How I Successfully Made a Career Transition in Medicine

Life transitions always take some adjustment…even when they’re exciting changes. Moving, expanding your family, getting a new job—you’ll go through many revisions throughout your lifetime. Sometimes they’re planned and expected, and sometimes they’re not, but each transition requires you to get out of your comfort zone. One of my big life changes was a decision to leave clinical practice as a rheumatologist to begin working in the urgent care. 

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Making a change from rheumatology to urgent care is not the usual path most physicians take to get to the urgent care. Going from ordering and analyzing scores of immunologic blood work and prescribing biologics to treating lacerations, bronchitis, sore throats, and fractures was a long and winding path—one that life’s many twists and turns led me to. I was very happy with the decision—it worked for me on many levels at that time in my life—but it required a fair amount of hard work to feel comfortable practicing and to feel happy with the level of care I was providing. 

Interpreting ECGs and suturing were long in my rearview mirror. Just the thought of suturing brought back the anxiety of my surgery rotation and being asked to close. Let’s just say I was not one of those medical students sitting around practicing tying knots in the common area. Once I committed to the path, I needed to do some serious retraining. Part of me felt like I was back studying for my internal medicine shelf exam, IM in-training exams, and IM board certification exams all over again.

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Any time you change focus in your career in medicine, whether it is a change from academic medicine to private practice or vice versa, or a change in job locations that may have different patient populations, you’ll probably need to brush up on some aspects of the medicine you’ll be practicing. That might include taking courses, reading textbooks, and reviewing topics online. If you’re interested in transitioning to urgent care work, here are some of the helpful resources I used. If you’re preparing for a career transition in medicine, try using these as guidelines but filling in the relevant subject matter:

1. Learn about your new field

Before I started, I took an online urgent care course with experts in each field lecturing on the most common diagnoses seen in the urgent care and how to treat them. The one I took isn’t offered anymore, but take a look at AAFP and their Emergency and Urgent Care CME.

2. Take a course about specific skills you’ll need

I took a CME course for suturing geared toward nurse practitioners.

3. Read the essentials

Before starting, I read these books and referenced them daily in the beginning:

• Wounds and Lacerations Emergency Care and Closure by Alexander T. Trott, MD
  This is written by an emergency medicine physician reviewing the basics of wound healing, nerve blocks, wound cleansing, and suturing, stapling, and tissue adhesive and their use in different parts of the body.
• Minor Emergencies by Philip Buttaravoli, MD, and Stephen M. Leffler, MD
  This is organized by problem and covers most everything seen in the urgent care. It is written by two emergency medicine physicians.

4. Brush up on your old notes

I reviewed the ECG interpretation notes that I had taken leading up to my internship year.

5. Review commonly seen topics

Once in practice, I reviewed the UpToDate topics that I repeatedly encountered and also the ones I felt most unfamiliar with.

6. Utilize your colleagues

I contacted friends and started relying on consults again. Repeatedly in the beginning I consulted a nurse practitioner friend at my new office who loved draining abscesses and suturing. My highschool friend who is a pediatrician gave me a crash course on otitis media and strep throat. I spoke with the ED attendings who took the calls regarding my transfers to the ED.

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In the end, I feel this transition made me a better doctor. I realized I had never really learned the basic pathology, diagnosis, and treatment of some of the most common diseases. My training had become focused on inpatient care while in internship and residency and then on rare autoimmune diseases during my fellowship and my work as a rheumatologist. It was like being an expert at differential equations without ever having fully grasped fractions.

Transitions can be hard, but the more I do them, the easier they become. Preparing and then letting go enough to learn along the way is a helpful skill to develop. Asking questions is another. In medical school, the culture teaches us that admitting we don’t know something is a sign of weakness. Some of my best memories from this transition were when I asked for help, and then in return, someone asked for my help. I once called the emergency department physician who I once worked with in the urgent care and asked him what to do if you can’t suture a large flap on a finger. He said, “You send them to the ED for a purse stitch. That’s what we’re here for. Send ’em over.” And then he asked my opinion on which Lyme test is best to order. 

Being strong enough to admit you don’t know something and asking for help so you can learn from someone else is an essential skill to develop and a crucial part of lifelong learning. With each transition you face, reach out to those around you—in turn, you’ll help others through their own life changes.

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How to Choose Your Medical Specialty
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