Alternative Careers in Medicine
A NextGen Pathways in Medicine Article
Based on an interview with John R. Wesley, M.D., American Society for Parenteral and Enteral Nutrition (ASPEN) Rhoads Research Foundation
The journey from student to physician has been navigated for generations. In the past, Eugene Smith's black-and-white image of the practiced family physician in Life magazine would have exemplified the idea of "physician for life" in the United States. However, with the changing demands of managed care and specialization, many physicians are reshaping this idea and asking themselves the professionally novel question: "What's next?" As the head of pediatric surgery at University of California, Davis and a physician involved in private practice in Sacramento, Dr. John R. Wesley was asking himself this very question. Having arrived at the stage in his career where he had accomplished the goals that he had set out for himself upon graduating from medical school, he felt restless and longed for an environment different from what he describes as "a deteriorating system of 'mismanaged' care." With insurance companies cutting back on reimbursements for patient bills and his co-workers not willing to fight these cuts, he began to consider an alternative career.
Dr. John Wesley
Because of Dr. Wesley's acquired knowledge in the latest clinical practices and biomedical technologies, Baxter Healthcare, a global pharmaceutical and medical devices company, found him to be ideal for the position of Vice President and Medical Director. Plus, Baxter provided him with more appealing hours, a job location that worked for his family, and a new approach to striving for improvement in patient care. Dr. Wesley emphasized that his candidacy stemmed from his career networks among patients and physicians, many of whom were the target clients for Baxter. While his last ten years at Baxter didn't involve patient care, Dr. Wesley acknowledges that "the value [he] provided was because, and only because, of [his] career in a medical specialty that gave [him] a network and a sense of what's appropriate in terms of evaluating a medical device, service or drug." Thus, in general, alternative careers for practicing physicians are not meant to be pursued immediately after medical school or even just after residency. Without extensive clinical experience, a physician would have difficulty establishing credibility among potential employers. As Dr. Wesley comments, "I think it would be very unusual in the United States to go through all the trouble and stress of obtaining an M.D. and not practice. Even Michael Crichton practiced for a year or two before taking up his successful writing career, and he is a better writer for having done so."
The idea of "physician for life" is evolving into one of continuing medical education rather than isolated practice. Furthermore, the previous standard of a medical school education being enough knowledge for the remainder of one's career is no longer valid. Accordingly, medical schools, Dr. Wesley argues, have a responsibility to clearly articulate the gaps – to teach the students what they do and do not know. To maintain an ongoing base of current medical knowledge, many physicians that choose alternative careers still practice medicine to some degree. "You learn how to learn," remarks Dr. Wesley, "The whole challenge is open communication and being very honest with the situations that you encounter... It is unfortunately too easy for physicians to kid themselves into believing their academic learning is complete."
With the fast pace of medical technology and information, Dr. Wesley estimates, "Once out of one's subspecialty, you're out-of-date in six months. Within a year, you're out of sync with the primary issues, because you are no longer involved. To prevent this, you should stay in contact with your parent discipline when you opt into an allied field." For Dr. Wesley, this meant volunteering at Chicago Children's Memorial Hospital on Tuesdays to round with pediatric surgeons, attend their weekly pathology conference and surgical seminars, and participate in staff meetings as a formal Adjunct Professor of Surgery at the Northwestern Feinberg School of Medicine. Dr. Wesley's Tuesday morning exercises are just one example of how he "stays in the trenches" so that he can provide up-to-date professional advice.
Away from the bedside, Dr. Wesley served at Baxter as "a bridge between academics and industry, an achievement only attained through a successful career in academia." Previous to his new career at Baxter, he was already involved in connecting these two worlds through the American Society for Parenteral and Enteral Nutrition (ASPEN). ("Enteral" means delivered by the digestive system; "parenteral" is its antonym, so delivered interavenously or intramuscularly.) For example, the recipients of ASPEN's Rhoads Research Foundation, an endeavor that was initiated by Dr. Wesley and his colleagues, are "instrumental in providing the ideas and innovation that will fill the pipeline for the healthcare industry." This perspective encourages contributions by the industry to fund the foundation's growing endowment for research grants as well as building a conduit between academia and industry. Furthermore, Dr. Wesley describes the effort as one of many that "helps breakdown prejudged attitudes that label people with academic success turning to industry as having 'sold out.'"
Indeed, it was Dr. Wesley's involvement with the healthcare industry, specifically with Baxter and ASPEN, that gave him the opportunity to further his conviction that nutrition should be more heavily prioritized in medicine: "There was such a need to understand how to best apply the science and art of nutrition support to the everyday problems that pediatric surgeons face." Especially taking into account the stress of a surgical operation, the pediatric patient must be evaluated for his extra caloric needs. Up to about ten days following the operation, the patient's wound is a privileged site with local hormonal conditions favoring wound healing – regardless of nutritional status. However, if the patient is not provided with an adequate exogenous source of energy after this time, the obligatory catabolism of lean body mass will expand to include the wound, and the risk of wound breakdown is markedly increased. Previous to this nutritional knowledge, many surgeons interpreted ensuing wound complications as technical error, when in fact, it was the consequence of inadequate nutrition. Dr. Wesley passionately asserted that this "kind of message, simple as it is" remained unappreciated, partly due to the deficiency of nutrition education in medical schools in the past, and arguably even today. Baxter's parenteral nutrition products and services is one avenue where Dr. Wesley continues to advocate and increase awareness of the importance of nutrition, especially in the healing process.
In addition to his continued leadership at the Rhoads Research Foundation of ASPEN, Dr. Wesley has pursued yet another avenue: education and mentorship. I first met Dr. Wesley for a different interview, in which he asked me why I wanted to go to Harvard. Since then, our ongoing discussions of medical standards and innovation have challenged me to look beyond the broad, well-traveled roads of medicine. In the middle of my first year of medical school, Dr. Wesley introduced me to the notion of "consilience" via E. O. Wilson, a humanist biologist who theorized the unity of the sciences, humanities, and the arts through a fundamental human endeavor. Literally defined as the "jumping together" of knowledge, consilience challenges careful consideration of the phrase, "the art of medicine." As medicine becomes increasingly specialized, more and more medical professionals strive toward integration. Descriptions such as "interdisciplinary" and "team-based approach," for example, are now a common turn of phrase in many hospitals. An understanding of consilience has advanced the flexibility and creativity of medicine beyond traditional boundaries, resulting in professions such as a medical director for a pharmaceutical company, an M.D. and J.D. patent lawyer, or a medical journalist. When he interviewed for his new career, Dr. Wesley found Baxter to be "very cooperative and supportive of my academic goals... Once I made the decision, the transition was much easier than I anticipated. I didn't miss practice as much as I thought I would, because I was so challenged by my new environment."
Whether in or out of the practicing medical community, Dr. Wesley encourages self-awareness and an open mind: "Ask yourself, 'Is this what I want?'" The answer should be surprisingly liberating. 
Karen Lo is a writer for the Next Generation and a member of the University of Michigan Medical School, Class of 2009.
John R. Wesley, M.D. is a medical business consultant, Adjunct Professor of Surgery at Northwestern University Medical School, and the Chair of the Board of Directors for the Rhoads Research Foundation, American Society of Parenteral and Enteral Nutrition.