Medical students, residents and practitioners need an exit ramp

The next phase of medical school education reform is in progress. One question medical educators and Deans will have to address is, "What business are we in?" Are you in the business of graduating doctors who will only take care of patients directly, or, are you in the business of creating opportunities for graduates to pursue biomedical careers of their choice, including non-clinical careers that do not involve seeing patients face to face for a significant part of their working life? Patients are not the only stakeholders that have a dog in the sick care hunt.

In other words, are you practicing marketing myopia, creating a railroad instead of a transportation company?

Here is a McKinsey analysis of why people are quitting their jobs and what they do after. Lack of career advancement and advancement tops the list.

The fact is that medical students (about 5% don't finish), residents (about 6% don't finish within 8 years of med school graduation) and practitioners (1/5 are thinking about non-clinical careers) are already heading for informal exits like dropping out of medical school, graduating but not doing a residency, dropping out of a residency, and dropping out of clinical practice prematurely, Most of these workforce leaks are not looked upon favorably by the medical education establishment and are discouraged by most. Those that choose this path are often stigmatized or excluded from medicine. Even premeds who don't follow a traditional pipeline pathway are at risk of not being accepted or their motivations are suspect.

As intimidating as medical school can sound, surprisingly, most students drop out for non-academic reasons. Between 1993 and 2013, the motive for?medical students dropping out ?came close to an even split between academic and non-academic reasons.

Still, in every single year, most dropout causes were non-academic.

With such a consistent majority of non-academic attrition, it is smart to know many of the causes for this before beginning medical school.

But what if we formalized the process for those who choose to take an exit ramp, offering support and outplacement guidance to keep them in medicine and science in their own ways of creating value for stakeholders?

If you plan to offer the latter, what are the issues?

1. What would a medical school exit ramp look like and where would it be located?
2. How would you practice medical education organizational ambidexterity?
3. What collaborations or partners would you need e.g. in your engineering or business school?
4. How would you make the existing medical education business model obsolete?
5. How should you change how you select applicants to medical school who reveal or realize that they have little or no interest in a lifelong career in clinical medicine?
6. What outplacement services would you offer for those who want to use the exit ramp?
7. How do you accommodate the needs of the new premed and medical student persona?
8. Is there a competitive or business advantage to the model?
9. What would a non-four year degree look like?
10. What impact would it have on existing MD/MBA or other dual degree offerings at your institution?
11. What about re-entry possibilities if a student decides they made a wrong turn and blames it on Google Maps.?
12. What is the evidence demonstrating that such a program lessens burnout, anxiety and medical student suicide or bullycide. ?

For physicians, there are 3 exit ramps if they are no longer interested in direct patient care:

1. Medical administration or support (UR, QA, medical legal, etc)
2. Medical entrepreneurial roles (advisors, consultants, service providers, chief medical officers, or founders)
3. Non-medical roles (franchise owners, real estate investors)

Roles within health service organizations include administrative and bioinformatics ones.

Roles outside of healthcare locations include industry or creating your own company.

Here are four reasons to be an employee before starting your own business.

Given the nationwide focus on physician health and wellness, these authors believe that the creation of options to leave medical training without compromising one’s self-esteem or incurring unmanageable debt (i.e., compassionate off-ramps) is a moral imperative.

They present the following recommendations for consideration (all of these recommendations would likely benefit from local legal review to ensure that both the student and the institution are protected in the decision-making process).

• Recommendation 1: Explicitly enable the ongoing assessment of students’ commitment to becoming physicians as part of a required professional identity formation curriculum.
• Recommendation 2: Implement competency-based education and training to enable rigorous assessment that would allow early identification of struggling leaners.
• Recommendation 3: Use career advisors and coaches to provide career counseling for those using a compassionate off-ramp. This counseling should include options that enable students to potentially apply some of their acquired competencies toward alternative careers in health care. We recognize that this would require rigorous faculty development and a culture change in our institutions as advisors and coaches would need to become more aware of the training requirements for other health care professionals, health administrators, or researchers.
• Recommendation 4: Give credit or credentials for competencies already achieved at a number of points along the medical education continuum (e.g., master’s degrees in medical science, certificates in clinical competence) to promote the attainment of alternative degrees.
• Recommendation 5: Require financial counseling for students who must or are considering leaving training, and support restructuring of debt (including forgiveness) and other services that would make it easier for students to choose to leave the profession and that incentivize schools to actively ensure career fit.
• Recommendation 6: Require medical schools to specifically report to the Liaison Committee on Medical Education (LCME) on their remediation programs and handling of debt for students that use off-ramps, with the LCME considering debt forgiveness a marker of excellence.
• Recommendation 7: Create a Career Center that offers courses and workshops on career development , including non-clinical careers.
• Recommendation 8 :Create internal “talent marketplaces” to give their employees the power to take their careers to the next level . These career-mapping portals include job postings, of course, but they also connect employees with educational, training and mentoring resources to facilitate their advancement. Especially attractive are opportunities to work on short-term projects outside of their current role or physical location, thus broadening their work experience.?
• Recommendation 9: These authors worked with 15 organizations and over 7,000 employees to experiment with ways to increase internal career development opportunities and prove promotion isn’t the only way people can advance. They found that when organizations enable ways to progress that go beyond promotion, it unlocks the flow of talent, skills, and strengths. Employees gain opportunities to grow, develop in different directions, and increase their career resilience. In summary, everyone wins. In this article, they share four experiments that unlock career progression
• Recommendation 10: Rotate on the startup service.

According to Gartner, the pace of employee turnover is forecast to be 50–75% higher than companies have experienced previously, and the issue is compounded by it taking 18% longer to fill roles than pre-pandemic. Increasingly squeezed managers are spending time they don’t have searching for new recruits in an expensive and competitive market. Unless efforts are refocused on retention, managers will be unable to drive performance and affect change. Leaders need to take action to enable their managers to keep their talent while still being able to deliver on results. Managers need help with three things. First, they need help shifting the focus of career conversations from promotion to progression and developing in different directions. Second, they need help creating a culture and structure that supports career experiments. Finally, managers need to be rewarded not for retaining people on their teams but retaining people (and their potential) across the entire organization or sickcare system.

The?Medscape Physician Nonclinical Careers Report 2021 ?published Oct. 8 found one in five physicians has considered leaving their current job to pursue nonclinical careers.?There are probably medical students who knew a clinical career was not a good fit early in their education but felt trapped by the golden handcuffs.

It would have been better if they had an exit ramp so we wouldn't lose the talent. At least, if for no other reason, then they can go to the rest stop to take a biobreak.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack