Matthew Alkaitis, a third-year student at Harvard Medical School, is calm, friendly, and a good listener—the kind of qualities you’d want in a doctor. But though he spends 14 hours a day studying for his board exams, the 29-year-old isn’t sure how long he’ll be wearing a white coat. In September, Alkaitis, who also has a Ph.D. in biomedical sciences, will be starting a two-year fellowship at McKinsey & Co., where he’ll be advising clients in the health-care field. “I really hope that my career involves a period of dedicated time taking care of patients,” he says. “But I also have this competing goal to one day start or help build out a company that really adds something new and interesting and innovative to the medical system.”
Like Alkaitis, more people are coming out of medical school and choosing not to practice medicine. Instead, they’re going into business—starting biotech and medical device companies, working at private equity firms, or doing consulting. In a 2016 survey of more than 17,000 med school grads by the Physicians Foundation and health-care recruitment firm Merritt Hawkins, 13.5 percent said they planned to seek a nonclinical job within three years. That’s up from 9.9 percent in 2012. A separate Merritt Hawkins survey asks final-year residents: “If you were to begin your education again, would you study medicine or would you select another field?” In 2015, 25 percent answered “another field,” up from 8 percent in 2006. Among the reasons they cited: a lack of free time, educational debt, and the hassle of dealing with insurance companies and other third-party payers.
The trend is worrying, as the U.S. already suffers a shortage of doctors, especially in rural areas. “If you have a large number of people out training to see patients and taking care of people in our communities, then all of a sudden deciding not to, that’s a concern,” says Atul Grover, executive vice president of the Association of American Medical Colleges. The AAMC projects a nationwide deficit of as many as 100,000 doctors by 2030.
“I think that we are at a crossroads,” says Dr. Kevin Campbell, a cardiologist in Raleigh, N.C. “I trained in the early ’90s, and back then you definitely were thought of as a sellout or a second-class citizen if you weren’t going into clinical medicine.”
Medical students have more options nowadays. Medical and business schools are teaming up to offer joint degrees. There were 148 students enrolled in M.D.-MBA programs in 2016, up from 61 in 2003, according to the AAMC. At Harvard Medical School, in a class of about 160 students, about 14 will pursue the joint degree, and an additional 25 or 30 will do master’s in other areas, such as law and public policy. “We have some students who want to go back to the Midwest and practice in a community setting,” says Dr. Anthony D’Amico, a professor of radiation oncology at Harvard Medical School and an advisory dean. And then there are those “who want to implement skill sets they’ve been blessed with and apply them on a broader scale.”
Dr. Rodney Altman of San Francisco says the time he spends treating patients in the emergency room informs his work as a managing director at Spindletop Capital, a private equity firm that invests in health-care companies. “I really wanted to practice health care on a macro level,” says Altman. “For me the one-on-one interaction with patients, while important and rewarding, wouldn’t have been as rewarding as being able to impact a larger number of patients.”
Altman says his mentors and colleagues had mixed feelings when, after a decade of practicing full time, he decided to dial back his hours in the emergency room. “Most people were supportive, a lot were envious, and some appropriately cautioned me about the risks I would be taking,” he says. “Out in the business world, you’re subject to the whims of the capital markets and to a lot more that is out of one’s control. I think medicine is quite safe and secure in that way.”
Some consulting companies are also stepping up hiring of doctors. Steffi Langner, a spokeswoman for McKinsey, says her firm is actively recruiting doctors because the analytical skills necessary to be an M.D. are similar to the problem-solving skills a consultant needs.
Dr. Jon Bloom trained as an anesthesiologist and practiced for three months, then enrolled at Massachusetts Institute of Technology’s Sloan School of Management. He says he was inspired by other doctors he knew who were inventors and entrepreneurs. One reason more are choosing that path is that investors are willing to fund them. Figures compiled by the National Venture Capital Association show that investment in medical-related startups climbed from $9.4 billion in 2007 to $11.9 billion in 2016.
Bloom is co-founder and chief executive officer of Podimetrics, a startup in Somerville, Mass., that has developed a mat device that predicts and prevents diabetic foot ulcers. He says that even though his invention is now on the market after receiving approval from the U.S. Food and Drug Administration in 2015, he’s still living the startup life. “I definitely don’t make nearly as much as what a doctor makes. That wasn’t really important to me,” he says. “My friends who graduated residency many years ago, they have multiple cars, fabulous houses. They did OK. I still occasionally eat ramen noodles,” he chuckles.