Should I Complete Residency If I Don’t Want to Practice Clinical Medicine?
- 4 days ago
- 9 min read
As burnout amplifies and the landscape for practicing physicians becomes increasingly difficult, we’re unfortunately seeing more and more medical students and residents make the decision that they don’t want to practice clinical medicine before even starting their jobs as attending physicians. When they post about making this choice in our online communities for doctors, reactions from the community members are always mixed, with many physicians jumping in and telling them to reconsider at least finishing residency before making that decision. While this is a very personal decision without a clearcut answer, we’ll cover the pros and cons of staying in (or starting) residency if you know you never want to practice clinical medicine, what to consider before closing off any doors, and how to weigh the opportunity costs of finishing a residency, in hopes of giving trainees a framework by which to evaluate their options.
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Why are so many trainee medical students and residents considering not completing a residency program?
Everyone’s situation is different, but common scenarios we see on our communities include:
Deciding that they don’t enjoy clinical medicine
Watching physicians around them burnout and deciding its not worth it
Finding it hard to balance residency with their personal lives (significant other can’t live in the same city, had children, need to move for some reason, health issues, etc)
Interested in another health related field such as tech or politics where the medical background is helpful, but where a residency may not be necessary
Want to pivot to an entirely different career path
No matter what the situation is, these are usually not decisions that are taken lightly. Most trainees have invested a lot of time and money into getting their medical degrees, and also may have a large student loan burden that needs to be addressed.
Feedback from the communities about why completing a residency is advised
Perhaps not surprisingly, most physicians in our online communities have completed residency programs and generally advocate for those in training to finish the pathway that they started. They typically cite a few reasons consistently.
Attending life can be very different from residency if you want it to be
It’s important to decipher what a trainee says they don’t like about clinical medicine before assuming that they know being a doctor is not a good fit. The fact is that the life in medicine you see as a trainee - whether it be as a medical student or a resident - can be quite different than attending life. This is because:
You no longer have to live according to somebody else’s schedule or priorities. You can work part time, locums, per diem, or full time - and even within full time, there are many different job environments with different hours. You may enjoy medicine a lot more when you have this control.
You can be in charge of your own practice - you can choose what procedures you like and don’t like, what patient demographics you enjoy, etc, and shape your practice accordingly. Make sure that it’s not just a particular part of the job that can be eliminated that’s causing you to write off a career as a clinician forever.
Life is different when your salary goes up, and some of the stressors can be alleviated by having the finances to outsource and hire help, and otherwise live a little more comfortably.
It’s different working under someone and having to deal with the hierarchy of the medical training system and being at the top of the totem pole. If what’s stressing you out is work dynamics, consider that those could change.
You close off a lot of options if you don’t have a residency program
While this part may be obvious in some ways, it’s not always obvious the extent to the doors you shut off by not completing residency. Obviously, without residency, you can’t work as a physician in a clinical setting, and you can’t apply to fellowships. But what you should also realize is that you won’t be a board certified or licensed physician, and many non-clinical jobs or side gigs require that you’re a licensed physician or have board certification even though your role isn’t clinical.
Learn more about nonclinical career options for physicians.
The market for nonclinical jobs has changed a lot
It used to be that if you didn’t want to practice clinically, there were a lot of nonclinical jobs at your disposal that practicing physicians didn’t want. With widespread burnout, changing physician demographics, and frustrations with clinical life, it can now seem like every other physician is seeking a non-clinical career. Thus, the market for nonclinical jobs has become a lot more competitive, and many companies who do hire physicians for nonclinical roles (such as pharma) very much value clinical expertise and experience. These jobs that used to go to physicians without residency experience are now often going to physicians who have completed residency and have worked for a few years.
You may not have fully thought through what you might want 10 or 20 years from now, or you may not realize how unpredictable other career paths are compared to medicine
The fact is that life in your 20s and 30s is very different from other chapters of your life, and you want to make sure you understand what you’re giving up with a stable physician career (or at least the option of having a stable physician career).
Most physicians have a very defined career pathway, and they’re used to that. Take a test, do an application, complete a rotation, rinse and repeat until you have a high paying physician job. We don’t often hear about physicians that complete residencies and then have a hard time finding a job. The fact is that other jobs have layoffs, market cycles, and hierarchies as well. Starting salaries can be lower than your residency salary. The grass is not always greener, and finding your way through a very different professional world may make you wish you’d stuck with the original pathway. Make sure you understand the other options fully before you decide they’re better than medicine.
Scenarios where physicians are generally supportive of physician trainees not finishing their medical residencies
There are some scenarios where our members generally agree that it doesn’t make sense to finish a residency. These include:
You have an amazing opportunity now to do something big and could make a smooth transition
Many medical students and residents have other interests or talents, and sometimes those take off. We’ve heard of trainees that have decided not to finish medical school or residency because a business idea took off, they went all in on a sport, or they had another opportunity that they couldn’t pass up.
Health issues make it unlikely that they could have a long and fulfilling career in medicine
Life in medicine is challenging, mentally, physically, and emotionally. If the job truly isn’t in your best interest and is causing distress that is acutely harmful, many doctors will be in favor of you taking a break or leaving. You will often hear physicians say to still see if there’s a way to finish residency, even if it takes a while, to keep as many doors open as possible.
Your medical degree has served its purpose, but you can already make the transition to the other thing smoothly without incurring the opportunity cost of residency
There are certain careers in healthcare where having a medical background may be helpful but where clinical experience is not necessary. While it is likely always nice to have that additional experience, the opportunity cost of taking another 3-7 years to finish residency may not make sense if you can already make the leap. This could be true in fields like:
Health innovation
Venture capital
Politics
Administrative positions
If those opportunities are already coming to you and you already have a foot in the door, you could reasonably argue that the opportunity cost is not worth it to stay in a residency program.
Weighing the opportunity cost of finishing a residency program vs the lost options by not completing your training and being a licensed, board certified physician
Ultimately, you’re going to have to weigh the opportunity costs of both scenarios, and make a decision that you can live with.
Weigh the opportunity costs of doing residency
3-7 years of your life is a long time, particularly in the era of life that residency occurs in - when you’re developing out career and family. If you know you don’t want to practice medicine, those years could be used to instead:
Gain experience in the field you do want to work in - jobs, publications, product development, startup positions, internships, etc
Get other other relevant degrees
Develop new and necessary skills such as leadership, technical skills, coding, etc
Build out a network in the field you want to work in
Earn money to fund your ability to pursue something different
Figure out your life with a fresh mind instead of trying to think about the big picture after a 24 hour call shift
Spend time with loved ones
Ask yourself if you are okay closing off the doors to clinical medicine entirely
People sometimes assume that they can always come back to clinical medicine later. Realize that this may be harder than you think. It’s not easy to get into residency after taking a break, or to finish up medical school. Aside from just carving out a pathway where you can do so (re-applying and getting in), mentally and personally, you may be in a different place once you’ve left this world. You may find that you can no longer subject yourself to some of the things that we all do during training out of habit once you’ve taken yourself out of that environment. You’ll also have to convince a lot of people to take a chance on you and that you are cut out for the profession (whether or not you should have to do this is another question - these are just the realities people face).
Look at the options you’ll have within healthcare adjacent fields that you are interested in and see if you would have a harder time entering them without residency, a medical license, or board certification
Many physicians are surprised to learn that pharmaceutical jobs (at least physician level pharma jobs), chart review jobs, expert witness work, physician advisor, CDI, and many health tech jobs such as Chief Medical Officer positions will be harder to get, if not closed off to you, without saying that you’re a board certified physician. While there are exceptions to every rule, recognize that the board certified title brings a lot of value in many medical adjacent spaces.
Consider whether having board certification will make you more likely to be successful in your intended career path
We have within our network tangible examples of physicians who have made the choice to pursue residency even though they didn’t ‘need’ to as they had already opened up nonclincal options or launched successful careers outside of traditional clinical medicine. These decisions are never taken lightly given their opportunity costs, so it’s worth asking others in your desired pivot pathway whether their having dedicated clinical experience through their residency programs helped them or not. For example, if you want to be an investor in healthcare companies through venture capital, VC firms may be a lot more likely to hire you for your expertise if they can lean on your clinical insights into what moves the needle and what doesn’t. Similarly, if you want to be a media personality in healthcare, it could lend credibility to your brand to have experience and stories to incorporate, rather than just textbook knowledge of medicine.
Conclusion
Obviously, nobody takes these decisions to not pursue a residency lightly after investing so much into becoming a physician. The main thing that trainees thinking about not pursuing residency, licensing, or board certification should take into consideration is what doors they would be closing off, and whether they’re okay doing that after coming so close to the finish line. When in doubt, it probably makes sense to complete the residency if you’re able, as it’s hard to project at ages 25-35 what options you may wish you have over the next 30 years. However, if you are confident that you can have the career (or life) you want without the extra 3-7 years of training, then it might make sense to not spend the extra years doing residency when they could be used to build out other skill sets or aspects of your life.
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