Subscribe now

Think about a colleague you know who’s been noodling on the same idea for two years. The enthusiasm and curiosity and interest has remained there, as has the lack of actual execution.

This physician is very bright and fully capable, and they’re not exactly paralyzed out of fear. What’s actually stopping them is the sense that they’re contemplating a big irreversible move which will change the trajectory of their entire career. It’s hard to make a decision that big.

But the reality is that you don’t have to redesign or blow up your career before taking a first step.

Small, intentional experiments can produce enough data to propel you forward in the right direction. Thinking about career redesign in this way can become something that’s able to be subject to a test. Let’s look closer at how the right design of an experiment can maintain your clinical foundation while still creating options for expansion. We’ll go over a practical 90-day example template for running a career experiment, and go over what distinguishes a good experiment from a bad one.

First, we have to lay out the false dichotomy between having to choose between two extremes. You’re not limited to either: a) completely leaving your practice, or making a large decision such as pursuing an advanced degree, or starting a company, versus b) staying stagnant in the same professional location and with the same role.

When you have a lingering curiosity about something, whether that happens to be entrepreneurship, investing, AI, or something else, the challenge is how you take that interest and translate it into a manageable, actionable step without feeling that you need a complete upheaval of your career. This gap between your signal of persistent curiosity and your demand for a complete career path is where many physicians get stuck.

The Gravitational Pull That Keeps Physicians Still

Some of the reasons why physicians lean towards a strong and abrupt career change make sense. For one, as physicians we tend to want certainty before we take action. Our clinical training and clinical practice awards certainty and precision and advises us to reduce ambiguity and uncertainty. This mindset is great for keeping patients alive and healthy and minimizing errors, but ends up being artificially restrictive when it comes to career experimentation and redesign.

Additionally, the realities of what is the best fit for you often can’t be answered through introspection alone, but through hands-on application and experimentation.

Another reason is that medical training tends to be built around large structured decisions such as what specialty to train in, where to do your fellowship, what type of practice to join, etc. And so physicians become used to these large, structured commitments as opposed to smaller reversible trials. As mentioned previously, a physician’s sense of identity can also restrict experimentation as it tends to threaten what you’ve worked so hard to build. And lastly, physicians tend to over-inflate the cost of trying, assuming that it will require a formal title, credential, a large audience or following, significant capital, or reduced clinical work. In many cases, if your experiment is designed well enough it won’t require any of those.

What is a career experiment? It’s a time-bounded, risk-bounded, small action which has the intent of producing information that will help you guide your future direction.

The main purpose of the experiment isn’t immediately to generate income or prestige or certainty, but rather to generate a small amount of data and evidence. What you actually want to get back is some form of feedback indicating whether you like the type of work that you started doing, whether you find it valuable, and whether you want to become known for that type of work. In running the experiment, you’ll get a sense of whether it fits with your purpose and identity, and it will also inform you as to what other types of skills or experience or relationships you would need to add. You’ll get a sense of the true fit with your underlying central thesis. Ultimately, you’re seeking clarity and better signal, all of which will inform your next steps.

Instead of predicting the future, learn your way into it through a career experiment.

The Architecture of the Experiment

In terms of duration, the ideal career experiment is 90 days in length. This is long enough that you can get some genuine feedback and data and help you overcome the initial uncomfortable first few weeks. But it’s short enough that it triggers a reflection and review before forcing you to be part of a longer-term commitment that’s not the best fit. It doesn’t have to be 90 days, but this provides a clean demarcation point. Alternatives include one bounded project or deliverable, or one committee term.

The experiment should also be structured so that it has low downside risk. It will ideally have little to no financial downside, and it will minimally impact your personal and family obligations. Most likely it will have little to no impact on your professional reputation and clinical skill set.

It also needs to be specific and prompt action: for example, instead of saying “learn about startups” the concrete action would be “talk to four digital health founders”. It should generate evidence and you should be able to document that evidence so that you can refer to it and analyze it. Make note of how you were able to function in this experiment, the relationships that formed, and your sense of the strategic fit with the bigger picture of what you’re trying to do. Remember, try to align this with your central thesis instead of being a random activity that you’re adding on. And ideally it should provide you with the opportunity to build upon it when it comes to its end, if you should so choose. But also realize that if you stop, it doesn’t imply that the experiment failed, it just means that you learned what you don’t want to pursue.

Examples of Career Experiments

Subscribe now

Tangible Steps For Running the Career Experiment

1. Notice the Signal - What have you been persistently curious about? What has been frustrating you for a long time? And what are the things that provide energy, swings, or recurring interest?

2. Create a Hypothesis - Get specific about what you want to build or test.

3. Find the Smallest Possible Test - Resist the urge to have a grandiose project, but at the same time have a test large enough that will generate data, but small enough that you can complete it within 90 days.

4. Execute the Experiment - Put on your calendar a start date and an end date, the actual scope of the project, and what time blocks you will use to run the experiment.

5. Capture Return Signal - Write down data relating to how you were able to execute on the project, your energy level, the relationships formed, any inbound opportunities that came from it, and generally how you feel it aligned with your expectations.

6. Decide - Make a decision at the end of the 90 days as to whether you’re going to continue with more activity that is along the same lines as your experiment, and if so, how you will expand the scope or formalize it, or decide if you’re going to repeat the experiment again, or if you’re going to stop entirely.

7. Reinvest the Learning - Start a new experiment, but this time from a stronger baseline.

Failure Modes to Avoid

Make sure to avoid some of the common failure modes. One of these is making the experiment too large. The examples of this would be enrolling in a long or costly degree program, quitting your job and starting a company, or reducing your clinical work before you test the demand for the thing that you’re building. Make sure you’re only running one experiment at a time so that you can actually gauge process and outcomes. Make sure you prioritize learning over prestige and income; avoid the urge to tack on another side hustle for the sake of it or for the sake of income. Also remember that a title, while impressive, doesn’t necessarily produce forward momentum in the direction that you want to go. Also, manage your expectations regarding financial returns as you may not capture any income from this first experiment and the returns will accrue to you in the form of credibility, relationships, introductions, and knowledge.

Make sure to define an endpoint or at least a point in time in which you will check in with yourself and assess how the experiment aligned with your intentions. Lastly, remember that negative evidence doesn’t necessarily mean that there was a personal failure. There might have been an issue with your hypothesis, the scope of the project, the format, or any number of factors.

Even if the experiment doesn’t work or doesn’t become a permanent part of your larger body of work, it still provides useful data and can provide a new source of leverage. This is because you’ll have built up more knowledge, more relationships, and a better overall point of view. You may end up with a result that comes out of it that includes a publication or presentation, a speaking topic, or even just greater market understanding. Perhaps the most important of the things that will come is clarity about what to pursue and what not to pursue.

Ultimately, the key to moving forward in your professional discovery and redesign is that you don’t have to choose a specific future before acting. You actually create this future through making a hypothesis, running an experiment, testing, observing and gathering data, iterating, refining, and running the next experiment.

You don’t need a 10-year roadmap to start. You need a general direction, your best effort at a thesis, and a well-designed 90 day experiment.

So for the physician at the outset who had been pondering whether to pull the trigger on the idea they’d been mulling over for two years, the reality is that they don’t need to quit their practice, make a grand announcement, or enroll in a costly degree program. They need to articulate a good question and lay out a precise small test to run.

What professional decision have you been postponing because it feels like an all-or-none decision? What 90-day experiment could you design and run without abandoning your clinical work that would provide you with useful data? Let me know in the comments.

• 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.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated and make sure you don’t miss my upcoming posts.

Subscribe now

Think about two of your former co-residents.

They finished the same training program at the same time, and both were very smart and capable. Fast forward 15 years, and one of them has a conventional career by all metrics: well respected in the community, doing well financially, and with great patient reviews. A success by anyone’s standards.

The second one, on the other hand, has created something that would take a paragraph to describe. On top of clinical medicine, she has created innovative training and mentoring programs at her institution, served as chair of society leadership committees, worked on nonprofit initiatives, become a prolific writer, and made multiple media appearances.

They had the same starting line but very different destinations.

How and why does this happen?

The underlying reason for this doesn’t have to do with luck, abandoning medicine, or being wired differently than the rest of us.

These physicians are certainly intelligent and ambitious. But what often happens is that they made a small number of different choices: choices about how they saw themselves and what they were capable of, how they saw their career, what they decided to focus on, and what they said yes to and intentionally said no to.

Made consistently over a long time horizon, these decisions helped forge the fascinating physician.

Before we get any deeper, let’s define more specifically what fascinating means.

Because a fascinating career isn’t necessarily characterized by fame, followers, ultra-high income, prestige, or a move into non-clinical work.

Fascinating doesn’t necessarily mean the most exceptionally talented MDs and DOs, and it also doesn’t mean leaving clinical medicine. In fact, physicians who keep clinical work at the foundation and build something larger around it often create the most fascinating careers.

It’s also not about fame. Many interesting careers are almost invisible to anyone outside a particular professional community. For example, think about the cardiologist who advises AI startups, founded his own company, and serves as a venture partner: he may not be famous, but his career is certainly fascinating.

Ultimately, what makes a career fascinating is that it sparks curiosity in other physicians. It’s been pointing in a clear direction for a period of time, and it shows accumulation rather than repetition or mere piling on of activities. And it’s one in which the physician uses medicine as a foundation and strategic leverage point, rather than as the ceiling.

A fascinating career is one that thoughtful physicians are legitimately curious about. Not envious of or confused by - but curious about.

That curiosity is the strongest resonant signal.

Myths of the Fascinating Physician

There are a few myths about what these physicians have in common, and most of those assumptions are incorrect.

The first myth is that these physicians simply had great timing or great luck. Conceding that some elements of luck and timing are always at play, the reality is that the physician who puts herself into interesting places and interesting conversations is not merely getting lucky. She is increasing the surface area for luck.

One CEO I talked to called this ‘creating your own luck’. These physicians are making choices about where they should show up and how they should spend their time and attention. This is primarily strategic preparation and positioning, which create the preconditions that increase the chances of luck.

The second myth is that these individuals must have made some great sacrifice. They must have given up their personal life, or stepped away from medicine, to build something interesting. This is one of the most strongly held beliefs physicians have about other physicians who have built fascinating careers. And it’s also mostly not true. These fascinating physician archetypes have rarely left clinical medicine. Instead, they are using to access healthcare-adjacent opportunities and as the anchor for different activities they are building around it. Certainly, in many cases they have to re-design their clinical work - this could be going part time, or it could be creating an atypical schedule to allow for time to do other activities. But ultimately choosing between professional achievement or a personal life is a false dichotomy when thinking about becoming a fascinating physician.

The third myth is that these physicians are inherently predisposed - maybe they have a particular personality, or maybe they happen to be more creative or better connected.

But the main difference is usually an orientation and action difference, not an intrinsic personality difference. They just think about opportunities and costs, their relationship to time, and the potential outcomes of these decisions in a different way. This type of perspective is something anyone can adapt and use.

The Underlying Signature Patterns

Let’s take a closer look at these fascinating physician careers and see what type of signature they have - what type of pattern underlies these career arcs.

First, they tackled one opportunity that was outside of the regular scope of their daily practice, and it had a tangible result.

This first moment - you could call it a ‘hinge’ moment - may not have been a large, grand gesture, but it was something specific and distinctive that resulted from the physician saying ‘yes’ to an opportunity they thought of - yes to a leadership role, yes to volunteering on a task force or committee, yes to co-writing an article.

What followed was likely not a sharp shift in their day-to-day, but it did make the activation energy to walk through that next door a little bit lower. It made it a little easier to say yes to the follow-up opportunity.

Along with this, they likely held an ‘experimentation framework’ as an approach to their career design, similar to an artist experimenting on the canvas. This is likely the biggest orientation contrast with these physicians compared to their peers.

While most physicians think of the path as fairly rigid, prescriptive, and fixed, these fascinating physicians default to action and experimentation. They actually think about the next 5, 10, or 15 years ahead of them as wide-open, instead of pre-determined benchmarks and milestones that they’ll hit.

They also generally built something interesting, notable, or impactful outside of their clinical work at their institution. Whether it’s a multi-institutional collaborative workgroup, whether it’s a digital health startup, whether it’s an online educational course - it’s something they can point to outside of being an excellent physician at their practice. This is what makes them broadly visible, and able to pull in future opportunities - think about platform leverage, mentioned in one of the prior essays on the Five Forms of Physician Leverage.

Subscribe now

Another trait is that they developed and maintained a central thesis about what they were working on and where they wanted to go. They don’t necessarily have a fully mapped out five to ten year plan, but they should at least have an internal sentence or two about the through line: the oncologist who decided on a ‘mission of educating patients about the cancer-care journey and how to best navigate the system, by speaking, podcasting, writing, and publishing’. The pediatrician whose thesis is around ‘how to help busy working parents navigate behavioral issues with their kids’. This conceptualized thesis creates a filter that lets them say yes or no to opportunities as they become visible. Without this underlying orientation, the same amount of activity and energy produces a long resume - which can certainly be impressive, but there’s a lot of noise, and not necessarily compounding growth. With it, the activities build a portfolio.

Lastly, they have this underlying trait of curiosity, including about adjacent domains.

They talk to people in adjacent industries. They read broadly. They have an interest in how AI gets developed, how policy gets made, or how healthcare startups operate. They don’t necessarily plan to do all of these things, but they have an underlying innate curiosity about how all of the different elements are related to each other.

One aspect tying together all the patterns mentioned above is the different relationship with time that these physicians have. These physicians building these fascinating careers aren’t necessarily ones that are able to work more efficiently or work harder or achieve outcomes at a faster rate. But they understand that they’re playing a long-term game. They started creating something at age 37 that’s now paying dividends at age 47.

They had conversations at a conference that became useful five to seven years later. They wrote an article that was initially read by five people, then 50, then 500.

Most physicians, by contrast, tend to focus on shorter time horizons and play a shorter game. There are a lot of structural reasons for this. The clinical day is demanding and requires immediate, full attention. RVU targets tend to be monthly or quarterly. Performance reviews are biannual or annual. We’re forced in many ways to break down time into short intervals. But the physicians who create fascinating careers also look critically at the longer arc. They understand the long game while still playing the short game. That longer game runs in the background. It is something they patiently build toward, slowly and progressively, without needing it to pay out in the next quarter.

The compounding of a fascinating career is almost never visible in year one or year two. It needs time. It becomes visible in year seven or year ten.

The physicians who created it started earlier than you think, with less than you think.

Factors Spurring the Proliferation of Fascinating Physicians

The underlying differences between these two types of physicians have existed for a very long time. What has changed recently is a set of structural factors that accelerate and scale the process.

One of these forces is market pull.

Startups, including medtech, health tech, AI companies, and value-based care organizations, are creating real paid demand for physicians to serve as co-founders, consultants, board members, and advisors. The need for this is increasing over time.

Another force is that distribution is now free or nearly free.

Writing, speaking, podcasting, and other avenues of visibility require little to no capital, and they do not sit behind a permission gate. Physicians who want to make their opinions visible can now do so. The cost today is time, consistency, and energy, not capital or access.

Lastly, the model is becoming increasingly visible and increasingly named.

This might be one of the biggest structural changes this entire series is trying to make. We are seeing the emergence of the portfolio physician: the physician who has built a fascinating career by design.

When thinking about how to begin transforming your own career into something more interesting, start with your underlying thesis, if you have one.

If you had to choose a single cohesive statement to explain the different activities you have participated in so far in your career, what would that sentence or two be?

If you do not have the answer yet, that’s okay. At least start to think about it. Consider which pieces of your career so far have been most resonant and which ones you want to build upon.

But you have to start by asking the question and developing your best working answer.

Next, find the one adjacent yes.

There is usually a specific hinge moment where you can take a step into something healthcare-adjacent and explore it with a relatively limited investment of time and effort. This may be a leadership role. It could be committee involvement. It could be an article series you want to launch. It could be a discussion with someone who is doing things you want to do. Take a step in that direction and see what you can explore.

Remember, there will likely not be a huge dramatic change after starting with one adjacent yes. There isn’t a quick payout or monumental shift early in the process. Think of the journey in terms of years instead of weeks. The journey is something many physicians can take, but you have to be willing to spend the time and stack these different choices on top of one another.

Fascinating physician careers are accessible to more physicians than we realize. They’re built over a long time horizon. They start with small, unassuming departures from the normal road and the commitment to keep walking when you feel a resonant thesis developing.

I’m curious who comes to mind when you read this - a physician you know whose career generates that genuine curiosity in you. What do you think they did differently? I’d like to know what you noticed, let me know in the comments.

• 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.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with all of my upcoming work.

Subscribe now

There are a few physicians I know personally whose careers are absolutely fascinating to me. What makes them so interesting is that they are multidimensional and rich in variety, and yet, taken as a whole, their careers are far more powerful than the sum of their parts.

The first is a physician I met when I first became involved with the Massachusetts Radiological Society about a decade ago. She started out with relatively humble beginnings as a young attending with some leadership roles in her radiology department. Over time, she gradually added additional leadership roles within her institution and with the American College of Radiology, and then began layering on experiences with different startups in consulting and advisory roles. Ultimately, she shifted away from academic medicine and now serves as the Chief Medical Officer of the Enterprise Imaging Division of a large healthcare company.

Another physician has built a distinctive career spanning clinical practice, healthcare AI, entrepreneurship, and investing. After leading major AI strategy and implementation efforts within a large health system, she founded a healthcare technology company focused on improving care coordination in underserved communities. She also invests in and advises healthcare AI companies, using her clinical and operational experience to influence care at scale.

It’s tempting to look at these individuals and assume there must have been a lucky break or some magic formula that enabled them to achieve such rare success and become the people who are always offered opportunities. While acknowledging the effort, intelligence, and small amount of luck required to achieve these outcomes, we also have to realize that these fascinating careers are not the result of one moment in time.

Rather, they represent what happens when the Physician Leverage Flywheel has years to compound.

None of this happened purely by luck or at one moment in time.

The flywheel represents the system through which physician knowledge and expertise, visibility, relationships and network, opportunities, and capital all reinforce one another. This is how a physician career moves from linear effort to compounding leverage.

What is a Flywheel, exactly?

From a physics perspective, a flywheel is a heavy rotating mechanical device that stores excess kinetic energy. Because a flywheel resists changes to its current state of motion, it absorbs excess energy during power surges and releases it during power drops. This is why the flywheel is difficult to move at first, but with each subsequent turn, the next turn becomes easier. Each turn stores momentum.

This has parallels with a physician career: the early turns feel very difficult, almost as if they are not amounting to anything, while the later turns become far easier once the benefits of the prior turns have accumulated.

Keep in mind, though, that the flywheel isn’t a linear ladder where you leave each rung behind as you climb. The flywheel is circular, with each component feeding back into the others. It’s also not a hustle asking for more hours. It asks for the same effort to be sequenced so that each turn builds upon the next, rather than starting over from the beginning. And it’s not a list of unrelated and uncorrelated activities.

The Physician Leverage Flywheel is a loop of activities that compounds: knowledge becomes credibility, credibility becomes relationships, relationships become opportunity and platform visibility, and opportunity becomes the capital and learning that fund the next turn.

The difference between this dynamic model and a static model, in which you simply accumulate each of those assets independently, is that the dynamic model shows what happens when the assets begin interacting. The Five Forms of Physician Leverage are the parts. The Portfolio Physician Model showed what a good collection of those parts looks like. The flywheel is the motion underneath both - it is what actually connects the parts to each other instead of letting them sit side by side.

The Four Turns of The Flywheel

Here is how that motion actually works. The Physician Leverage Flywheel turns through four moves, and each one should be thought of by name: creation, attraction, compounding, and reinvesting.

Creation is the central thesis come to life, starting with the clinical anchor: the accumulated knowledge, trust, and judgment that grounds everything else, plus a small, bounded experiment built on top of it. The experiment produces knowledge - data and feedback that create insight and judgment - and that insight becomes an output: an article, a presentation, a project, a conference talk, a conversation. It’s essentially something visible that didn’t exist before.

Attraction is what happens once that visible object exists. Once people are able to see what you are thinking about and working on, some of them respond: they connect with you, make an introduction, or bring you an opportunity you did not go looking for.

Compounding is the result of what an engaged network does with that attention. The opportunities start to enhance each other - whether an invitation to speak, an advisory role, a consulting arrangement, a chance to invest, or a new professional path altogether. Each one deepens into credibility and capital: new relationships, access to capital, social proof, authority, income, or equity.

Reinvesting closes the loop. The feedback you get back, what people say, who they introduce you to, and what they ask for next, all tell you whether what you built is working and how to adjust the next turn. The next experiment starts from a stronger, more informed, better-positioned baseline than the last one did.

One full turn from my own life relates to the evolution of my involvement in AI projects and AI initiatives.

The creation turn began with reading radiology journals to learn which AI algorithms were already available in the market and which were in development, then formal coursework followed - the Radiological Society of North America Imaging AI Fundamentals course - so I would have a working baseline for evaluating, implementing, and monitoring AI software in clinical practice.

The attraction turn arrived from two directions at once: joining an angel investing group that invested in healthcare startups, and having them look to me for advice on healthcare companies building with AI. Additionally, I was asked by my department leadership, who knew of my interest in AI, to serve as clinical champion for our department’s initial AI software search and deployment. Both were people noticing a visible interest and pulling me toward them.

The compounding turn is where those two threads turned into real roles. The angel investing group led to advisory invitations from AI and healthcare companies and a few opportunities to invest. The clinical champion role led to a seat on our Institutional AI Advisory Board, where we evaluate AI solutions for the organization.

The reinvesting turn is still running. The Advisory Board seat has led to other downstream introductions and opportunities, including a recent invitation to be interviewed for perspectives on the challenges leaders are facing in the age of AI implementation, which is intended to ultimately be published into a book. All of this credibility and authority now feeds the next round of projects and opportunities, including this one.

Subscribe now

Why is it so hard for physicians to start turning this flywheel?

One reason is intimidation or overwhelm about where to begin: it’s easy to look at examples like these and think, how would I ever do enough to get there? Adding to this, many physicians wait for a sense of permission before taking action, assuming someone else must give them a signal that they are allowed to begin.

Another reason is that many physicians keep their knowledge and achievements private. They have a reflexive reservation about exposing their ideas, and as a result, those thoughts never become visible outputs that the creation turn depends on.

Another reason is that physicians over-index on credentials and under-index on signal. Your CV is a living record of what you’ve already done. If you don’t talk about it, or about what you want to do next, you send no signal into the world about what you’re becoming. This is also where isolated opportunities get lost: a committee role, a side job, or a speaking invitation can each look like progress without tying into a larger thesis, which is another way busyness gets mistaken for leverage.

One of the biggest risks is quitting before the signs of success appear. This is especially challenging because there may not be a true blueprint to know how long you should work before getting those early successes. The first few turns of the flywheel will be hard, and it might feel like you’re doing it alone and with no reward. Stopping before the compounding has had a chance to prove itself and store momentum is one of the main failure modes.

Lastly, letting the clinical foundation slip away is another way that the flywheel can fall apart. All of the initial momentum and progress is put in motion from the basis of the clinical work, and letting that central anchor slip away can undermine the credibility that began those initial turns of the flywheel.

How to Begin Turning the Flywheel

Start with something that has a low activation energy, something accessible from where you are today. For example, writing, building, or creating something visible that doesn’t require anyone else’s approval are good starting points. Something where you don’t need to see signal back immediately is also a strong choice. These examples might be better than an advisory role or something requiring a substantial amount of capital, both of which depend on someone else’s approval.

Make sure you focus on turning one flywheel and not several simultaneously. Pick a single starting point, aligned with your central thesis, and let it run its full course before starting a second flywheel. This allows you to focus your energy and give the first flywheel time to store its energy, compound, and run its course.

Manage your expectations. Little to no signal in the early stages is expected. Keep track of the process and the loop itself, while keeping tabs on the outcome as well, so that the underlying mechanism stays visible even if the return signal isn’t there yet.

Once you start to look for the return signal, here are a few things to pay attention to:

Are people repeating your terms, language, and concepts unprompted? Are colleagues or readers making introductions to others, and are they thinking about you when opportunities come across their radar? Are you beginning to receive inbound requests for collaborations, partnerships, writing, or speaking, all without you asking? Do you notice that you’re having an easier time filtering opportunities and saying no to the wrong ones, because they just add work without compounding or without resonating with your central thesis? Is your work being discussed and forwarded beyond the people that you directly know? These shifts indicate that opportunities are starting to align with the direction that you desire to go, above and beyond pure attention that’s coming to you.

One more thing about time. The turns compound rather than simply add up, so a wheel with twenty years left to turn is not just accumulating more turns than one with five, each turn is increasing what the next one is worth. That means starting matters more than starting big, and it means the wheel doesn’t care how old you are when you give it its first push.

When you see an impressive, multifaceted career, remember:

What looks like luck from the outside is often a flywheel that has had years to work from the inside.

You are probably looking at the fifth turn of the wheel that someone has been quietly pushing since the first.

Physicians don’t need to do more things - they need to realize that they have more leverage than they’re aware of, but most of it is potential and latent leverage until it is connected.

The Physician Leverage Flywheel is that connection. It’s the engine that takes the holdings you already have access to and connects them to the network you already have.

If you are in the middle of a dry spell right now, tell me which turn you think you’re on: creation, attraction, compounding, or reinvesting. I’d be interested to know where the wheel feels stuck.

• 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.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with my upcoming work.

Subscribe now

A handful of years ago, I was quietly searching online job boards after the workday was done, looking for a change. I talked to recruiters, browsed postings, and touched base with colleagues at other institutions - the usual methods. None of it led anywhere interesting.

The way I learned about my next opportunity was from talking to a physician who also served with me on a statewide quality and safety committee. It just came up in casual conversation at the beginning of one of the meetings, when people were just settling in, and I asked him where he practiced and how he liked it. It turned out that there was a whole different type of practice structure in my geographic area that I had no idea existed - a multispecialty outpatient practice, one which would allow me to read similar types of cases and perform similar procedures compared to my current private practice, but with different workplace settings and hours, as well as a few other key differences. Long story short, I ended up joining his practice a little while later - Atrius Health - and it’s the exact one that I practice at today.

This led me to the realization that a physician could spend a lot of time searching online for the right job, role, or opportunity, without realizing that the best opportunities often travel through networks of people - human one-to-one connections - not online databases.

This revealed a truth that I understand today. Physicians often underappreciate the multifaceted relationships they currently have and the ways in which they can activate them. They tend to think about their network the way you’d think about an iceberg: the visible part - the referring physicians, the current colleagues, the people you’d call this week - is all they see. But below the waterline sits something much larger and almost entirely unappreciated: the full decade or more of medical school classmates, former co-residents and fellows, former attendings, conference contacts, and colleagues who left clinical medicine entirely and now serve inside health systems, venture, or industry. Most physicians can describe the visible part of the iceberg in detail but haven’t mapped the rest. The better way to think of the network is as a wide system of context, trust, and visibility that can allow opportunities to come to them.

Many physicians get really uncomfortable with the word ‘network’ or ‘networking’, and for good reason. But it’s important to understand that the network is really a set of relationships where information, introductions, reputation, and opportunities can travel, not merely a pool of people from which to extract favors when they’re needed. This network includes immediate strong ties, weak ties, and adjacent and tangential ties. Importantly, it’s not just about who you know but also who knows you - what do other people know you for? When your name is mentioned, what comes to mind for people? What do they think that you’re capable of, what do they think that you’re curious about, and what do they think that you spend your time on? Network leverage starts to form when people can connect your abilities to a specific opportunity.

The network shouldn’t be thought about as something that’s directly related to your popularity or how well known you are on social media, or even if you’re constantly visible or not. We should move towards thinking about the network as a source of quality connections where there’s some type of context, trust, and a reason to re-engage down the line. In this way, the network doesn’t get conceptualized as a promotional tool, but something in which there’s a mutual exchange of value and a sharing of curiosity.

And it’s often the most distant connections - the ones you’d be tempted to discount - that have the most potential opportunity. The classmate you haven’t spoken to in ages, now a VP at a health system, connects you to a world your immediate colleagues simply can’t. Research on professional networks consistently shows that these dormant, weak ties are disproportionately valuable precisely because they bring you into rooms your inner circle never touches.

Structural reasons why physicians tend to underestimate their networks

One central reason is that the training rewards competence and adherence to rules, more than visibility and network building. Clinical training, after all, rewards individual excellence: you’re evaluated by your knowledge and judgment, and not necessarily by the deliberate cultivation of your network. Another reason is that many physicians are at an inherent disadvantage if they spend most of their time inside their institutional walls and they don’t spread their message more broadly at conferences, other speaking events, or online. If you have an excellent reputation locally, that doesn’t necessarily translate to a wider network where people may understand your credibility and skills.

Also, making an ask (from a networking perspective) can feel uncomfortable. This is because physicians are used to a position of authority and being the ones who are being asked. And so it can sometimes feel uncomfortable to project the ambition or desire for a bigger path if one reaches out to their network. Physicians also tend to be more to themselves as opposed to more broadly visible. As they may reflexively guard against self-promotion, they could unintentionally keep their budding interests and skills more quiet.

Finally, the significant busyness of most practicing clinicians can erode relationships that have formed over time. When your calendar is completely full and you gradually lose touch with colleagues that you trained with or you practiced with in the past, the opportunities that used to trickle in can slow, since no one is kept up to date on what’s happening in your life. Maintaining relationships takes time, which can be in genuine short supply as a busy physician.

Subscribe now

Most physicians already hold several network assets that have quietly gone dark from underuse.

One of the most valuable of these assets is trust and credibility. As a physician, people generally believe you’re competent, serious, and worthy. This is hard for anyone in society to generate, and physicians already tend to have this at baseline. Another inherent advantage is proximity to different opportunities, many of which are not widely advertised. They move through trusted networks first.

Another asset is your context. People will recognize your specialty, where you practice, the prestige and reputation that goes along with it, what your judgment tends to be, and also what interests you have been vocal about in the past. This type of context helps people understand what opportunities to send your way.

Another network asset is distribution, where your network can help you spread the word about important initiatives that you’re working on by forwarding your writing or bringing up your name in the right circles. Finally, another key asset is translation, where people in healthcare-adjacent fields can translate your credibility into advisory, startup, consulting, AI, or leadership opportunities.

Something even more fundamental exists however that most physicians don’t consciously think about: the trust multiplier. Physician outreach to another physician - or even to an industry leader or founder - starts from a credibility baseline that a cold contact just doesn’t have. The shared training, the shared stakes, and the credential itself all silently vouch for you before you’ve said anything. A peer-to-peer message from one physician to another gets answered at rates most professional outreach doesn’t hit, not because of communication prowess, but because of what that white coat signals.

This makes a difference because the trust multiplier exists specifically because of the clinical identity. The network isn’t a separate skill unrelated to medicine - it’s a downstream byproduct of the clinical credential. Every year of training and practice deposited trust into the bank of these relationships, and that trust is there, waiting to be seen and used. This turns “you have more contacts than you remember” from a pep talk into a legitimate leverage argument.

Your network is more nuanced than a single entity - you actually have several, each creating different types of opportunity. Your clinical peers - colleagues, referring physicians, multidisciplinary tumor board peers - carry the strongest trust, but the least expansion potential. Your training network, including medical school classmates, former co-residents and fellows, and mentors, is often dormant but emotionally durable, and the easiest to reactivate with a single message. Your institutional network - administrators, leadership teams, and committee members - create internal leverage. And then there are two networks most physicians barely think about: the adjacent ecosystem of investors, consultants, founders, and AI builders who are healthcare-adjacent, and the audience and community network of readers, subscribers, and online connections where platform leverage and network leverage merge and integrate.

Examples of the Networks in Practice

These multiple networks can work together in the following way, with the end result being that your credibility travels to someone distant from you.

First, it could start with you writing on a subject of importance to you, such as your views on the healthcare workforce crisis. This writing could then be noticed by someone who makes the mental link between that problem and your opinions and potential solutions. When that person later on has a subsequent conversation about that very same issue, they think about you and bring your name up. This then transfers your credibility to a new opportunity.

And the subsequent time that you write and send a signal out there, it becomes easier for it to transfer because your network now understands a little bit better about what to listen for.

So the initial writing created that signal telling your network what you’re thinking about before you’ve ever asked for anything. The later conversations create specificity about a particular opportunity - where your credibility and skill can transfer.

These introductions over time increase the number of people who know you and can imagine an opportunity for you. Your reputation and credibility compound when different people repeat the same ideas and phrases about you. Ultimately, as long as you’re known for something valuable by the right people, your network leverage is doing its job; it’s not necessary to be known by everyone everywhere.

Practical Implementation

Here’s a useful exercise to try in a single sitting - which should take fifteen minutes and a piece of paper. Write down five names per bucket across these five categories:

• Clinical peers who have a high opinion of you

• Former physician contacts from training who would remember you favorably

• People who’ve seen you teach, create something, lead, advise, or solve a problem

• Adjacent professionals from outside your clinical practice

• People who you would just enjoy reconnecting with just for its own sake

Take that list in front of you, and notice three things about it:

1. Do they know what I’m currently working on, and where I hope to go with it?

2. What could I offer them that’s of value - any introduction, information, opportunity, or encouragement?

3. What people or problems may they have visibility into, that I don’t?

Then, when you’re ready to engage with them, send a short, friendly re-introduction. You could give a quick update on what you’ve been working on recently and any relevant updates. Share any recent article that you’ve written - or an impactful one that you’ve read. Let them know about the success of a project that you’re working on, or even a detail about someone you met that might be mutually interesting to them.

Try to make it easy for them to conceptualize you and understand you by using simple, clear language, such as, “I’m working on implementation of new AI software in my practice.” Then use your curiosity about the other person and ask them what projects they’re working on. Doing this in small pieces, week by week over time, is more impactful over the long term, than trying to chunk this all into one heroic effort at one time point during the quarter. Ultimately, see if you can trend towards bringing people together into some sort of gathering - online discussion groups, in-person dinner events, informal get-togethers that bookend conferences. These have the strongest long term impact, and over time, your network gets to understand who you are and what you stand for. When people think of you, they think of a clear idea - and the physician behind it.

Once a physician begins to activate their network, the next question is how these assets compound over time. That is exactly the question that I’ll tackle in detail in the next essay. It’s about the Physician Leverage Flywheel, where knowledge, credibility, network, platform, capital, and opportunity feed one another.

Take a few minutes this week and write down a name you haven’t thought of in years. Look up what they’re doing now. Reply and tell me who came up for you - I’d love to know what you find.

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.

Subscribe now

You’re sitting in the front few rows of the conference room at your specialties annual meeting. On the stage sits a physician who is being introduced by the moderator who stands at the lectern. As you sip your coffee in preparation for the talk, the introduction for the speaker starts in an unassuming way, with the moderator noting the speaker’s expertise in a certain domain. Then, the description starts to unravel in a very interesting way - you start to learn that the speaker has advised numerous startups, they have created a nonprofit, and they are involved in local volunteer efforts. The list of activities goes on and on, to the extent that you think to yourself, this person must have left clinical medicine. However, at the very end of the description, the moderator mentions that the speaker still practices clinical medicine at their institution. Taking another sip of coffee, you lean back in amazement, eagerly awaiting the speaker’s presentation.

I’m sure many of us have experienced this moment. And frankly, this type of speaker introduction is becoming more common. The reality is that a new kind of physician is emerging, one that builds a portfolio of complementary roles and interests that is anchored by their clinical work, as opposed to a single job held for 30 years. The narrow track that serves as the default is being gradually replaced by a multidimensional, multifaceted physician who has created their own blueprint as a practicing physician: the Portfolio Physician.

The portfolio physician is designing a broader professional life from medicine.

As we dive deeper to understand the concept and emergence of the portfolio physician, we have to make sure we understand the underlying architecture. The portfolio physician career is best thought of as an intentionally assembled set of complementary roles and assets that is unified by a single thesis and that has clinical work as its foundation. Similar to a financial portfolio, it has diversification, which provides resilience. It has layers that are intentionally added for asymmetric upside, and its structure allows compounding. The underlying assets that the portfolio physician career holds are analogous to the five forms of physician leverage discussed previously: knowledge, credibility, network, platform, and capital, which are modified into tangible working parts of the physician career.

Structural Considerations

It’s important to note that the portfolio physician isn’t simply a collection of different side hustles or side gigs. Side hustles tend to be added on, sometimes at random, and sometimes with the sole intention of adding income. Done in such a way, they can compete with clinical practice for the same scarce resource - time. The portfolio architecture, however, is integrated intentionally where each activity or role relates to, and can feed, the others. Importantly, this does not require leaving clinical medicine. Clinical practice remains the anchor and is not something that is trying to be replaced. The idea is expansion, not escape.

It’s not necessarily about ‘more’ or about ‘doing everything’ - some opportunities will be declined because they don’t fit into the coherent architecture. Collecting titles for its own sake could paradoxically harm the architecture. It doesn’t require perpetual reinvention and pivoting, or changing your identity every few years. Rather, it’s understanding that different layers and assets will compound over a long-term time horizon, and strategic moves help to build the portfolio career into a coherent architecture. Think evolution, not revolution. In this way, the career that you have built stays central and you don’t feel a false dichotomy of choosing between practicing pure clinical medicine versus abandoning medicine for something totally different.

The portfolio physician is someone who has built a deliberately assembled, thesis-driven set of holdings around a clinical anchor, not necessarily someone with a crowded calendar or an impressive LinkedIn.

Structural Forces, as opposed to a Personality Trait

There are a few reasons why the portfolio physician concept is emerging now. These reasons have to do with emerging market forces and underlying structural realities of the healthcare ecosystem, not just increasing ambition or curiosity on behalf of physicians. Conditions have changed since we started our training. For example, one big reality is that AI is restructuring the clinical day. Routine and mundane cognitive tasks are being compressed and the space that that leaves will be filled by new physician roles - some of which were discussed in the prior essay - including AI implementation, governance, monitoring, and so forth. The overall range of medicine is widening even as parts of it are being automated and eliminated.

Next, single-track economics are quietly deteriorating: reimbursements generally continue to decline, RVU expectations generally continue to increase, and consolidation continues to permeate the marketplace. All of these factors make the standard default single track career paradoxically riskier than it looks. Diversification and building intentional optionality no longer becomes the risky move, but rather one which de-risks the professional career.

Another reality is that your ability to impact other physicians, patients, and other members of the healthcare ecosystem is now more within your reach than ever. Distribution across multiple channels has become free to near free. This includes social media platforms such as LinkedIn, Substack, Facebook, YouTube, podcasts, and the like. These allow you to create a platform and spread your credibility much easier than you were able to a decade ago. You can collaborate with people across the country and across the globe. You can co-host conferences. You can work together in amplifying and spreading a message.

Another trend is that health tech and med tech needs more physician involvement, at all stages of their evolution. Expanding technological capabilities and the availability of capital have resulted in tremendous growth in these areas, particularly digital health, and this has resulted in real paid demand for physician founders, advisors, and board members. The market actively needs clinicians and pulls them into portfolio roles. Finally, related to the increasing availability of capital is that capital leverage is now available to individuals in a way that previously was reserved just for institutions. There are now startup investing syndicates, there are ways to have founder and advisor equity, and there are many different groups that provide physician-friendly investment opportunities. Your ability to be involved as a healthcare investor has never been easier than today.

So ultimately the portfolio physician isn’t a rebellion against the state of medicine today, it’s more a natural evolution of medicine’s underlying changing structure. As physicians, we should be aware of the multiple tailwinds that are blowing.

Subscribe now

Construction Mechanics

Let’s break down a little more tangibly how you would construct such a portfolio and what the underlying holdings are. The portfolio is more than a feeling or an aesthetic; it has underlying specific components, each of which connect to the different forms of leverage that the physician already possesses. Here are the four underlying components:

Clinical practice as the anchor. This remains the foundation, which informs the physician’s sense of meaning, purpose, identity, and respect, it also provides the core financial stability and makes the physician credible as they expand into the other components of the portfolio. This anchor is what is built on and is never a ceiling to escape.

Medicine can remain the foundation without becoming the entire architecture.

Intellectual assets - publications, writing, speaking, patents, IP. These are the ways in which you are known beyond the walls of your clinic. These are your knowledge and platform leverage components made visible more broadly.

Advisory holdings - consulting roles, leadership roles, board seats, advisory roles, industry involvement. These are the ways in which your credibility and network forms of leverage create an impact outside of the clinic. They also are ways in which you can create rewards for yourself that are uncorrelated to the direct exchange of time during your clinical work.

Equity holdings - founder shares, startup options or stock, angel investing, real estate investing. These are the ways you amplify the impact of your capital and start to create forms of financial leverage. You shift from exchanging time for money to owning assets that can either generate income for you semi-passively or that have the possibility for asymmetric upside.

What you’ll start to realize by looking at the above is that all of these map to one of the five forms of leverage that you already possess as a physician. The portfolio physician is the container that lets you hold all of these simultaneously and have them work together in a coherent, compounding, and amplifying way.

Conceptually, think of this model as a central planet with multiple orbiting satellites. The central planet is the stable clinical core and the satellites orbiting it are the complementary holdings. All of these are held together by the unifying single thesis. There are a few important characteristics of this model that make it robust and resilient at the same time:

Firstly, it has a central thesis, and isn’t a random accumulation of titles and activities. This central thesis is what turns the activities and roles into a portfolio as opposed to a collection of titles and activities. You may not know what this is at the outset, but after spending time in constructing the portfolio, you will eventually arrive upon it. It is the through line that makes all of the activities aligned and have the potential to impact each other and make the other components grow. For example, a radiologist’s thesis might be investing in imaging-related AI companies, or a dermatologist’s thesis might be helping patients understand truth from misconceptions about skin care in the public media.

A pile of projects is not the same as a portfolio.

Another aspect is that it is intentionally designed, not accumulated. All the roles make sense in light of the whole - if they don’t, they are declined, or they are trimmed or cut over time. The differentiator is the intentionality behind them.

Lastly, the underlying diversification of the portfolio occurs along three different axes at once. These axes are meaning (multiple sources of purpose within the construct of the career), diversification of income (multiple uncorrelated streams, some of which are active, some of which are passive/semi-passive), and there is diversification along the risk axis (no one activity represents a single point of failure). Wise physicians will diversify across all 3 of these axes.

What the Portfolio Looks Like in Practice

These are a few archetypes that emerge when the components mentioned previously combine around a central thesis - note that these are examples and not a comprehensive list:

• The clinical-AI translator: clinical practice plus AI evaluation, implementation, governance, and workflow

• The investor-advisor: clinical practice plus angel investing, startup advising, and board seats

• The physician-writer: clinical practice plus public writing, speaking, and a platform

• The institutional builder-intrapreneur: clinical practice plus leadership, operations, quality and safety, and care-model redesign

• The clinically diversified physician: clinical practice plus healthcare adjacent roles such as utilization review, telehealth, AI training, or expert-witness work

One note about the last archetype: some holdings, particularly the clinically adjacent ones, diversify your income and lower your risk more than they build compounding leverage. That’s still a valuable part of many portfolios - and along the three axes of meaning, income, and risk, not every holding has to hit all three. These all become a portfolio rather than a pile of projects because of the through-line running through them.

In an earlier essay, the physician leverage flywheel was discussed, and this flywheel is a big part of the reason that the components of the portfolio model work well together. For example, writing can create a platform, which then attracts advisory opportunities, which then in turn deepens and expands one’s network and can ultimately generate capital or access to capital. The capital then funds more building and creation, which ultimately creates more to write about. The longer the time-horizon for these activities to compound, the better it works - these activities begun in your 40s, for example, have 20 to 30 years to compound. Also, the compounding works best when these activities are synergistic, related, and additive - which is why having a clear through-line that ties them together has the best chance of amplifying the portfolio career as a whole. However, the earlier you are in this process, the harder it will feel. The first few turns of that flywheel are the hardest and require the greatest activation energy. But once the momentum has been built, the cascading effect is real. In my own case, these essays built a platform, which led to advisory conversations, which have expanded my network and access to additional opportunities.

The next steps to building out the portfolio career begin by assessing where you are today and keeping the clinical work at center. The portfolio is going to be built and scaffolded around this anchor. Next, see if you can write your thesis that’s going to tie your portfolio career together. When you have this, it will serve as a filter to decide what roles or opportunities will be layered on next, and what will be declined. It’s okay if you don’t have the thesis yet. You can make your best guess and start by adding one holding, not multiple holdings. Identify your first career experiment. This could be one essay that you’re pondering writing, one investment that you’re going to make, or one advisory conversation, and let it run its course before layering on the next holding. Avoid the instinct to build out all the layers at once, comparing yourself to someone who is years ahead of you. A fully built out layer is better than four half built layers. Also, keep your long-term perspective: think about the next 20 to 30 years as a design space instead of a fixed structure and path.

The portfolio physician has built a strategic, compounding, and resilient career, anchored by their clinical practice. The most interesting physician careers are designed, not inherited - one holding at a time, around an anchor you never let go of.

If you’re already building a portfolio without having a name for it, I’d like to hear what it holds. Comment and tell me your anchor, as well as the first new holding you’d add.

• 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.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with my upcoming work.

Subscribe now

I remember reading the frantic press headlines from the media coverage of the Radiological Society of North America (RSNA) Conference in 2016. Everywhere, suddenly, the sky was falling. Famously, Geoffrey Hinton proclaimed that residency programs should stop training radiologists immediately because AI would be taking over. And he compared the radiologist to Wile E. Coyote standing at the edge of a cliff and not realizing that he was about to fall off.

A decade later, the reality is that not only are radiologists very much still an integral part of the patient care journey, but they are also in very high demand in the healthcare marketplace for a variety of reasons. Nevertheless, a lot of individuals believe that Geoffrey Hinton was directionally correct, and this notion of how AI will re-shape physician careers deserves serious attention as we see how dramatic the capabilities of these technologies have become. Having said that, this isn’t a doom narrative, and it isn’t a hype narrative either.

If you’re anything like me, anytime you’re at a cocktail party and let anyone know that you’re a physician - especially if you are a radiologist - there is a greater than 50% chance that the next statement out of their mouth will be, “So what do you think about AI?” What they usually mean is, “Do you think you’ll still have a job in the next five years?” But the more useful question - and the one I’ll focus on in this essay - is, “Given that AI is the single most consequential development of our professional careers, how can we position ourselves strategically to stay relevant and come out on top? How does AI change a physician’s value?” I believe that AI is the most powerful driving force that makes complacency about your career arc dangerous, and career design very valuable. AI can certainly be used as a tool and as an agent, but it is most powerful when wielded as career leverage.

At a high-level, let’s think about the application of AI into 3 levels:

Tool usage (prompts, ambient scribes, elevated search/research, general productivity, etc)

Workflow (triage, prior-authorization, communication loops, etc)

Career Architecture (new roles and optionality, acceleration of existing forms of leverage, and access to new levels of authority)

Level 3 is what this essay is about: how AI is creating novel physician roles, accelerating certain forms of leverage, and widening the gap between physicians intentionally designing their careers around it and those who have a watch and wait perspective.

Here’s what’s shifting right now. Firstly, AI technologies are becoming increasingly good at pattern recognition, across all domains of medicine. While imperfect, narrow use cases - such as detection of pulmonary nodules on CT scans, or patient triage, or prior authorization workflows - all of these are becoming faster, cheaper, and more seamless with AI. The gains are real, but they have been taking longer than expected and are still bounded by certain conditions that need to be true in real clinical environments. This doesn’t mean physician pattern recognition disappears, rather the value stack starts to skew towards the judgement, communication, and orchestration abilities of the physician. As this happens, the value of these human skills increases - there starts to be more of a premium placed on the ability to synthesize ambiguous data, to handle edge cases, and to communicate uncertainty to patients and other physicians.

Many AI discussions - particularly those in the C-suite - focus the conversation about AI around efficiency - more clinical work completed by fewer physicians, coupling AI with Advanced Practice Providers (APPs) to reduce the number of physicians on staff, and so on. These strategies are important value drivers, but for the purposes of this essay, I want to focus on something different.

As the human-specific elements of healthcare delivery move up the value chain and AI technologies mature in tandem, we will see an increasingly wide gap develop between physicians who use AI and are AI-literate, versus those who either don’t use AI or who interact with it very passively.

Given that, here’s a suggested way to think high-level about AI. Think of it as career leverage, and not just a clinical tool. The latter is something that is given to you to use in the workflow - whether you asked for it or not - almost like something done to you or done to your practice. The former is thinking about AI as an amplifying force for the five forms of physician leverage that you already have, discussed in a prior essay. AI isn’t a new form of leverage. It’s a force that accelerates the five you already have. Let’s look more closely at each one:

Knowledge leverage: Understanding how to use AI tools in a clinical context becomes a new form of knowledge, differentiating those who are AI fluent from those who are not. This form of physician who has the technical capabilities of using AI to drive outcomes or efficiencies becomes more rare and valuable.

Credibility leverage: Becoming an early, trusted voice on AI confers a form of differentiation and leverage because most clinicians are either silent or engage with AI from a position of cautiousness or fear, or they are too busy to engage with an AI in a meaningful way.

Network leverage: AI touches so many disciplines of healthcare and innovation that it creates a meaningful way for physicians to expand their network. They can be exposed to founders, engineers, scientists, writers, investors, and others, in ways that they may not have through a routine clinical career.

Platform leverage: Given that AI is one of the hottest and most in-demand topics, a physician who speaks or writes about AI can gain a meaningfully large audience. The demand for discussion and expertise on this topic may be higher than any other.

Capital leverage: AI familiarity and expertise can translate into advisory opportunities, investment opportunities, and other ownership roles in this rapidly expanding segment of the healthcare ecosystem.

Let’s contrast two physicians - one who is AI-reactive, and one who is AI-strategic.

The AI-reactive physician is fully intelligent and capable but views AI primarily as something that is happening to them. They wait to see what AI tools will be integrated into their workflow and then they start to learn how to use them. They think about AI primarily from the lens of disruption or efficiency and their default thinking tends to drift towards “how will AI affect my job?” They like to wait to see how AI will be adopted by others in the community and others in their specialty, and when the tool is unloaded into the workflow, they learn just enough about it to maintain competence in using it. From a career standpoint, it’s ‘something happening to them’, and in a five-year time horizon they are a competent physician who is able to use the tools in the marketplace, but they are essentially interchangeable with other physicians. Their leverage position is either the same or lower than what it was five years ago.

In contrast, the AI-positioned physician thinks about AI opportunistically, strategically, and from the perspective of something that is coming and will cause disruption, but that can be harnessed for positive gains for patients and the profession. This physician thinks about how they can best use AI tools and technologies in advancing the goals of their practice. They think about what opportunities that AI will create both in their institution and outside their institution - this is AI being used as material for new roles. They view AI as an exciting way that the career is being expanded. They look at AI education and fluency as a required investment into their future, and as a way to potentially differentiate themselves from the more AI-passive physicians. They don’t just learn the minimum required to use the tools, but they look at many tools across the marketplace, trends across the industry, and develop a point of view about where things are now, and where things are going. They look for roles that let them shape AI’s direction - in the rooms where these decisions are made - rather than just receive it. On a five year time horizon, they become a respected public voice that has greater career optionality and leverage. They experience the compounding effects of knowledge, network, and platform.

Subscribe now

AI has already created new roles adjacent to clinical work. Here are a few practical examples which are emerging at the intersection of medicine and AI. Not every physician should pursue these, and also we should keep in mind that they can co-exist with active clinical practice. They are listed as examples to make the opportunity more specific and concrete:

The implementation leader guides AI evaluation and adoption inside a practice or healthcare system - understanding not just the technology but the clinical use cases, the true clinical workflow, trust dynamics and buy-in, and how clinicians actually behave when new tools hit production.

The clinical-tech translator helps engineers, data scientists, founders, and physicians understand each other. Clinical expertise informs product and process requirements that developers don’t necessarily possess on their own.

The model evaluator assesses AI tools from a clinician’s perspective - performance, safety, usability, brittleness, real-world reliability, data bias and drift - helping bridge the gap between a promising demo and successful real-world deployment.

The governance and safety voice participates in oversight, policy, and risk evaluation for responsible AI deployment. This is the physician or clinical champion who makes sure that the humans stay in the loop.

And the educator and sense-maker teaches other physicians how to think about AI without resorting to tips, fear, or hype - a role that is increasingly needed and more underserved than most others right now.

Again, none of these require abandoning clinical work wholesale or joining a startup. For most physicians these start with one decision and one action.

In my own professional work, I’ve walked down some of this road. Having been interested in AI for many years, particularly in the specialty of radiology, which lends itself very well to many AI applications, I started to learn early on about different AI companies and the tools they were developing. This included companies like RadAI (in which I later became an investor, disclosed below), developing tools to streamline radiologist reporting and closing patient communication gaps, and Prenuvo, developing whole-body MRI screening technology. This led me to being more deliberate about my AI education, and I completed the Radiological Society of North America (RSNA) Imaging AI Certificate Program. This course taught me how to assess and confidently use AI tools, and the different parts in the development of AI algorithms. After the course I felt more comfortable in knowing how to safely evaluate, deploy, and monitor AI tools in my practice. This doesn’t mean I became an AI expert, rather, it gave me the baseline knowledge where I felt comfortable being in the rooms where discussions about AI are had. In my practice - and in many others out there - that is relatively rare.

This then informed the evaluation, selection, and usage of some software we then used in our practice, such as Koios AI for thyroid nodule detection. Today, I sit on the Optum AI Advisory Board, where we critically evaluate emerging AI technologies and platforms and their potential benefit across multiple Care Delivery Organizations in our network. In this capacity, I see where there’s hype and where there’s reality - the potential gap between the demo and the deployment. This is practical, real-world knowledge that makes a difference in how healthcare is delivered.

Along the way I also started to learn - through my network - about opportunities to participate in AI imaging trials. These studies helped commercial vendors creating AI algorithms for radiology applications understand how the software would work in radiology applications. Through these trials, supporting companies such as ContextFlow, Aidence, and IBM Watson Health, I participated as a reader and helped evaluate new artificial intelligence software algorithms in the diagnosis and characterization of lung nodules on chest CT scans, the detection and diagnosis of liver disease, and other applications.

At around the same time I also became involved in AI as it touches the investing domain - I became a clinical advisory board member for AngelMD, as well as a member and investor of Launchpad Venture Group. Through these activities I joined a group of early-stage startup investors in evaluating rapid-growth startups that were aimed at creating innovations in healthcare (as well as non-healthcare sectors), many of whom were using AI - one such company that came across my radar was the aforementioned RadAI. Through evaluating these startups, I get a glimpse into the problems these founders are trying to solve, and the physician-centric elements that they can’t replicate.

This isn’t to say that you need to do all of these things in order to parlay your interest in AI into larger opportunities - the point is the orientation around how to approach AI and how to participate in ways above and beyond simply using AI technologies once they are integrated into your practice - and wondering ‘What’s going to happen to me?’

The certificate I earned started with one course.

The investing started with curiosity.

The advising started with one conversation.

Each led to the other.

Ultimately, AI is here and is accelerating change in all industries - with healthcare being no exception - but the real frame here is AI as career leverage. There are real challenges, questions, and limitations around how these technologies will be able to be used in clinical workflows. The time to engage with it and be proactive is here, and it’s available to any physician, regardless of specialty, background, or skillset. It’s possible to engage in a way that matches your interests and aptitude and fits within the context of who you are professionally and how you practice - every specialty has it’s AI-adjacent frontier. This isn’t a call to become a data scientist, an engineer, or a machine learning expert. After all, as discussed previously, it’s the human judgement, coordination, and communication layered on top of the AI-augmented intelligence that will drive value. This physician-anchor remains foundational as you build AI-fluency across your career - and remember that this shouldn’t be viewed necessarily as a new task, but rather a new lens that makes your work more leveraged.

For a next step, think about where it is in your clinical practice that you already have specific credibility? What AI-adjacent clinical problem do you understand better than most of your colleagues - and what role could you test out, in a small way, in the next 90 days?

If pure diagnostic ability and pattern recognition starts to decline in value, then the physician who builds beyond that - by developing their integration, communication, AI-fluency skills, and different forms of leverage - will start to become the de facto ideally positioned physician. This means that the natural form of the physician role won’t be the conventional standard ‘one job, one role’ but rather a portfolio. There’s a name for the type of career that fits this moment in time, that is crafted with multiple deliberate layers rather than in a single track. I’ll be writing about that next.

Where are you in your AI journey currently? Thinking, exploring, using, building, worrying…? Using AI as a clinical tool in your practice, or as something that you’re actively building with, as leverage? Let me know in the comments.

Disclosure: I hold investment positions in and advise healthcare AI companies, including RadAI and through Launchpad Venture Group and AngelMD. I also participate in AI evaluation work in my clinical role. The views here are my own, are not intended as an endorsement of any specific company, and are not those of my employer or any affiliated organization.

• 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.

Subscribe now

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.

Share

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.

Subscribe now

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.

Subscribe now

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.

Subscribe now

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.

Subscribe now

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.

Subscribe now

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.

Subscribe now

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.

Subscribe now

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.