To hold a medical license in the United States, you must complete undergraduate school, medical school, and at least one year of residency training in most states. It is, however, difficult to cultivate a successful medical career without completing residency training. Most physicians complete several years of residency before achieving Board certification. Physicians seeking further sub-specialization may then complete fellowship training.
Even with a valid medical license, physicians do not have viable paths to Board certification and specialization without full residency completion. However, not all medical school graduates who begin residency training complete their programs. In fact, a JAMA Surgery study found the residency attrition rate to be approximately 6%. The discontinuance of graduate medical education (GME) is a costly phenomenon that can be disruptive for medical professionals and the facilities in which they work.
Since residency attrition is somewhat common, it helps understand what opportunities are available to physicians who cease residency training. Even without Board certification, licensed physicians who have not completed residency may still pursue opportunities such as academic work, non-specialty practice, research, and consulting. For those who still seek autonomy, clinical satisfaction, and hands-on patient interactions, wound care is a viable option as well.
Wound care is a specialty that provides physicians with a flexible schedule, a competitive salary, and meaningful clinical opportunities. Although wound care does not have a Board-certification, it will likely become a recognized specialty with certification in the next few years. Physicians with extensive training and experience in wound care will likely have a path to board certification and be grandfathered into the specialty. Wound care is a rapidly advancing field with a high level of patient need. It is an ideal career option for physicians who are technically skilled, procedurally-oriented, and patient-focused.
If this sounds like you or someone you know, continue reading to learn more about practicing without residency and the value of pursuing wound care.
Why do physicians leave residency?
A variety of factors may influence a resident’s decision to leave their GME program. Examples include burnout, dissatisfaction with specialty choice, personal conflicts, and/or a desire to pursue a different career path. When considering leaving residency, it’s helpful to identify which of these factors are contributing to your decision so that you can determine your next career steps.
Burnout is an incredibly prevalent phenomenon that affects approximately two-thirds of physicians and significantly contributes to residency attrition. Burnout is caused by long-term occupational stress due to high workloads, improper work-life balance, and ongoing administrative burden. It is characterized by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment, all of which can hinder personal and professional success and satisfaction.
Burnout is widespread in physicians, as they experience significant academic and professional pressure. To become a practicing physician, students must push themselves academically for years of undergraduate and medical school, after which they complete rigorous residency training and medical practice. Once they begin practicing medicine, physicians often have unpredictable and irregular schedules that can hinder work-life balance. In addition to personal frustration, physician burnout has been linked to diminished professional performance and increased medical errors.
“When I was in residency, they had just switched over to no more 24-hour call for interns, so the trauma surgery attendings had to stay in-house overnight. Whereas, for years, they didn’t have to do that because there were residents in-house. I realized at that moment that I was 20-something years old, and these 50 and 60-year-olds were sleeping in a call room…and that would be me in 30 or 40 years! I didn’t like sleeping in the call room when I was 24. I was not going to enjoy it when I was 64. So, I wanted to find something that allowed me to sleep in my own bed every night. And wound care lets me do that.”Dr. Hiral Gallimore, MD, a former General Surgery resident who transitioned to wound care.
Specialty Choice Regrets
Residents’ decisions to leave their GME program can be significantly impacted by specialty choice regret. A 2018 JAMA study found that over 7% of second-year residents regret their specialty choice. Specialties with the highest reported levels of regret included pathology (32.7%), anesthesiology (20.6%), general surgery (19.1%), neurology (17.4%), and psychiatry (16.9%). The majority of respondents who reported specialty or career dissatisfaction also reported burnout symptoms.
The length of residency may be a factor in specialty regret, as it can range from approximately two to seven years, depending on specialty. For example, specializing in neurosurgery requires seven years of training, whereas psychiatry requires four. Most residents experiencing specialty regret decide to transfer specialties, but others decide to leave residency – or medicine – completely.
During residency, some physicians experience disruptions or changes to their personal lives that cause professional conflict and lead to residency attrition. These changes can include getting married, having children, or caring for an elderly relative or injured loved one. Since the commitment needed for a successful residency can prohibit adequate personal freedom, it can lead physicians to discontinue their training.
“It’s really nice for me to have a predictable schedule. Work-life balance was also a huge thing for me. When I started in wound care, unfortunately, my dad had a lot of medical issues, and that’s where I really found out that surgical residency does not give you the time that you need to spend with your family. It was important to me that I had to spend time with my dad and my family while he was dealing with some chronic medical conditions.”-Dr. Justin Mahida, MD, a former General Surgery resident who transitioned to wound care.
What options are available without residency?
Even without completing residency training, the skills gained in medical school and the first year or two of residency can be utilized in various other career paths. Depending on when a physician leaves residency and how much they want to employ their medical training, many options are available. Some of the most popular are as follows:
Administrators with medical experience are uniquely equipped to make informed decisions in a hospital setting. Physician administrators typically earn the respect of hospital staff and lead successful facilities.
Pursuing research roles at undergraduate or graduate institutions is an appealing option for physicians who wish to engage their medical training and maintain the ability to conduct research. Teaching allows physicians to share their knowledge and influence with the next generation of medical professionals while enjoying benefits such as a consistent schedule, a steady salary, and ample family benefits.
Writers with expert medical knowledge are highly valued and enjoy benefits such as remote work opportunities and schedule flexibility. Physician writers are needed to assist in creating and editing medical textbooks, pharmaceutical and medical device materials, healthcare publications, peer-reviewed journals, and more. Medical journalism is also a valuable option for physicians willing to invest time researching stories and building partnerships with publications and clients.
Physician consultants are in high demand in healthcare environments. Consultants are needed by organizations such as hospitals, pharmaceutical companies, insurance providers, medical device developers, government agencies, and technology companies. Healthcare consultants earn a competitive salary and enjoy using their medical backgrounds to address myriad organizational concerns.
Specialization without Residency
For those that wish to further specialize without earning Board certification, there are several options. Examples include aesthetic medicine, genetic testing, occupational medicine, and wound care. Let’s dig into the option of wound care.
Pursuing wound care
Wound care is an evolving specialty. Although it is not yet Board-recognized, wound care necessitates significant clinical experience and procedural skills. Effective wound care physicians often have wound care certification and training and are familiar with common skin procedures such as debridement, biopsies, and cauterization.
Wound care physicians typically work in wound care clinics, develop partnerships with skilled nursing facilities, or operate independent practices. Most wound care patients are part of the underserved geriatric population and significantly benefit from specialized care. Treating these patients is rewarding and enables physicians to utilize their clinical and procedural expertise.
Practicing wound care
The practice of wound care involves managing the treatment of chronic and acute wounds. This includes those caused by trauma, pressure, burns, autoimmune disorders, diabetes, and nutritional deficiency. Wound care physicians use their clinical skills to evaluate and manage their patients’ wounds and develop treatment plans. Effective wound care practitioners are procedurally adept and can contextualize a patient’s wounds and assess relevant comorbidities to provide optimal care.
Depending on the wound care practice, physicians typically operate outside of a hospital setting, have high levels of schedule flexibility, and provide continuity of care. Wound care physicians enjoy following their patients throughout the healing process. Physicians with wound care expertise can also serve as a resource for other doctors and nursing staff and further their community’s knowledge of wound care best practices and specialty advancements.
Wound care physicians benefit from schedule flexibility and personal freedom. These physicians typically work set, regular hours, do not work on nights or weekends, and are never on call. They have excellent work-life balance, spend ample free time with loved ones, and report high professional satisfaction levels.
“I chose general surgery because I like being hands-on and being able to use my surgical skills to help people. But, my experience with general surgery residency was that it was such high demand, very long work hours, long work weeks, and many opportunities missed of being able to enjoy your life. After coming out of residency, I had to decide whether I wanted to have a good work-life balance and not have work consume my life. That was one of the main reasons I pursued wound care. I currently work four days a week and have three-day weekends, no night call, no weekends, and no holidays. I’m able to take off whenever I want to. It’s a pretty good balance.”-Dr. JP Wuilleumier, MD, a former General Surgery resident who transitioned to wound care.
Interested in wound care?
If you are considering leaving residency or have already left residency and are debating your next steps, wound care is a viable option. Physicians with procedural proficiency, strong communication skills, and a passion for patient care make excellent wound care physicians.
Success without residency
Even without completing residency, it is more than possible to have a meaningful career in the medical field. If you wish to take a step back from clinical work, academia and consulting roles may be the right choice. If you are ready for a more administrative role, hospital leadership positions are an option. If you are looking to apply your clinical skills and practice hands-on, meaningful medical work, consider practicing as a wound care physician.