The Role of Physicians Outside Healthcare Delivery Settings

Wherever they work, physicians belong there. They belong in hospitals, outpatient practices, and clinics. They belong in pharmaceutical company headquarters, consulting firm client sites, labs, lecture halls, government buildings, health insurer offices, and the crammed spaces of health tech startups.

Though the vast majority of their training takes place in clinical settings (with good reason), the potential environs to which physicians can take their careers are not limited to these. Physicians are needed outside of healthcare delivery settings to develop and implement services and products that ultimately affect disease treatment and prevention.

Sometimes the physician’s relevance to patients in these alternative venues is clear and proximate; at other times, the connection is loose, distant, or gradual. Regardless, a physician who is tasked with forming a line of business or overhauling a process can help clinicians deliver improved patient care through better knowledge or equipment. A physician also might develop a health policy that guides how clinical care is administered or contribute in another way to better healthcare.

Any organization whose products affect human health can benefit from the insight, experience, and knowledge of a medical doctor.

Value of Physicians In Nonclinical Environments

Just as the primary medical team caring for a hospitalized patient might consult a specialist to assist in health management, physicians working in education, insurance, business support, biotechnology, and other industries indirectly function as consultants to the providers and systems treating patients.

An attending physician considers input from others on the care team, yet final management decisions are determined by the attending. Similarly, physicians working as medical directors or in comparable roles in other sectors are routinely viewed as authoritative, but input from other professionals and disciplines is often considered.

A hospital’s clinical teams rely on processes, leadership guidance, and strategy to deliver patient care. In the same way, physicians outside healthcare delivery settings are regularly engaged in strategic planning and provide clinical direction for the company.

There is a growing need for physicians in organizations that don’t deliver patient care; industries that touch the healthcare system are increasing at rates that rival or exceed clinical services sectors. The expected compound annual growth rate (CAGR) — only one of many possible measures of growth, but useful for this comparison — of the hospital services market over the next several years is roughly 8 percent.(1) Compare this with the healthcare IT market growing at a 16 percent CAGR,(2) the biotechnology growing at a 10 percent CAGR,(3) and the professional services market growing at a 9 percent CAGR.(4)

Physicians must be involved to ensure that this growth is accompanied by changes and innovations that are in the best interest of patients and the profession.

While clinicians frequently are the end-users of health IT solutions such as electronic health records, these services have become progressively multifaceted, now encompassing other aspects of healthcare operations such as revenue cycle management. Health IT solutions are regularly marketed to corporations other than clinicians; therefore, physician input upstream in health IT product development is key to rendering tools that are useful to both clinicians and patients.

Health technologies also are increasingly directed toward consumers, allowing individuals to take charge of their own health. These technologies must be safe and evidence-based; their design must ensure there is no delay or risky avoidance in seeking medical care.

As a result of advancing technologies, as well as evolving regulation and complexities of care delivery, health systems often depend on outsourced services to meet some of their needs, including analytical infrastructure, cost management, quality management, and clinical information services. Demand by hospital systems is increasing for high-level business consulting to help them stay viable.(5) The fundamental goals of healthcare are blurred if physicians are removed from these services.

There is a similar need with regard to pharmaceutical products. High drug prices create a barrier to patient treatment despite evidence of effectiveness. New classes of drugs and approaches such as precision medicine require changes in the way that drugs are tested and marketed. Physician involvement is imperative for success.

The need for physicians isn’t limited to private, for-profit organizations. The role of public health in our communities is broadening.

State and local public health spending increased by nearly 33 percent between 1990 and 2018.(6) My own county’s department of health, for example, is acutely focused on addressing gun violence and neighborhood blight from a health perspective. This creates an opportunity for physicians to essentially practice medicine on a population level through work with their state and local governments.

Nonprofit organizations — many of which have missions related to healthcare, combating disease, and patient advocacy — have enjoyed an upward trend in charitable giving in recent years.(7) Who better than those with extensive clinical training and medical knowledge to guide how those funds are used?

These are a few illustrations demonstrating the value of physicians in nonclinical environments.

Change In Mindset

Making an impact outside of healthcare delivery requires full-time physician participation.

A change in mindset is necessary to fully leverage physicians in these roles. It’s not enough to expect physicians to be involved in these settings and situations “on the side” by acting as consultants, advisors, or board members, and certainly not solely as volunteers, committee members, champions, or task force participants. Though such roles are essential, they serve a different purpose from full-time appointments dedicated to nonclinical responsibilities.

It is not uncommon for a physician to act as an educator, medical writer, policymaker, strategist, expert consultant, clinical reviewer, and more in a single nonclinical position. Success in a job of this type requires a solid understanding of the company, the field, the science, the relevant regulation, and the competitive landscape. This multifaceted involvement, when combined with the depth of medical knowledge gained from medical training and clinical experience, is an immense asset to a company’s workforce; moreover, its impact on the company’s product or service is substantial.

Some physicians say they wouldn’t work for “industry” out of principle; however, industries such as the biopharmaceutical industry are here to stay, and they have enormous impact on how we treat patients. This has been recognized by some countries that distinguish pharmaceutical medicine as a medical specialty, including the UK, Ireland, and Switzerland.(8)

I’m not advocating for this in the United States; rather, it suggests the gravity of physician involvement in bringing medicines to patients. Furthermore, while the use of doctor’s skill sets in other sectors may not warrant discrete specialties, it is weighty enough that it should recognized as a commendable way to spend a medical career.

For our profession and our patients to maximally benefit from physician contributions outside of healthcare delivery settings, we cannot consider nonclinical jobs negatively. They do not represent “quitting medicine” or “selling out.” They shouldn’t be thought of as a last resort option for the burned out or discouraged physician.

Considering a nonclinical position can be viewed as equal to deciding between private practice and hospital employment, inpatient and outpatient responsibilities, or urban and rural practice location.

Conclusion

The span of physician territory goes beyond hospital and clinic walls. This is not only acceptable, but also necessary to ensure the highest quality patient care and best health outcomes for our communities.

There are several ways that physicians can help to normalize nonclinical career paths and increase awareness of the roles that medical doctors play in nontraditional work environments. First, be inclusive of physician colleagues in all positions. Second, to the extent possible, engage with physicians working with your organization as vendors, consultants, or as part of a collaborative effort. Finally, educate medical students and trainees about the expansive career options available and the diverse ways they can use their knowledge and skills.

References

1. Grand View Research, Inc. Hospital Services Market Size, Share, & Trends Analysis Report by Service Type (Inpatient Services), by Hospital Type (State Owned), by Service Area (Others, Cancer Care), by Region, and Segment Forecasts, 2019–2026. Sept. 2019.

2. Markets and Markets. Healthcare IT Market by Product (EHR, RIS, PACS, VNA, CPOE, HIE, Telehealth, Healthcare Analytics, Population Health Management, Supply Chain Management, CRM, Fraud Management, Claims Management) End User (Provider, Payer) - Global Forecast to 2024. Apr. 2019.

3. Global Market Insights, Inc. Biotechnology Market by Application, by Technology, Forecast, 2019–2025. Nov. 27, 2019.

4. The Business Research Co. Professional Services Global Market Report 2019. May 2019.

5. Onitskansky E, Reddy P, Singhal S, et al. Why the Evolving Healthcare Services and Technology Market Matters. McKinsey & Co. May 2018. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/why-the-evolving-healthcare-services-and-technology-market-matters . Accessed January 24, 2020.

6. Kamal R, McDermott D, Cox C. How Has U.S. Spending on Healthcare Changed Over Time? Peterson-KFF Health System Tracker. Dec. 20, 2019. https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time . Accessed January 24, 2020.

7. Giving USA. Giving USA 2018: The Annual Report on Philanthropy for the Year 2017. Chicago: Giving USA Foundation, 2018.

8. Stonier PD, Silva H, Lahon H. Pharmaceutical Medicine. Int J Pharm Med. 2007;21(4):253–62.