A physician I know left clinical practice for a digital health company about a year and half ago.
He was hired for his experience and clinical judgment. After about a year in the role, he noticed something nobody had warned him about: his judgement was starting to fade. Meetings that used to lean on his firsthand experience started to feel more difficult.
Colleagues began introducing him as someone who used to practice. Nobody talked about this intellectual fading out loud, but he could feel it.
This essay is about what the practice of medicine actually does *for* us, while we sometimes complain about the hardships and the long hours.
The busy workday, back-to-back patients, administrative burden, prior authorization, and navigating the referral system and insurance pathways are all real - and they all can contribute to a strained day. Many experience the ‘hamster wheel’ production style feeling of medicine - not in all practice types, but in many.
But there’s another aspect of practicing medicine which deserves attention and appreciation - because while the costs of staying in medicine are visible and felt on a daily or weekly basis, the costs of leaving are also there - but they are more subtle and in the background. Those costs show up in a delayed fashion, popping up once the clinical door has closed, months or years later. That asymmetry doesn’t get talked about much in our professional circles, but let’s look closer at what physicians can potentially lose if they leave clinical work behind:
Credibility that can’t be replaced elsewhere. “I’m a radiologist deploying clinical AI” and “I used to be a radiologist” have different market weights, and that gap widens every year that goes by. Companies are much more interested in how you actually practice than in your opinion.
Real world problem and solution context - the raw material that you don’t get anywhere else. These aren’t hypothetical things that you might encounter, they are things that actually frustrate you and your colleagues. The outside imaging study that didn’t get requested for comparison when it should have, the notes from the technologists worksheet that should have been automatically imported into the EMR that didn’t. Real-world relationships with colleagues, administrative leaders, patients, technologists, and vendors that inform clinical decisions.
Reversibility - the thing that makes the experiment the experiment. After all, the bounded career experiment is only safe inasmuch as there’s a career to return back to, a strong foundation from which to build on again. If you remove that clinical anchor, you’re making a bet that doesn’t have a floor. If you keep your practice, you could run nine tests. If you leave it, you might be running one.
Cash flow that provides an operating cushion, and a solid ‘fall-back’ plan B. Clinical income doesn’t just keep the lights on, it also gives you that long runway with which to evaluate opportunities carefully instead of hastily accepting whichever one is the quickest to reach you. It helps you pass on a bad investment opportunity or a suboptimal term sheet. The income allows greater risk-taking elsewhere. The clinical anchor also buys patience that can help you win negotiations.
Regarding the clinical credibility point - realize that this credibility is a depreciating asset when you leave clinical practice, and these days it depreciates faster than it used to. Scientific advances, practice guidelines, workflow adjustments - all of these can outdate one’s professional practice context the farther removed you are. If you start saying “this is how it worked when I used to practice” it doesn’t have quite the same meaning. And with AI compressing time cycles of these changes, this matters more than ever.
The corollary that makes this practical (and in my case has been true from a personal perspective) is that reduced clinical work (i.e. part-time practice) is more powerful than none at all, and in some ways more powerful than full time practice. This is because a part-time physician keeps all of the credibility and buys back part of their hours. The dangerous cliff turns out to be between some and none - not full-time and part-time.
When you find this sweet spot where you can practice medicine and have all of the benefits and credibility that accrue from this - and yet you have hours in which to do your experimentation and growth - you have the best of both worlds - instead of operating at the extremes. The number of days will look different for each person, depending on how they’ve constructed the other components of their career.
Sometimes the clinical anchor might need to go, if it’s the natural evolution of one’s career trajectory - and that’s OK. Some roles are going to require a full-time commitment that won’t leave space for clinical practice, or they might require leadership that is all-consuming from a time and focus perspective. Or, some clinical environments are too toxic - or the fit between the physician and clinical practice isn’t there - and those situations need to be modified in a more radical fashion.
Ultimately, what makes a difference is if that particular exit is intentional or if it’s something that gets defaulted into. There’s a difference between leaving a position if it gets too unbearable versus leaving because an experiment generated sufficient data and direction to drive an informed decision into a new path.
Keeping that clinical anchor as your foundation will cost you some hours in the short term and might slow the trajectory of what you’re building - but leaving and being wrong costs you the credential and context that made you really interesting to someone else in the first place.
Think about your clinical career as something that gives you a stronger place from which to grow, instead of something that’s holding you back. Re-design the foundation, and build the next layer on top of it.
Over time, the different proportions of clinical work can change, but the constant that stays is the credibility, judgement, perspective, insights, and relationships that come from actively practicing medicine.
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.