leverage do you feel is strongest for you, which is dormant, and which one do you think you could change the most in the next five years? Comment and let me know.

Disclosure: I hold investment positions in healthcare companies including through Launchpad Venture Group. Views expressed are my own and not those of my employer or affiliated organizations.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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I remember the first time I heard one of my colleagues talk about her role as an advisor to a healthcare AI company - RadAI.

We were chatting informally at one of our state medical society meetings, and she mentioned almost in passing that she spent a half day per week helping the company build out their technology. She was integrally involved in product development, working alongside engineers, marketers, project managers, and other physicians. She was excited, energized, and clearly in on something at the ground floor.

I thought, “how did she even know that was an option"?

At the time, I also had the opportunity to become an advisor to that company, but I declined - I told myself I didn’t have the time. Looking back, I remember this as one of the formative moments where I first understood that there were paths available to physicians that simply weren’t visible from inside the normal clinical day. This, and other experiences since, has led me to one of my central observations:

Physicians don’t have an opportunity problem. They have an opportunity visibility problem. That distinction matters - because the first is hard to fix, while the second can be addressed today.

WHY THESE OPPORTUNITIES ARE INVISIBLE

This visibility problem exists for a handful of reasons, most of them structural realities of modern medicine.

First, medicine is fairly insular. Many physicians work within a relatively closed ecosystem. If you work day to day alongside similar physicians doing similar things, you aren’t naturally exposed to other ideas and possibilities. Even across different institutions, the day-to-day experience of physicians can be remarkably similar.

Second, role models can be hard to come by. If you don’t happen to have someone around you who has constructed an interesting or atypical professional career, you won’t be exposed to that type of person - or to who you yourself could become. My chance encounter with my colleague advising a healthcare startup is one example of this. If you happen to be introduced to someone who created a healthcare startup incubator, for example, you realize this path is possible. Without that role model, you simply wouldn’t know it existed.

Third, medical training doesn’t introduce us to these adjacent possibilities. It’s focused on teaching the foundations of medicine - physiology, clinical practice, and direct patient care. Advisory work, innovation, advocacy, leadership, and platform building don’t appear in most curricula, although some institutions are beginning to layer in a few of these elements.

Fourth, these healthcare-adjacent opportunities tend to be quietly active. There are many opportunities available to physicians at healthcare companies, conferences, and venture capital firms. But these worlds generally exist in parallel to clinical practice rather than being integrated with it. Our day-to-day clinical work rarely collides with these adjacent worlds.

Fifth, the default physician career script plays a role. When you’re in the middle of your professional career, no one is necessarily going to stop you along the way and say, “Maybe you should look into X, Y, or Z.” You simply continue moving down the professional path you’re already on.

The opportunities exist. The problem is an absence of visibility and awareness. The landscape is there - it’s just that the line of sight is obstructed. In Essay #2, I called this Opportunity Blindness - one of the four structural drivers of the Physician Optionality Problem. Here is what it actually looks like on the ground.

THE EVER-EXPANDING LANDSCAPE

The good news is that these adjacent opportunities are growing, and there are more of them than ever before. Several forces are driving this expansion.

One major force is the AI revolution, which is creating entirely new roles for physicians. Healthcare AI companies are actively seeking physician advisors, and health systems want physicians who can architect care delivery models and evaluate, implement, and monitor AI software tools. AI implementation leadership is becoming a growing category of role that didn’t exist five years ago.

Healthcare innovation continues to accelerate as well. There is more capital flowing into healthcare - especially as interest rates have declined relative to recent years - and more demand for physicians to be involved at every stage of product development, from idea validation to board advisory.

Significant institutional changes are also shifting the landscape. As health systems restructure and consolidate, they adopt new technology and rethink their infrastructure. The physicians who position themselves in AI leadership and internal innovation roles are creating specific career opportunities that didn’t exist a decade ago.

Lastly, public platforms have democratized the ability for physicians to make an impact and have lowered the barrier to influence. Writing on LinkedIn, publishing on Substack, and speaking at conferences - whether in person or online - are available to any physician willing to show up consistently. Platform leverage was once reserved for those with established media power. It is now available to anyone with an electronic device and a commitment to publishing.

The takeaway: even if you’ve felt stuck for years, the opportunities around you have been expanding the entire time. The opportunities in front of you today are not the same ones that existed when you started your training.

THE FIVE CATEGORIES OF OPPORTUNITY

Here are five categories of opportunity where physicians can have an impact, starting with the lowest barriers to entry and scaling toward the more ambitious.

1. Within Your Institution

Sometimes called intrapreneurship, this is the most accessible category. Examples include AI implementation leadership - I’ve done this myself through my institution’s AI Advisory Board, where I evaluate AI software technologies (such as software detecting and evaluating thyroid nodules seen by ultrasound), interface with vendors and IT personnel, and play an active role in shaping the future of our radiology tech-stack. Another example is quality improvement projects with meaningful impact. I once created an e-consults program for our radiology department, where we provided reinterpretation of outside imaging studies to help ordering providers answer specific clinical questions - with the goal of eliminating unnecessary downstream imaging. This initiative was widely successful and is a model that could be extended across a larger practice ecosystem. Any negotiated, protected time tied to value creation also falls into this category.

2. Adjacent to Clinical Practice

An example would be medical advocacy and leadership in professional organizations. I’ve been involved for many years in the Massachusetts Radiological Society, having served as past president, where I played an active role in shaping policy around payment models, AI governance, scope of practice, and patient insurance coverage. I’ve also been involved in creating CME-accredited curricula for quality and safety initiatives - including a multi-part webinar series developed in partnership with the insurer Coverys, focused on the management of incidental findings seen on advanced imaging. Another example is structured innovation education, such as the MESH Healthcare Innovation Bootcamp at Mass General Brigham, which I completed and which helped build my foundational literacy in medical innovation.

3. The Healthcare Ecosystem

This category includes advisory roles for healthcare startups - such as my prior advisory work with Quantively, a company that helps optimize MRI scanner utilization - and investing in healthcare startups through angel groups. I’ve invested in several early-stage companies through Launchpad Venture Group, where we collectively evaluated and invested in promising healthcare ventures. These roles depend more heavily on external networking but can pay off disproportionately in terms of knowledge, relationships, and financial return.

4. Public Platform

This includes speaking at conferences - I’ve presented at national meetings such as the Radiological Society of North America - as well as creating conferences, such as a new conference I created and moderated on behalf of the Massachusetts Radiological Society, where we partnered with the Massachusetts Radiology Business Management Association. This can also include teaching online, creating CME courses, and writing publicly - such as what I’m doing here at Physician Vantage Studio. These platforms are available to any physician who is willing to publish consistently.

5. Entrepreneurial

This is the most ambitious category, and includes building a physician-led practice with a new model, co-founding a healthcare startup, creating a new service or product, or taking an interesting role in industry. It exists, it is accessible, and many physicians have chosen to follow this path.

What I’d like you to notice across all five categories is that none of them require you to leave medicine. They all build upon your foundation as a physician and leverage the clinical expertise you’ve developed over the years. And they all start from exactly where you are today.

WHAT THIS ISN’T

I can anticipate some reflexive objections, and I want to address them directly.

First, I’m not advocating that anyone take on a role that adds significant hours to an already packed schedule. It doesn’t make sense to layer on a 10 to 20 hour per week commitment when you’re already working 40-plus hours. Career architecture is about awareness and strategic reallocation of time - not adding to your already busy workload. Most physicians who layer on these opportunities do so by strategically replacing lower-value activities - committee work they don’t care about, charting they could batch more efficiently - with higher-value ones. The total number of hours doesn’t go up. The composition changes.

Second, this is not an all-in entrepreneurship strategy where you push all your poker chips to the center of the table. Categories one and two are fully available to physicians with no entrepreneurial aspirations whatsoever. Most readers will find their most natural alignment in institutional and adjacent roles - not in startups.

Third, this is not about abandoning medicine. Every category keeps clinical practice as the anchor. The point is to add layers - not to replace the foundation. Evolution, not revolution. Opportunity expansion is about doing things differently, more intentionally, and with a wider line of sight.

In the next essay, I’ll walk through the Five Forms of Physician Leverage - the specific tools that make accessing these opportunities not just possible, but increasingly inevitable.

Which of the five categories surprised you most, or resonated most with your situation? Which one feels like the most natural starting point right now? Comment or message and let me know. I’m building this conversation with the physicians who recognize themselves in it.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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You’re at a family gathering and before you know it, one of your parents wants to introduce you to someone who’s there that you haven’t met before. You know exactly what they’re going to say before they say it – “This is my son - he’s a doctor.” As they beam with pride, you realize that there’s really no other way that they would have introduced you. And it’s probably the most common way that you would introduce yourself to someone at a dinner party, or when you’re seated next to a stranger on a plane. It’s become such a core part of your identity that you’ve said it a thousand times before without thinking.

As it turns out, your physician identity is the most successful identity that you’ve ever created. It’s also the most expensive.

There are several forces that combine to create the Physician Identity Trap, which is actually one of the more deeply formed identities compared to almost any other profession:

Duration: Over a decade of training and apprenticeship take place before practicing independently. Very few professional identities take this long to forge.

Sacrifice: All the things that you delayed or gave up along your journey. Relationships, opportunities to socialize, years when you could have been earning, sacrificed sleep, and lack of geographic flexibility.

Meaning: What you do is deeply important and meaningful. It is a calling. You help people at their most vulnerable. Identity built on meaning is stronger than identity built on status.

External Validation: Societal rituals enforce the identity. Graduations, white coat ceremonies, the moments your parents introduce you as “the doctor”.

Community: Your collaborators and colleagues, the peers that have been in the trenches with you, and your social network, all of these reinforce the identity that being a physician is who you are.

This identity is truly a gift in many ways. It gives you a clear sense of purpose and meaning. It gives you direction and fortitude during the hard moments of your practice. It gives you a strong sense of respect in society. It gives you a sense of satisfaction for the skills and knowledge that you’ve earned over many years. And it gives you a clear sense of who you are as a person and as a professional. For many of us, it’s the clearest sense of the self that we’ve ever had.

However, the physician identity trap has its costs. You can have difficulty imagining yourself as anything else, or embracing any role that is outside of the predefined concept. You can cling to it tightly because of all of the aforementioned benefits. Ironically, the very same identity that served you and propelled you during your first 15 years of practice can artificially constrain you for the next 15.

Here’s how this identity trap can manifest:

The identity confirming choice:

Every spare moment somehow gets assigned a medically related task to do. There’s always a patient chart that you could be completing, a medical article that you could be reading, or a PowerPoint presentation you could be updating. You even do this on your days off, evenings, or weekends because that’s what a committed physician does. The identity is hungry, ambitious, and competitive, and will consume your choices and free time. This can also manifest in the physician who accumulates titles, institutional roles, and committee memberships not out of genuine interest, but rather because they confirm the physician identity and ascension up an identity ladder.

The “I’m just a doctor” excuse:

If you’re asked about your views on any subjects that are not directly related to what you do, such as policy, business, AI, or finances, you think, or say out loud, ‘I’m just a doctor’. This disclaimer keeps you safely inside the role.

The pre-emptive rejection:

If someone at a conference mentions to you about a new opportunity such as startup advising or consulting for a healthcare company or writing publicly, you instinctively reject that, thinking to yourself, ‘this isn’t what a physician does’. This dismissal can happen in a few seconds before there is even any genuine consideration.

The frozen mid-career physician:

You have this nagging sense that something more could be out there, but you feel scared about how to start, or feel like it could in some ways be a threat to who you are. So there’s this weird middle ground between persisting in what you’re doing and stagnating, versus jumping onto a different path and losing your identity. Neither option feels quite right.

The pre-retirement panic:

Some physicians’ identities are so deeply tied to being a physician, that the thought of retiring is almost tantamount to losing a large sense of one’s identity. If you’re not a practicing doctor anymore, who are you?

We need to think about the costs of maintaining a rigid professional identity. One cost is lost possibilities - avenues that could have been pursued but that didn’t necessarily neatly fit the physician role get rejected without proper evaluation and consideration. 15 to 20 years of foreclosed opportunities create a much narrower and less interesting professional life than what the physician’s capabilities could have actually allowed. Second, there is identity fragility. If your sense of self is built on one role, anything that threatens that role can feel existential. For example, AI changing radiology workflows feels like a large threat rather than a tactical adjustment. Lastly, there’s this nagging thought that there are unlived versions of yourself. Who could you have been as a builder, as a consultant, as a strategist, as an investor, as a writer, as a founder? These versions of you are possible and exist as untapped

potential but they can get no energy put towards them because of the physician identity trap.

The beautiful structure that you have built around yourself was built brick by brick, year by year, but you don’t see how it confines you, you see it as who you are.

We need to understand, however, that there is a path forward that preserves your identity as a physician but expands upon it instead of replacing it. It’s adding layers to your foundation as a physician. It treats your position as a physician - which is a source of purpose, competence, and pride - as the anchor and not the ceiling, and other identities are built alongside it. Understanding that identity can be architected rather than just inherited, we can trace its evolution through four phases.

The Identity Expansion Model:

Phase 1 - Fused Identity: “I’m a doctor.” The physician and the person are strongly fused, and being a physician is inseparable from one’s sense of self. Many physicians can occupy this phase for years if not decades.

Phase 2 - Permission: I’m a doctor who also happens to be curious about other possibilities. The window to explore different avenues has opened and you start to peek through it.

Phase 3 - Integration: I’m a doctor who also happens to be an advisor, a consultant, a writer, a speaker, or an inventor. You become a physician who has embraced multiple identities and roles. You become a multi-hyphenate and the self becomes plural.

Phase 4 - Architecture: I’ve intentionally designed a career and life that complement each other and are bespoke to me, with my clinical work laying the foundation for the other things I do. Identity becomes something you consciously craft and architect rather than something that you passively propagate through time.

Adding identity layers doesn’t diminish the physician identity. It actually expands upon what the physician identity means and what it can hold, rather than replacing it. The radiologist who also serves as an AI advisor is not a lesser radiologist. She is a radiologist whose identity has expanded to include something more. The internist who advises a healthcare startup is not less of a physician - she is a physician whose clinical experience is now shaping products that even reach patients she will never meet in the clinic.

Ultimately, identity is not something you have, it’s something that you intentionally create and architect.

In the next essay, we’ll dive into the Five Forms of Physician Leverage. These are the tools that underpin identity expansion. This is because expansion is by necessity strategic and not just a psychological reframe.

If this essay resonates with you, let me know which of the trap manifestations hit hardest - the “I’m just a doctor” deflection, the pre-emptive rejection, or something else? Let me know. I’m building this conversation with the physicians who recognize themselves in it.

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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I remember one quiet morning walking into my office and cleaning off my keyboard, turning on my monitors and the lamp behind them, and sitting down and staring at an incredibly long list of imaging cases for me to read. I realized in that moment that this was deja-vu all over again from last Tuesday and the Tuesday before that. I understood that I was essentially executing the same plan over and over again, with no real reflection on where it was ultimately going. I was essentially doing my job - and I felt a sense of predictability, not possibility. Most physicians have never written a career plan. Rather, they have followed a path, but a path is not the same thing as a plan. I had been executing someone else’s design of a career. And the more I looked around, the more I realized almost every physician I knew was doing the same thing.

I was executing a default physician career script. I was living in it.

Here’s how I break down the Default Physician Career Script:

• Stage 1: Pre-med: Make sure you have the highest grades possible. Volunteer in a hospital or health clinic if possible. Shadow a physician. Perform well on your MCATs. Ultimately decide you want to go into medicine by your late teens or early 20s before you have any significant meaningful exposure to medical practice.

• Stage 2: Medical School: Intense focus on didactic courses and dedication to core clerkships. Decide on a specialty based on perceived interest, lifestyle, prestige, salary, or the random influence of one or two friendly or charismatic attendings.

• Stage 3: Residency: 50 to 80 hour work weeks. Overnight shifts. Submission to hierarchy. Making a fellowship decision based on the fact that “everyone successful in this specialty does a fellowship”.

• Stage 4: First Attending Job: Choices made based on geography, where a partner works, proximity to family members, or whichever practice made the first reasonable offer.

• Stage 5: Mid-career: Productivity expectations, RVU metrics, committee responsibilities, slow accumulation of administrative burden, the same Tuesday in clinic year after year. Seeking titles, partnership, leadership.

• Stage 6: Pre-retirement: Decrease hours to part-time. Mentor the next generation of physicians. Retire. The end of the default career script.

At no point in the path does someone necessarily stop you to ask, is this what you actually want?

This script isn’t necessarily a bad thing, or even bad intentioned. It’s created by structural forces that individually make sense and to keep you progressing along the path.

This script gives physicians a clear path, external validation, stable income, a sense of professional and social respect and identity, and deep clinical expertise. However, the script doesn’t necessarily give you insight into how to design a second professional arc, how to utilize leverage beyond your clinical productivity, how to negotiate or create roles, how to assess optionality, or how to choose a path when no one guides you towards the next step.

It’s easy for physicians to stay on this path because from the very outset we know that medicine attracts and awards individuals that are excellent at executing well-defined paths. We’re very good at learning what the next step is in the chain and preparing ourselves and doing that very well. Consider the pre-med student who mapped out every prerequisite and extracurricular activity, and every shadowing opportunity - not because anyone told them to, but because those are the next steps required. Medicine selects for exactly that skill: executing a well-defined path with precision and discipline. Furthermore, during the course of either education, training, or practice, things can be so busy and time can be so scarce that there’s very little bandwidth to think about and consider other career alternatives or paths. A specialist may want to write publicly to clarify their ideas and create unexpected opportunities, but may not necessarily have the time in their schedule to do so.

By the time the bandwidth appears in mid-career, the script has started to feel normal. Not chosen - just normal. And there’s a meaningful difference between the two.

Your training path is over, but your professional life is not. The rewards that are coming to you can be some variation of the same. More volume, more responsibility, more titles and committees. You may have more credibility, but not yet have the language for using that credibility in a different way.

Furthermore, when everyone around you is following the same path and executing the same script, alternatives can feel somewhat illegitimate. Lastly, financial pressures can create a sense of commitment to the path that financially sustains you.

While these things all make sense, we have to consider that there is a hidden cost here. One cost is lost optionality. Understanding that decisions that are made at an early age, such as age 24, when you make your specialty choice, can constrain your options down the line when you’re 44. This impacts your career architecture. This script essentially forecloses possibilities that you didn’t know existed. The more that you invest time into this path, the more calcified your identity becomes and the harder any deviation from that becomes.

A second cost is identity fragility. When your professional identity is built on one script, anything that threatens it can feel like a threat to who you are. AI changing your workflow feels existential. A difficult year feels like a crisis of the self rather than a difficult year. The narrower the identity, the more fragile it becomes.

The third cost is harder to name but easier to feel. It’s the quiet discovery - often in mid-career, often on a Tuesday morning - that the script delivered exactly what it said it would. But what it promised isn’t actually what you wanted. The script succeeded - but the question is whether it succeeded at the right thing.

The script did exactly what it was designed to do. The question is whether it was designed for you - or designed by you.

The problem which most physicians intuitively realize is that even if you wanted to follow this script for the next 20 years, there are accelerating external forces that are making it harder to do so and that are threatening to break this model. This script was designed for a world and an environment that no longer exists. One huge disruptor is AI and workflow changes. And we know that the way physicians are performing their work is changing faster than the script can adapt to. We understand that AI literacy is becoming a career asset and may eventually become a requisite, but it’s not part of the default career script. Another driver is productivity pressures and reimbursement declines. The economics to sustain a clinical practice are becoming increasingly strained. Pure clinical careers are becoming financially less rewarding, adjusted for the amount of work input relative to the alternatives. Healthcare consolidation and the rise of employed physician models have reduced the autonomy the default script assumed. We have to understand that designing our own career architecture is no longer a luxury, but rather a necessity. It’s a shift for the world physicians are actually operating in.

The good news is that there is a possibility around the corner to address this Physician Optionality Problem. While we understand that there is a script executor who essentially follows the default path, reacts to situations and opportunities as they arise, and measures success by external metrics, we also understand that there is an alternative. The alternative isn’t dramatic reinvention. It’s a different orientation to the same career. For example, you can be a clinician negotiating an AI implementation role within your institution. Or you can be a physician using advisory work, consulting, or teaching as an expansion layer as opposed to an escape pathway. The metric shifts towards intrinsic variables where success is measured against the barometer of alignment with your actual capabilities, skills, values, and interests.

Intentional physician career design and physician career architecture is all about asking different questions.

It’s not necessarily what’s the next step for me, but rather: what do I want to be building or creating over the next ten years?

Rather than asking what opportunity should I accept, ask: what opportunity should I create?

The question is not necessarily should I be clinical or non-clinical? It can instead be: should I follow an inherited path or an intentionally designed path?

This shift in perspective can generate a meaningfully different career.

The default physician career script was created for the average physician in 1996. You are not the average physician, and this is not 1996.

We should operate from a vantage point of physician evolution, not revolution. Your clinical skills and experience serve as your foundation, not as a constraint.

This is the progression we’ll be building out across the coming essays — starting with why Identity Compression makes the first move so hard.

In the next essay, we’ll take one specific driver of the Physician Optionality Problem -Identity Compression - and dive deep. Identity Compression is the deepest reason physicians stay stuck, and recognizing it is the first step toward redesigning it.

If this essay resonates with you, let me know. Which stage of the script hits hardest for you?

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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After I published that first essay, I heard back from physicians across multiple specialties, telling me that the feeling is real. Their responses were versions of the same message: “I thought it was just me.” Just because we acknowledge this feeling, however, doesn’t mean that we fully understand it - we have to dig deeper and discover the reasons why we feel this way. Why do we have this sense that despite all of our training, achievements, and abilities, we can feel constrained in a professional identity that is narrower than their skills should allow?

Physicians have many possible career paths and many forms of leverage that they can use, but medicine rarely equips them to truly understand what these options are or how to use them. This results in a wide gap between what physicians actually do, and what they are capable of doing. After recognizing this pattern, I’ve started calling it the Physician Optionality Problem. In the context of physician careers, we can think of different optionality domains that can impact the experience of one’s professional arc. For example, you have financial options, but you also have intellectual, creative, and professional options as well. Without recognizing these, you artificially constrain yourself. This isn’t a personal failing - this is a consequence of a system that is designed to have you perform in a narrow lane.

There are 4 main drivers of the Physician Optionality Problem.

Driver 1: Identity Compression

Becoming a physician requires tremendous time, energy, and sacrifice, focused on the goal of becoming a doctor. You form this identity over a timeframe of a decade or more, with each year invested providing additional reinforcement that the end-result is near. Once your goal has been achieved, there is a rightful sense of pride and ‘arrival’ at the destination. However, once you place this identity as so central to your sense of self, it can become solidified to the point that it is hard to see yourself as anything else. It’s in the way that you accept certain responsibilities as just ‘part of being a doctor’ - like the after hours or weekend shifts, or the clean-up charting in the evening - in a way that other people wouldn’t understand. These things are ‘part of the package’ of being able to be a doctor. But the very same thing that gave you fuel and direction in the early days of your journey can in some ways become a constraint. It becomes challenging to see yourself as anything other than an outstanding doctor practicing medicine in the way you were taught to do.

Driver 2: Path Rigidity

Another reason the Physician Optionality Problem exists is that the pathway to become a physician is relatively rigid and well-defined. From the early pre-med days of MCATs, to the core clerkships in medical school, to the checklists and SOAP notes on the rounds, medicine has historically followed a very prescriptive educational and developmental structure. Much of your roadmap is very well defined for you. Deviate from it and you may find yourself off of the road, in a dimly lit area without a flashlight. As such, you become guided along a path that has few branch points or opportunities for exploration along the way. Running career experiments or simultaneously entertaining very different outcomes at the same time becomes very challenging to do, especially when you consider how demanding medical education, training, and practice actually is.

Driver 3: Opportunity Blindness

Another major driver is being unaware of the options that are available to you. Much of this has to do with your environment. If you are in a place where physicians generally follow the same career path, you may not be exposed to new ideas and understand the different ways you could use your skills in medicine, outside of medicine, or in medical-adjacent fields. How can you learn about the different ways in which to innovate within your institution if you don’t have anyone role-modeling this for you? How can you know that it’s possible to create a conference, a new service line opportunity, or a writing platform if you haven’t seen or heard of others doing it? Artificial Intelligence is creating numerous opportunities for physicians to become involved in healthcare startups as well as within one’s own institutions - but where are the people who are talking about these things? If you don’t know what and where the opportunities are, then you won’t know how to act.

Driver 4: Leverage Underdevelopment

Finally, underdevelopment of different forms of leverage is a large part of the Physician Optionality Problem. Leverage exists in various forms - knowledge, capital, networks, platforms, and credibility. But nowhere in training are you ever taught how to fully understand these forms of leverage and how to activate them. You may have low financial leverage despite a high clinical income. You may have great writing skills and clinical expertise but no platform leverage. You may have deep domain knowledge in different aspects of medicine, but it doesn’t necessarily mean you can articulate to other members of the healthcare ecosystem what the value is that you truly bring, or how you can capture that value and utilize your leverage to optimize your position. If you don’t know, it limits your optionality.

Here’s why this matters now. The pressures have been building over the years - reimbursement challenges and productivity pressures, burnout and isolation, consolidation and the healthcare workforce crises. Liability concerns, defensive medicine, and administrative bloat are all leading to work hours creeping into the fringes of the day.

And now, artificial intelligence is completely re-shaping the way in which we deliver our work product - not only in terms of how we can make diagnoses, but also in terms of our workflows and tools, and even the ways in which we interact with our patients. The timing for positioning ourselves to fully use our true optionality matters. When we realize that external pressures are all shaping our careers and our experience more than ever, we understand that our autonomy is at risk and that our opportunity to be proactive in designing our future state may be narrower than we think. Physicians who think strategically about their careers will find themselves in a career that was designed by them instead of for them. For all the energy we have spent on wellness solutions to combat burnout, meditation and yoga cannot fix a career that is too small for you.

Ultimately, we have to move beyond a diagnosis and into treatment - so in the coming essays, I’m going to explore some specifics of what we as physicians can do about these problems. I’ve been thinking about specific frameworks - around the different forms of leverage that physicians have, around conducting career experiments instead of making career changes, and around what career architecture can look like when a physician designs a portfolio career. Evolution instead of revolution. More on that to come soon.

If the Physician Optionality Problem resonates, reach out and let me know. If you read those four drivers and recognized yourself, I’d love to hear from you and learn which one hit hardest.

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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When was the last time you felt genuinely excited about the long-term direction of your career?

Not about a recent accolade at work, or a patient satisfaction letter, or a case that went well, but excited about where you would be in 5, 10, 15 years or more from now? When did you have the sense that your career end-goal was something that you were truly energized by?

You may not have the answer to this. You strive to be great at what you do, without knowing if the final chapter of your career holds anything that is surprising or compelling.

The quiet but recurring question in the background keeps repeating - is there something more? It’s not necessarily burnout or fatigue - it may have a pinch of boredom or monotony - but it’s really about the question: Do I know what the potential versions of myself professionally even are?

The paradox of achievement

By every external measure, you are incredibly successful. A practicing physician, perhaps a specialist or subspecialist, respected for your expertise by your peers, respected in your community and in your social circles, and with all the conventional trappings of success - great income, vacation, home, and for many, a great family life as well.

But despite all of this, something is missing. In some ways, as time has gone on, you feel like your career has become more restrictive instead of more expansive. You may have more titles or responsibilities, but your feelings about future possibilities appear somewhat narrower instead of feeling like they are wide open.

Comparing yourself to your peers, many of them seem content or complacent - or just have a reluctant acceptance of the current state of things - and they aren’t necessarily being vocal about whether they’re feeling the same restlessness. You wonder to yourself - is this just a personal issue I’m having? Or is there something structural here? And since I have it so well in many respects, does it sound ungrateful of me to even be asking these questions? And so the conversation is suppressed before it ever gets vocalized.

This questioning tends to hit most acutely between the ages of 38 and 52. When the initial trajectory of one’s career plateaus a bit, and the next one or two decades on the horizon seem like they hold the potential for sameness or monotony. At this point, you’ve gotten into a rhythm which is working well in many respects, and you just don’t know if or how you’re going to break out of it…. and whether it’s even worth it to try.

Why this happens

A big part of why this happens is a structural one. It’s not a personal or character issue - it’s a design issue.

The first reason why this happens is the script. Medicine is a very well-defined pathway, with a very particular set of steps that leads to the desired outcome of being a physician. The journey is so well defined and rigorous that by the time you reach the end of the path, you may have forgotten that you have any control at all over your destination. Physicians become great at executing the script, but not necessarily great at the intentional design of one.

The second reason why this happens is narrow-mindedness. Medicine has its own ecosystem that tends to echo the same ideas within it. You are in close contact with peers in the same role in the same institution following the same path … and who measure their success by the same metrics. Possibilities available outside of the typical path may not be discussed, or you may not even be aware of them.

The third reason why this happens is a deep sense of professional identity. When you have invested so much of your time and energy into becoming a physician, and made so many sacrifices along the way, and can finally contribute to society in such as meaningful way, this becomes a core part of your identity as a human being - above and beyond a mere vocation. There is a sense of deep pride in knowing yourself as a ‘doctor’. There is the deep admiration when your parent introduces you as “the doctor”. And so ironically, by mid-career, the very thing that anchored you and gave you the strongest resonance early on can start to become a limiter to your other possibilities.

And the fourth reason this may happen relates to something more subtle: mild suspicion or awkwardness surrounding the conversation of ambition and branching out. Wanting to experiment - or even the sense of wanting more - can feel selfish or unappreciative to some, especially when they see what you have already achieved. Also, physicians tend to be risk averse, and so they may suppress these feelings and put their head down and continue to work as they’ve always done.

It doesn’t have to be this way

But here’s the thing - it doesn’t have to be this way.

We live in a world in which physicians are allowed to explore, have ideas and expand. You don’t have to do this by leaving medicine and pulling the ripcord, but you can do it by building upon the foundation that you already have.

Some of this could involve innovation and projects at your own institution. It may involve work with startups, advisory, or consulting. It may involve writing on a variety of topics, which could in turn create new ideas and opportunities. Some of this could involve investing in different parts of the health care ecosystem. And some of this could relate to strategic personal and professional positioning when rapidly developing artificial Intelligence is starting to reshape what physician careers look like.

These paths don’t necessarily involve ways to escape medicine, but rather, they are ways to build upon the advantage that you already have, using it as an anchor to create a richer and more interesting professional identity.

One of the commonalities around physicians that have more interesting lives and careers is that they’ve been much more intentional about the ways that they’ve built it. Instead of inheriting a pre defined formula and pathway, they’ve created their own custom solution. They are the designers and not just the executors of a plan that someone else gave them.

Why I’m writing this

I’ve been thinking about these questions for a while - because I’ve been grappling with them myself. I’m a successful mid-career physician who has been experimenting and learning for years, while trying to design a more interesting and purposeful career without leaving medicine. I’ve learned a lot along the way about what I’m starting to think of as optionality, leverage, and the intentional design of physician careers, and I want to share what I think it means for us.

If this resonates, I’d love to hear from you. I’ll be writing more about these topics - which I’ll be referring to as the architecture of modern physician careers. I think it matters to us as physicians, and I think the conversation is long overdue.

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.