Why Some Physicians End Up Building Fascinating Careers
Debunking the myths of luck, sacrifice, and deviation from clinical medicine.
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 physician-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.
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.
Some physicians have fascinating careers because they choose small decisions, compounded over years, that let the next version of themselves take shape.
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.