The corporate world can provide benefits and a steady paycheck, but those come with trade-offs, the author explains.

In recent years, forces have converged to make some physicians re-examine their personal and career goals: skyrocketing malpractice premiums, reimbursement and managed care hassles, clinical performance auditing, and the general sense of losing control. Many doctors are tempted to leave medicine but feel their options are limited.

Physicians who do examine alternative careers frequently look to the corporate world. Although some elect to start businesses of their own, for others the allure of a steady paycheck and benefits from an employer are difficult to ignore.

Given the enormously exciting development of clinical-decision support systems, many physicians investigate companies that specialize in healthcare information technology. These doctors assume that since they're highly educated, used to making quick decisions, and successful in running their practices, they'll rise swiftly up the corporate ladder.

I learned it doesn't work that way; if you're thinking of taking the corporate plunge, consider my experience a cautionary tale.

In 1992, after 15 years as an ophthalmologist in private practice, I suffered a shoulder injury that forced me to give up surgery. Fortunately, since I had computerized my office systems during the early 1980s, I had skills that helped me start my own computer consulting business. After a few years of working independently, I was ready to trade self-employment for a paycheck, so I sent my resume to various healthcare IT companies. I landed a job relatively quickly, as a clinical strategist at a firm with 1,800 employees.

Convinced that I had answers to my new company's business challenges—and certain that management couldn't possibly understand healthcare as well as I did—I made my recommendations for strategic planning and product development directly to the president and to the CEO a week after I was hired. I left each of their offices fully expecting to be showered with accolades and appointed to the position of departmental chairman, to lead the efforts I had recommended.

What I received was a pat on the back and a "thanks" for sharing my visions and ideas. Business went on as usual.

As I soon discovered, corporations have little tolerance for the take-charge, don't-question-me attitude that serves physicians so well in private practice. Businessmen consider themselves professionals on par with doctors. As such, they're not in awe of physicians' every utterance in the boardroom or around the water cooler.

I also had no understanding for the need to respect the chain of command. By going directly to the top, I had circumvented the people to whom I reported. That made them look bad, like they couldn't control their employees. Moreover, I had interrupted two key executives and taken up their valuable time.

I didn't realize that corporations work on budgets and set developmental and product-release goals based upon specified time frames, building their operations around these strategies. Experienced businesspeople know that attaining ambitious goals takes focus and the efforts of many. No wonder no one rushed to make immediate changes based on my suggestions.

At the time, I was frustrated. Now I wonder what I could possibly have been thinking.

As basic as these realizations are to businesspeople, they were lost on me. But I adapted, and 15 months after I started with the company, I was promoted to vice president of medical affairs. Now I'm responsible for hiring physicians, and I see many of my colleagues learning these same business lessons. My repertoire of interview questions for candidates includes a series of inquiries about their ability to adjust to a work setting in which they're no longer the absolute decision makers, and in which they may find themselves overruled by people they regard as having considerably less healthcare experience.

I also ask candidates how they would feel about having their suggestions or directives tied up in a lengthy decision-making process. In the corporate world, things happen slowly and according to consensus and established processes. Physicians, on the other hand, are used to having people—patients and employees alike—jump at their commands and follow their instructions.

Likewise, doctors who work in a corporate setting have to learn to be team players. They can't lash out at someone whose opinion conflicts with their own; they have to find ways to compromise. Being obstinate and personalizing differences—like doctors do, for example, by refusing to refer a patient to a particular colleague—won't work in the business world. Such attitudes only breed frustration and resentment among co-workers. Those who can't express their views respectfully in the boardroom will be perceived as difficult, no matter how much education and experience they bring to the company. Chances are, they won't be tolerated for long.

Physicians have much to offer healthcare firms. Indeed, many of these companies will never reach their full potential without the input and contribution of experienced MDs and DOs. If doctors recognize where businesspeople are coming from and vice versa—and if both respect the resulting differences in views and attitudes—the range of healthcare services and technologies available to patients will be vastly improved.

Samuel Bierstock. Yearn for a desk job? Medical Economics May 21, 2004;81:43.