Texas Directive To Physicians And Family Or: Fill & Download for Free

The proper term is Flight Surgeon, known as Aviation Medical Examiner (AME) in civil life. You need to become one of those first. While a limited number of residencies in the field of aerospace medicine exist (e.g.: University of Texas Medical Branch - Galveston (UTMB), Ohio State University, King's College London) in the civil sector, residencies are often more accessible in the military. Virtually any armed force on the planet which maintains its own medical corps/department. For example, in the U.S., the Army, Navy, Air Force and Public Health Service Commissioned Corps all have myriad opportunities for physicians and other health professionals (N.B.: the Marine Corps and Coast Guard do not have their own medical branch; those services receive their medical support from the Navy and PHSCC respectively).Unless one has a significant amount of direct, hands-on aviation experience already, a person applying directly out of medical school is seldom going to be a competitive candidate for any of the aforementioned residencies; the majority tend to have already completed a residency in something else. Going that route, what one's specialty happens to be is not all that crucial. The (U.S.) Federal Aviation Administration's Civil Aerospace Medicine Institute (CAMI) publishes a list of statistics on their own AMEs, and while most are boarded in such primary care fields as internal medicine or family practice (still called general practitioners -- or GPs -- in some countries), the ranks of their AMEs include physicians and surgeons representing virtually every field known to the medical profession.For example, I attended an AME seminar in 2011. As a public health student at the time, I was one of only two non-physicians taking the course (the other was a clinical psychologist). Apart from the usual crop of primaries, there were a significant number of emergency physicians (UTMB offers the option of doing a combined residency in aerospace plus a choice of internal or emergency medicine, by the way), quite a few general surgeons, an assortment of OB-GYNs, a colo-rectal surgeon, several anesthesiologists, a pediatrician (you think flight docs overseeing medical evacuations or caring for crewmembers' families don't have to deal with pediatric problems? -- think again, please!), as well as attendings in ophthalmology, psychiatry, otorhinolaryngology, cardiology and a few others. My point here is that no matter what residency you end up getting matched into out of med school, you can still find a way to make it applicable to aerospace medicine. The saying that "it's what you make of it" is very applicable here. Frankly, I believe that if one is offered a residency in something which isn't their first preference and it's the only residency match available, one would be foolish to *not* take it.In addition to the U.S., the civil aviation authorities of Canada, Australia, South Africa, India and a number of European nations have excellent AME programs and have done some superb research. ALL of these programs also have introduced the medical issues connected with spaceflight into their programs. You do not state which nation you're a citizen/resident of or where you plan to attend medical school, however the universal first step is getting the MD, DO or MBBS degree. The next crucial step is to complete a residency in *something*. I strongly recommend doing a Google search of all of the programs listed above. Good luck in your efforts!

Use forms available online that is specific to your state. Avoid “legal everywhere” type firms.You should complete a Last Will & Testament, Medical Power of Attorney, Directive to Physicians (aka Living Will), Statutory Power of Attorney, Declaration of Guardian (for you in case you need one). If you have children, you and your spouse need to make a Declaration of Guardian for Minor Children as well.Find two adults who are unrelated to you and who are not to inherit from you (they aren’t in the Last Will & Testament). You’ll need two disinterested witnesses. Tell them to bring a driver’s license, state ID, or passport to the meeting for the notary to use.Go online and search for a mobile notary. You’ll pay extra for them to come to your home, but that’s fine.Set up the signing in a large room where everyone can maintain social distancing separation (6 feet or more).You clearly state your name, that you’re intending to create several legal documents, that you are in your right mind and aware of your property and to whom you want to receive your property after your death, and that you’re creating several legal documents as clearly labeled. Next, you sign and date all your documents. Then you step away from the table.The first witness then steps up, signs and dates where needed and steps back.The second witness then does the same as the first.The Notary Public then signs, dates, and affixes a notary stamp where needed.Give photocopies of documents to those who need them.Store your Last Will in a safe place. In Texas, I highly recommend storing it at the county courthouse (Clerk of Court) where your executor alone will have access to it (or someone trying to probate it) and where it’s safer from fire, natural disasters, and far more protected from any family skullduggery.Call an attorney in your state to obtain services if possible or at least to provide advice as to whether my suggestions are good ones in your state. Do the best you can do under the circumstances. Do not ignore or postpone doing needed estate planning.

Q. What jobs can I do with an MD without a residency? I want to take a year off before residency.A. NON CLINICAL DOCTORSJOBS FOR PHYSICIANS WITHOUT RESIDENCYCertification and training options for MD’s without residency training/ medical licenseThere are other health related jobs that that MDs can get with some additional training or certification. Most of these options cost money for course tuition and examination fees. Starting salaries for these jobs are generally lower than the starting salaries of residency trained physicians, but they can offer full time employment in the health care field and a stepping-stone to leadership positions and promotions and even entrepreneurial opportunities in the future.*Research is a competitive field that requires experience and completion of a post doctorate-training program. Most post doctorate-training programs will pay you a stipend while you train in a research lab. In general, they do not require residency and they are usually filled outside of the match.*Medical informatics is a growing field that is open to physicians. This field involves working with electronic medical records and implementation of technology. Find information about certification here.*Naturopathic medicine is an option that would allow you to see patients. Naturopathic medical practice requires a license. You can take courses and then sit for qualifying examinations. Find more information about licensure requirements here, about board requirements here and about educational programs here.*Lifestyle medicine is an option that incorporates working with patients on issues such as weight loss and addiction. Find information about courses and certification here.*Preventative medicine is an area that offers the opportunity to gain certification. Information can be found here.*Genetics counselors also see patients and are generally paid through patients’ insurance plans. Most large medical systems and academic hospitals have genetics counselors. Find more information about training, certification and licensing here.*Acupuncture is a field that would allow you to see patients and perform procedures. Find more information about certification and examinations here. More Information about eligibility requirements here.*Cosmetic enhancement with procedures such as botulinum toxin injection require training and certification. More information here.*Aesthetic medicine involves a variety of procedures that range from hair removal to fillers. Find information about licensing here.*Electrodiagnostic medicine technicians work in electrophysiology labs. Find information about eligibility here and learn more about the work of an electrodiagnostic technician, the training and certification process here.*Ultrasound technicians and lab directors need to obtain training, courses and certification. Information can be found here.*Sleep medicine is a post residency specialty, but there are also certifications for non MDs and non residency trained professionals. See eligibility requirements here.*Personal trainers work with people who need fitness counseling and coaching. Fitness trainers must take courses and obtain certification. Find more information here.Job options for MD's without residency trainingTechnical writing/scientific writingWriting is an option for physicians who want to work for pharmaceutical companies or medical media companies to write grants, clinical trials reports, basic science studies, applications for approval of new medical products and safety inserts, among other assignments. Writing should be impeccable and sometimes fluency in another language or translating capabilities are a plus.Medical editingMedical textbook publishers and medical journal publishers often employ writers and editors with a health background for copywriting and editing assignments. These jobs do not require residency training or a medical license.Pharmaceutical industryPharmaceutical companies have jobs for physicians who are not licensed or board certified. These jobs are in the areas of clinical trials, basic science research, product development, marketing, administration and finance.Pharmaceutical sales and pharmaceutical liaison positions generally do not require an MD and there are international medical graduates who find jobs in pharmaceutical sales or pharmaceutical liaison.BusinessFinancial firms that have investments in healthcare companies hire MD's to review and report on investments. These are generally full time jobs that require travel and can provide opportunities for executive level promotions.Health/medical instructionTeaching at the medical school or university level is another career path for physicians. Most science departments in research universities employ full time faculty primarily for research and allow limited time for teaching courses, with research as the primary focus.Researchers in major universities are usually required to obtain funding for research projects through grants. This requires research experience and proficiency with grants. Some colleges employ faculty for teaching jobs without a research obligation. Community colleges, nursing schools and chiropractic medicine schools are among the colleges that have full time and part time teaching positions for doctors without a research requirement.Non-clinical job options that are usually not open to MD’s without residency trainingBesides clinical practice, there are some non-clinical healthcare jobs that generally require a medical license or residency or board certification.They include :*Medical-legal work- usually requires clinical experience, licensing and board certification.*Health writing for the general public typically requires specialization and clinical experience in a prominent medical center.*Chart review jobs, including healthcare utilization review and disability review, require board certification.Of course, there are exceptions to every rule and there are numerous examples of physicians who have achieved exceptional success without residency training.For more instructions on how to find a non-clinical job, explore Nonclinicaldoctors.com or see Careers Beyond Clinical Medicine, available at most http://booksellers.To find links to companies and job websites, visit the useful links page.What if Clinical Medicine Is No Longer Rewarding?1. Move Into Hospital Administration2. Become a Physician Advisor at Your Hospital3. Start a Practice Management Consultancy4. Become a Career Coach5. Work With Computer Technology6. Review Insurance Claims7. Work at a Management Consulting Firm8. Become a Financial Planner9. Work for a Venture Capital Company10. Get Involved in Retail or Manufacturing11. Get a Job in the Pharma Sector12. Become a Physician Recruiter13. Become a Freelance Writer14. Produce CME Presentations15. Become a Teacher16. Start an 'Encore Career'ReferencesWhat if Clinical Medicine Is No Longer Rewarding?If you're thinking of quitting clinical medicine, you're not alone. A 2010 survey[1]by The Physicians Foundation found that 40% of doctors planned to drop out of patient care in the next 1-3 years, either by retiring or seeking a nonclinical job.Doctors who decide to stop seeing patients are usually glad they did -- and in many cases, they're earning as much money as they did in clinical medicine, according to Steve Babitsky. Babitsky is an attorney who runs SEAK Inc., a Falmouth, Massachusetts-based company that trains physicians, including those who want to switch careers."Most, if not all, of the doctors who switch to a nonclinical career are happier," Babitsky said, adding that replacing clinical income is easier than you might think. "Look at what you're earning per hour of work," he said. "You may be getting less than plumbers, electricians, and landscapers."As sobering as that may be, don't take a switch lightly. Finding a new career is a big decision that requires a lot of soul-searching, said Heather Fork, MD, a physician coach at Doctor's Crossing in Austin, Texas. When deciding, "it's important to create some space in one's busy life for something new to come in," she said.Dr. Fork added that in many nonclinical jobs, it's possible to continue clinical work on a part-time basis. Indeed, some jobs require keeping one foot in clinical medicine. Also, clinical assignments, such as working for a locum tenens agency, can provide extra income as you build up your new career, she said.Here are 16 options for second careers, but before we get to them, let's first examine what kinds of doctors switch careers -- and for what reasons.Who Switches, and Why?Doctors have different reasons for leaving clinical care, depending on the stage of their career, their gender, and their specialty.Joseph Kim, MD, who runs a Website for doctors called Nonclinical Jobs, said physicians tend to leave clinical medicine at distinct stages in their careers. In the first wave, a small group of young doctors leaves clinical medicine right after medical school or residency, or just when they start practicing.Dr. Kim is one of them. Graduating from an internal medicine residency, he realized that he didn't want to practice. He instead worked for a consumer health company and then for a continuing medical education (CME) company, MCM Education in Newtown, Pennsylvania, rising to his current position of president.Typically, these doctors didn't plan to leave medicine. "They don't tend to have an entrepreneurial interest," Dr. Kim said, "so they might go into medical writing, medical communications, or pharma at various levels."On the other hand, another group of newly minted doctors never intended to practice medicine at all. "They might get a dual MD/MBA degree, which has really flourished," Dr. Kim said. "They can be very ambitious and very driven, and are willing to put in long hours." These young doctors might focus on financial careers, such as consulting or raising venture capital.Most doctors who leave clinical medicine, however, do so in mid-career, when they're in their late 30s or 40s -- the second wave, if you will. "These physicians have been in practice for a number of years and are getting burned out. They tend to be very disenchanted about the changes in healthcare," Dr. Kim said. "They want to find greener grass. They might go into pharma, health insurance, managed care, or health resource utilization."But the transition into a new career can be very difficult. "They've spent much of their career practicing medicine and haven't been developing other skill sets," he said. "It's hard for these doctors to convince a prospective employer that they have something to offer besides being a clinician."A third group of doctors switches jobs at or near retirement age. In this case, "someone age 50 or 55 years decides to take on a completely different career," Dr. Kim said. This strategy, called an "encore career," involves something the physician may always have been interested in, such as painting or working outdoors. "This isn't the predominate trend, but it became bigger in the recession," he said.Career changing also differs by gender. Women are more likely to exit clinical medicine to deal with family responsibilities. They may work part-time or not at all while their children are young. When their children are older, however, they have a chance to rethink their careers and may choose a job outside of clinical practice. A study[2] by the American Medical Group Association found that 44% of female physicians were working part-time in 2011, twice the level of male physicians.No one has pinpointed which specialties change careers the most, but we do know which specialties report the most burnout, which is a factor in career changes. A 2013 Medscape survey[3]found that the highest incidence of burnout was among physicians in emergency medicine, critical care medicine, anesthesiology, and general surgery, as well as in all major primary care fields except pediatrics.Specialty can also be an impediment to career change. Primary care physicians with high medical-school debts and low practice income may be less willing to exit clinical care because they can't afford to lose the income. On the other hand, specialists with high incomes are likely to have a harder time finding nonclinical work that matches their current income.Despite the risks, however, plenty of doctors still decide to make the leap. Are you ready to consider something new? If so, here are the 16 options for second careers.1. Move Into Hospital AdministrationHospital administration is a long-standing option for physicians, and the opportunities are expanding as hospitals try to align more closely with their doctors. For a practicing physician who is no longer feeling challenged by patient care, here's a chance to make a big difference across a whole institution and still earn a good living.Although chief medical officer is the traditional role of physicians, more key positions are opening up. These include chief operations officer; chief integration officer; chief administration officer; and chief strategy, innovation, or transformation officer.Typically, any of these career paths first involves serving on hospital committees for a few years. Once appointed, you may be able to rise through the ranks. But you'll need to deal with business issues that you might not be familiar with, and you'll run the risk of having some colleagues who won't view you as one of them anymore.Philippa Kennealy, MD, became Chief Executive Officer (CEO) of UCLA Medical Center, Santa Monica, in California in the late 1990s. She took the traditional route -- serving on hospital committees in order to build her reputation. A practicing family physician, she initially volunteered for a committee because she wanted to help out after an earthquake hit the area. Then she began to relish the role. "I realized I was unhappy in my own practice," she said. "I decided there was a lot more that I could contribute in administration." She initially left her practice in 1996 to become Hospital Medical Director before later becoming CEO.Dr. Kennealy thinks her experience as a practicing doctor made her a better executive. "Another physician really does understand the physician's point of view," she said. On the other hand, "it's a tricky role, because there are physicians who think you've moved over to the dark side."There are many opportunities for administrators these days. Eight in 10 healthcare organizations have at least one doctor in senior management, according to a 2010 survey.[4]However, whereas multihospital health systems and academic medical centers were most likely to have several physicians at the top, more than one half of community hospitals did not have any physicians in key roles.As Dr. Kennealy has experienced, MD or DO leaders can bridge the gap between the administration and physicians, the hospital's most important resource. A 2011 survey[5] revealed that 56% of physicians on hospital staffs didn't trust the administration as partners because of a lack of physician leadership, and 50% cited too little communication with the administration.Physician leadership is linked to the more highly regarded hospitals. A 2011 research study[6] found that specialty hospitals headed by physicians rank about 25% higher on U.S. News and World Report's Best Hospital list than those run by nonphysicians.At many hospitals, however, you won't be able to stop practicing altogether. A 2011 survey[7] found that more than two thirds of physician executives at hospitals continue to see patients, even if it's only half a day per week, and more than one half said it was a job requirement.Pluses: This is a relatively easy transition, and the income is good.Minuses: Former colleagues may distrust you in your new role.2. Become a Physician Advisor at Your HospitalOne job in hospital administration that has seen a lot of growth recently is that of the physician advisor. The position involves working closely with doctors to improve documentation of hospital charges, as well as making sure they adhere to quality and safety regulations. You may also interface with Medicare's recovery audit contractors and other regulators.Once a part-time position for physicians nearing retirement, the physician advisor is now usually a full-time gig filled by doctors in mid-career. Dr. Heather Fork, the career coach, expects a lot of growth in this field. Although only one quarter of hospitals currently have the position, most will have it in the near future, she said. Growth is driven by the need for alignment with physicians, the shift to Accountable Care Organizations, and increasing use of performance data.Physician advisors are chosen from within the hospital staff; these folks have earned their colleagues' respect and understand evidence-based medicine. "The physician advisor is a clinical educator, diplomat, and tightrope walker," Dr. Fork said. "This role is only for a certain type of physician who is able to handle conflict and deal with different personality types."Bernard H. Ravitz, MD, has been physician advisor at the 300-bed MedStar Good Samaritan Hospital in Baltimore for 10 years. Beforehand, he had served as an emergency physician at the hospital for 15 years.A key part of his job is to monitor admissions. "If even one hospital day is denied, that means we're still caring for the beneficiary but not getting paid for the care we're providing," he said. Working closely with physicians, he sees himself as an educator, helping with documentation and offering feedback to reduce denials and improve care."You have to be able to get along with the medical staff," Dr. Ravitz said. "You have to have people skills."Dr. Ravitz was a speaker at the 11th Annual Physician Advisor Summit in March and is a founding member of the American College of Physician Advisors, which was launched in May. He said there are roughly 50-100 founding members out of hundreds of physicians in the field. The college plans to provide assistance to doctors interested in this career.Pluses: This is challenging work for those interested in evidence-based medicine.Minuses: You'll have to deal with pushback from physicians.3. Start a Practice Management ConsultancyThousands of physicians have started practice management consultancy firms, based on a skill they learned when they ran a practice, such as coding, claims processing, or practice efficiency. "This is good for people who are self-starters," Babitsky said.For example, David Zielske, MD, an interventional radiologist in Tennessee, founded a company that addressed the difficult coding requirements of his specialty. "The coding for interventional radiology is unusually complex and error-prone," he said, but he enjoyed the challenge. "I've always had a passion for coding."In 2000, Dr. Zielske took his coding skills and cofounded ZHealth in Brentwood, Tennessee, to help physicians and hospitals deal with interventional radiology coding. For a while, he operated out of his home and had to continue practicing for a few years to keep up his income. The transition was "a very expensive, long-term process," he said. "You can't just quit and think you can be successful right away."The company has prospered since then, branching out into coding for vascular and cardiac care, and Dr. Zielske has also written books, hosted webinars, and given speeches and seminars on coding.Some physicians who start consulting firms keep practicing medicine. For example, L. Neal Freeman, MD, a practicing ophthalmologist in Melbourne, Florida, is President of CPR Analysts, coding and physician reimbursement analysts.The work can build on basic skills learned in clinical care. "Consulting is like the problem-solving you do in medicine," Dr. Fork said. "You have to take a project from beginning to conclusion."Pluses: You can build on a skill you learned in running your practice.4. Become a Career CoachLots of physicians stay busy these days serving as career coaches for their colleagues. And considering the high percentage of doctors in The Physicians Foundation survey who reported that they wanted to change careers, demand for this new field may not yet be fully tapped.In addition to counseling on career change, coaches help physicians upgrade their current careers, brush up on their management skills, and develop new sources of income for their practices. They may work with clients one-on-one, speak to small groups, or give seminars and speeches.There are even courses and certification programs for career coaches, who can earn six figures once they've established themselves.Dr. Kennealy left her post as hospital CEO in 2002 to start her own coaching company in Los Angeles. First she taught leadership skills to physician executives, department chiefs, and medical staff presidents. Now, in a business called The Entrepreneurial MD, she coaches physicians who want to start their own business. "It was a natural fit for me, because it allowed me back into the helping relationship that I enjoyed when I practiced medicine," she said.Dr. Fork decided to become a career coach after leaving her dermatology practice in 2004, and Francine Gaillour, MD, has been working in the coaching field for 18 years. In the past five years, Dr. Gaillour has coached more than 300 physicians in one-on-one and group settings, as well as through teleseminars, according to her Website.In 2003, Dr. Gaillour founded the Physician Coaching Institute, which has graduated more than 50 certified physician development coaches, including Dr. Kennealy. Enrollees take a six-month program that includes 12 live training teleseminars, other coaching sessions, and modules on specific skills.Pluses: Demand for coaching is high, and the income can be good once you get established.Minuses: You'll have to work hard to build up a client base.5. Work With Computer TechnologyIf you have expertise in computer technology, you'll have a variety of careers to choose from, including advising an electronic medical record (EMR) company, working for a hospital, creating software applications, and perhaps even launching a technology start-up company.In the flawed launches of EMRs and other systems in hospitals, physicians have blamed non-MD chief information officers (CIOs) for not understanding their needs. As a result, hospitals have started hiring physicians as chief medical information officers (CMIOs). These doctors serve as a liaison to the medical staff and apply a clinician's insights into developing computer technology.The Health Information Management Systems Society (HIMSS) recently stated[8] that the number of physicians who reported working with a CMIO has almost doubled, from 22% in 2012 to 40% in 2013. "When you think about the physicians and CMIOs coming on, they bring in this culture [of] connectivity and analytics," Lorren Petit, Vice President of Market Research for HIMSS, told EHR Intelligence magazine.[9]A model for this approach is John D. Halamka, MD, who has been CIO at Beth Israel Deaconess Medical Center in Boston for many years. He also writes the Geek Doctor blog and puts in time practicing emergency medicine.Similarly, physicians can offer useful input into improving EMR design. A company called Modernizing Medicine, based in Boca Raton, Florida, seeks to bridge the gap between doctors and software engineers by teaching physicians computer coding and having them design specialty-specific EMRs. The physicians even go on the road to market their product, even as they continue to practice medicine.Beyond EMRs, physicians can play a role in developing a variety of new software applications, ranging from at-home patient monitoring to providing doctors with quick access to best practices. For example, Thomas Osborne, MD, a radiologist in Vista, California, has been reading scans for vRad, a large telemedicine company. Recently, he was named the company's medical director of informatics. To demonstrate his abilities and get the job, he did IT work and volunteered for a company project. "My successful involvement has in turn put me in a position to be involved in other areas of the rapidly expanding business," he said.Some physicians dropped out of medicine to work on software even before they completed their residency. Scott Zimmerman, MD, CEO of Xola Booking and Marketing System, a travel Website based in San Francisco, said he became interested in software coding while in medical school and left a neurology residency program at Stanford to devote himself full-time to the company."People told me I was crazy," he said. "I only had $10,000 in the bank and nearly $200,000 in student loans, with a six-figure salary just in reach." But the new company raised $2 million from several investors.Pluses: A variety of career paths are available to those who are computer-savvy.Minuses: Most physicians don't have a strong enough background for these jobs, and additional learning and experience would be required.6. Review Insurance ClaimsThere's a growing demand for physicians to help payers with utilization review (UR). "The health insurance industry is just booming right now," said Steve Babitsky, citing the mandate under the Affordable Care Act requiring all Americans to have coverage.Although some physicians may view this as working for the wrong side, it's "actually a chance to do good," Dr. Fork said. "Your role has to do with stopping overuse of services within the healthcare system and helping to provide quality care for value."The advantages are that you can use your diagnostic skills as a physician; you're often able to work out of your home; and, if you work full-time, it may be possible to make as much money as you did seeing patients, although many UR physicians work part-time.Heidi Moawad, MD, a neurologist in Cleveland, served for several years as a UR physician, working part-time out of her home while raising her young children. Working with a radiology review company that contracted with several health insurers, she dealt with preauthorization requests for radiology from fellow neurologists.Contrary to her trepidations going into the job, she felt under no pressure to deny payments and felt little resistance from the physicians whose requests she was reviewing. In fact, many of them would even ask for her guidance. "They would tell me, 'This is the story; what do you think?'" she recalled. "When I said the test was unnecessary, they were actually relieved." The job helped her get on the Practice Guidelines Committee of the American Academy of Neurology.When her kids got older, Dr. Moawad switched to a teaching job, but she looks back fondly on her UR career. However, she thinks UR physicians are now under increasing pressure to closely follow practice guidelines rather than follow their own reasoning.Amy E. Odgers, MD, an internist in Chicago, also switched from clinical practice to UR work. Initially she worked in a call center, handling physicians whose charges were being challenged. "At times, the work can be contentious," she said. "Doctors don't like to be questioned about why they're ordering tests."After 9 years of reviewing claims, she now has a new position at the same company, studying ways to improve workflow. Working just 20 hours a week, she said she doesn't make as much money as clinical care physicians, but she isn't in debt either. Plus, she has time to pursue gardening and ceramics. "I love the balance I have between work and other things," she said from a cell phone while in her garden.Pluses: Reviewing claims pays relatively well, and in many cases, you can work part-time from your home.Minuses: The work is becoming more and more regimented.7. Work at a Management Consulting FirmA management consulting company might be a good fit for ambitious physicians who like problem solving and working in teams, but expect to put in long hours and don't mind having to be away from home a lot.Many doctors work for such companies as Accenture, Boston Consulting Group, Deloitte, McKinsey & Company, and Milliman. The work involves making in-depth studies on behalf of clients that include hospitals, government, and insurers. Salaries at the top firms start at around $150,000, with the chance to earn raises each year.Consulting firms often recruit doctors directly out of medical school, but also hire them in mid-career. McKinsey has a Webpage to answer questions from physicians and other people with advanced degrees looking for jobs there.Dr. Fork said assignments can last months, during which consultants usually work on-site for most of the week. "In many cases, you're traveling four days a week and putting in long hours," she said. This makes it impossible to work in clinical practice even at a minimal level.In 2001, Michael P. Ennen, then a senior medical student who had accepted a position with McKinsey, wrote an article[10] about the career in JAMA. Physicians attracted to this work often cite a "fear of reaching a professional plateau," he wrote. They like "the challenge of continually working on new problems and shaping new industries as a source of professional satisfaction."He emphasized the need to adjust to a team approach. "To be successful, physicians must modify their expectations about their role in a hierarchy, their individual input, and the service being provided to clients," he wrote.Pluses: The work is challenging, and the pay is good.Minuses: You'll work long hours and travel a lot.8. Become a Financial PlannerPhysicians who are successful in financial planning can use some of the skills they honed as clinicians and attain previous earning levels, but building the business involves hard work over several years.Joel Greenwald, MD, was a practicing internist in the Minneapolis area for 11 years before switching to financial planning. "I was in my mid-30s, and I said to myself, 'I can't feel like this for 30 more years,'" he recalled. He was always interested in financial planning, which he says is a lot like practicing medicine: Clients come to him with problems; he asks questions, comes up with solutions, and develops a program for them.But the switch took years. First came the required classes and an exam to become a certified financial planner (CFP), which he completed while still in practice. Then he quit practicing to launch his new business, Greenwald Wealth Management. But during the first three years, he wasn't allowed to represent himself as a CFP and didn't have many customers.When he could finally hang his CFP shingle, Dr. Greenwald realized that his best clientele would be other physicians. Very focused on their work, they often don't have time to tend to their finances. "Free time away from your practice is a precious commodity," he said. And because of the MD after his name, Dr. Greenwald could gain their trust, which is necessary when handling someone else's money.Dr. Greenwald has worked hard to get new clients, writing articles on his new profession in major publications and speaking before physician groups. But even with all of the effort he's put into his second career, he thinks the work is a lot simpler than running a practice. "I serve 80 households of clients, and I have two employees," he said. "All I need to do is make them happy." Now that he has a busy practice, "I make more money than I would as a general internist," he said.Pluses: This path is a good fit for physicians who have financial skills, and in time you can potentially match your clinical income.Minuses: You need to have a knack for managing finances, and it takes years to establish the business.9. Work for a Venture Capital CompanyWant a chance to earn millions? Then take a closer look at a second career at a venture capital firm. There, you'll often find greater challenges and even greater risks, with a shot at a huge income if you succeed.In this line of work, physicians closely analyze start-up companies in healthcare -- in such areas as software, drugs, and medical devices -- and help determine whether the venture capital company should invest in them. The work is best suited for doctors with strong analytical skills, an aptitude for finances and statistics, and a willingness to take risks on largely untested start-ups.Companies are often looking for young physicians with MBA degrees, but they also hire physicians who have proven their chops as consultants. Doctors can work full-time directly for the venture capital company or be hired as a freelance consultant.Physicians even start their own venture capital companies. Marlene R. Krauss, MD, left an ophthalmology practice many years ago to start KBL Healthcare Ventures in Manhattan, after working for 8 years at an investment bank, according to the company Website.Dr. Fork said physicians consulting with venture capital firms earn $300-$500 per hour. Working directly for a firm pays about $150,000 a year for entry-level positions, whereas some in the upper echelons can potentially earn millions.Pluses: Competitive physicians with strong analytical skills can earn as much or more (way more) than they could in medicine.Minuses: It's hard to break into this field -- and it's a real pressure cooker once inside.10. Get Involved in Retail or ManufacturingSome physicians enter businesses that have little or nothing to do with healthcare and do quite well, thanks in part to skills and temperament learned in practice. In business, "you need to be a smart, hard-working person who can stay focused," Babitsky said. "Those are things that physicians do quite well."Babitsky recalled a doctor who opened a bagel shop near him on Cape Cod. It was a shrewd move, because there were still no bagel shops in the area. The doctor worked hard and the business flourished. It wasn't a sure thing, because many restaurants and other retail businesses fail, especially when the economy sags.Similarly, Daniel E. Kohn, MD, an emergency physician in Baltimore, switched from practicing in an emergency department to running a manufacturing company full-time. Like many physicians, he had for many years been investing in real estate, buying old buildings and rehabbing them, when in 1997 he came across a dilapidated factory.The factory housed a shirt company that was about to go out of business. Dr. Kohn decided to buy the company, called Aetna Shirt, and bring it out of bankruptcy. "It was kind of a fire sale," he said. "The price was reasonable, and there was a book of business already there."As an emergency physician, Dr. Kohn had experience bringing back patients from near death, but rescuing a whole manufacturing concern proved to be a greater challenge. "I didn't understand how relentless the financial needs of this kind of enterprise can be," he said, "but I was determined to make it work."He left the emergency department and introduced a new product he knew intimately: white lab coats. "I never found a decent lab coat," he said. He set about producing a sturdier product that could also be custom-tailored to create a more fashionable look. The lab coat business, called On Call Medical Coats, now makes up 70%-80% of sales.After 17 years in business, Dr. Kohn still hasn't recovered his full investment, but the company is firmly in the black. To find customers, he used to go to 20 medical meetings a year, but he cut back that schedule as business improved. "It's still a work in progress," he said. "I want to continue to grow this company."Pluses: A successful business can provide a great deal of satisfaction and financial rewards.Minuses: You'll have to work hard, and failure is a very real probability.11. Get a Job in the Pharma SectorPhysicians can easily develop a side income by speaking about a drug to colleagues on behalf of a pharmaceutical company, but full-time work in pharma is more difficult to obtain. Although a few physicians work on the marketing side, most are involved in research and development. Even here, the field is hard to break into, in part owing to a complex set of rules and regulations not found anywhere else in medicine.Experts on pharma trends point to somewhat greater demand for full-time physicians in prescription-heavy specialties, such as oncology, cardiology, gastroenterology, neurology, and psychiatry. It also helps to have experience with drug trials or to have worked for the US Food and Drug Administration (FDA) for a few years. FDA pay is quite low, but the experience can be a springboard to a career at a drug-maker, where salaries start at $130,000 and top out at about $500,000 plus bonuses.Another way to share in the storied wealth of the pharma industry is to start an independent company that contracts with drug companies. For example, former plastic surgeon Mike McLaughlin, MD, cofounded Peloton Advantage, a New Jersey-based medical communications company that works with pharma, biotech, and medical device companies.Dr. McLaughlin also runs a side company, Physicians Renaissance Network, which provides information for physicians seeking a career change. "I quit clinical care all at once," he recalls. "I wouldn't recommend doing that, because it's important to test the waters to make sure it's a good fit."Pluses: Being a physician can help open some doors, and successful employees can match their old clinical income.Minuses: Landing a position often takes a lot of networking.12. Become a Physician RecruiterOne unusual but financially rewarding job is to recruit physicians for various jobs, such as clinical research, hospital employment, and group practice. As with many other jobs that require interaction with a lot with doctors, it helps to be a physician and understand what makes them tick.John Goldener, MD, runs a company that recruits doctors for drug trials. Although it took years of hard work to get Goldener Executive Search Associates, in Bryn Mawr, Pennsylvania, off the ground, he said he's now making more money than he did in clinical medicine.In 2000, Dr. Goldener traded his lab coat for a position with an executive search company that worked with pharma companies. It meant giving up clinical work, because "if a client calls and wants to talk to me, they don't want to hear that I'm seeing patients," he said. Three years later, he founded his own company, but a noncompete clause in his contract meant he couldn't solicit any of his old employer's clients. "I had to start at the bottom," he said.That meant making cold calls to pharma executives asking to do their physician searches and driving up to New Jersey to meet with them. "I'm rather introverted, so I had to learn how to call people one after another," he said. It took him six months before he landed his first search.As with any job that involves working with physicians, it helps to be one of them and demonstrate that you understand medical concepts, Dr. Goldener added.Pluses: Physicians who are willing to be patient and work their contacts can earn a high income.Minuses: It can be a tough field to break into.13. Become a Freelance WriterDo you like to write? If so, and you can prove that you have a talent for it, there are countless clinical writing and editing opportunities with pharmaceutical companies, marketing agencies, CME contractors, quality and performance improvement initiatives, and medical publications. In most cases, the work is done on a freelance basis, which means you have to build up your business.Once you have an established set of clients, however, your income can reach primary care levels. Dr. Fork said freelancers' average income is $70,000-$130,000 a year, and the starting salary for in-house clinical writers ranges from $75,000 to $180,000; the higher end of the range is usually reserved for those with an advanced medical degree."If you have the skills, it's not a big transitional hurdle," Dr. Fork added. Characteristics of good medical writing include thorough research, accuracy, logical organization, clear thinking, and readability, according to the American Medical Writers Association.This has been a growing field. According to a report[11] by CenterWatch, which studies the pharma industry, the medical writing market more than doubled in value from 2003 to 2008, increasing to almost $700 million. CenterWatch reported that pharmaceutical companies cut many in-house writing jobs, meaning there's more work available for freelancers.Diane W. Shannon, MD, MPH, a freelance healthcare writer in Brookline, Massachusetts, writes on performance improvement in healthcare as well as other topics. Her exit from general internal medicine in the early 1990s was an act of "self-preservation," she recalled. "I was less immune than others to the stresses of practicing medicine."First, she worked as editor and staff writer for a medical communications company for three years. As a freelancer, she's making more money than when she was working in clinics. "Leaving a relatively low-paying job probably made it easier to walk away from clinical medicine," she said, adding that she uses a variety of medical skills in writing, such as interviewing patients, having to be well-organized, and breaking down very complicated material.Mandy Armitage, MD, also moved from medicine to writing. In an article on Dr. Fork's Website, Doctor's Crossing, she said she stopped practicing sports medicine and rehabilitation after a year, and "I haven't missed it a bit." She initially enrolled in a six-week online writing course and then started a freelance company, collecting such assignments as conference coverage, medical news, and feature stories."What I love most about freelance medical writing is that I cover fields outside of my own specialty, so I'm always learning something new," she wrote. "Plus, I can set my own schedule, and this work is much less stressful."Pluses: Physicians who can write well have good prospects in this field.Minuses: It may take some time to get established, and for specialists especially, income is relatively low.14. Produce CME PresentationsDoctors can help organize and write presentations for companies that host CME for doctors and other health professionals, an industry that generates more than $2 billion in annual sales.These companies must meet a demanding set of requirements from the Accreditation Council for Continuing Medical Education (ACCME), such as documenting their target audience, stating course objectives, explaining how the course fills gaps in knowledge, and testing participants afterwards.Talented doctors can rise fast in the CME industry. For example, Dr. Kim joined MCM Education, a small CME company in Pennsylvania, in 2006 and is now President, making an income similar to that of physicians in clinical practice.Dr. Kim said he brought skills in both writing and computer software to the company. As an MIT undergraduate, he wanted to combine his interest in technology with population-based health, so he enrolled in medical school and trained in internal medicine but didn't go into practice."I just felt I could apply my skill set better somewhere else," he said. So he went to work at a consumer health company, where he helped build some computer-based education modules. But he preferred writing for doctors, which brought him to CME. He's currently studying for an MBA. "A lot of doctors have to learn executive skills to be successful in business," he said.According to the ACCME's 2012 Annual Report, the latest available, the total income for accredited CME providers exceeded $2.4 billion in 2012, a 5% increase over 2011. Accredited CME providers differentiate themselves from medical communications companies that work with pharmaceutical companies to provide seminars to doctors. Although CME companies still derive some income from pharma companies, the ACCME report said those payments fell by more than 10% in 2012.Pluses: Physicians with writing and computer skills can thrive at CME companies.Minuses: The production process is often cumbersome, because it must meet a variety of accreditation requirements.15. Become a TeacherMany doctors dream of becoming teachers, and for a lot of them, it's a good fit in many ways. Physicians know how to talk to patients about complicated medical concepts in simple terms, and they have had to speak in front of small groups. However, opportunities are limited to part-time work at colleges, and the pay doesn't match what can be made in clinical care.Despite the financial drawbacks, doctors have a surprisingly strong interest in teaching. In the 2011 Medscape Physician Compensation Report,[12] physicians who wanted to drop clinical medicine chose teaching as one of their top three alternatives. Indeed, teaching is regarded as a relatively stable refuge from the disruptive modern workplace. Among 14 categories in the Gallup-Healthways Well-Being Index,[13] teachers rank second.Dr. Moawad was satisfied with the move from her UR job to working as a college science teacher. After 4 years in the job, "I'm really, really happy," she said. The work draws on her skills dealing with patients. "Doctors are used to talking to people who don't know about the subject matter and have a limited interest in wanting to learn more about it," she said.She's an adjunct professor at John Carroll University in University Heights, Ohio, teaching two courses on human physiology and global health. The hourly pay is about the same as in clinical practice, but she works just 10-25 hours a week. Only full-time professors get 40 hours, she said, adding that fewer hours are a good fit for physicians raising a family or in semi-retirement. Her work schedule also puts her in sync with her school-age kids' vacation schedules."College teaching is the best teaching opportunity," Dr. Moawad said. Teaching high school science pays too little, and medical school also isn't an option, she said. Dr. Moawad, who served on the faculty at Case Western Reserve University School of Medicine in Cleveland, said there aren't any nonclinical teaching jobs for physicians who are not full-time faculty.Pluses: A good fit for physicians raising families or entering retirement.Minuses: Opportunities are limited to part-time, relatively low-paying positions at colleges.16. Start an 'Encore Career'The "encore career," the job switch made by older doctors, which Dr. Kim explained earlier, typically doesn't pay very well but may answer some personal calling. Dr. McLaughlin said he knows of plastic surgeons who have taken up sculpture full-time, and Dr. Moawad knows a physician who quit practicing to open an aromatherapy and jewelry shop.The Medscape Physician Compensation Report included responses of "chef" and "musician," which could represent doctors beginning encore careers. Steve Babitsky said one of his clients always wanted to work in the outdoors, so he found a job as a park ranger. "The job only paid $30,000-$40,000 a year, but that's what he really wanted to do."Michael Alberti, MD, gave up a job as an emergency physician in Scottsdale, Arizona, to become a portrait photographer. Working in a busy emergency department, "I was losing my love of medicine," he said. Then two things happened: He got a digital camera as a gift in 2001, and his wife had a baby four years later. "It rocked my world," he said.Having already mastered Photoshop, he began taking lots of pictures of his new baby, and within two years he had opened a portrait studio. By 2009, he had acquired a steady customer base in his affluent hometown, and he cut back on his emergency department shifts. In 2010, he was diagnosed with cancer, and by the next year he had quit medicine altogether.He isn't making as much money as in clinical medicine, but his wife, also a doctor, makes up for that. "Giving up my old salary was not easy," he said, "but I don't do this to make money. I do this because of the love I have for it."Pluses: This is a chance to pursue a personal passion while heading into retirement.Minuses: Income from these jobs is generally low.