Looking to add to your quality of life? Consider one of these physician practice opportunities

As an in-demand resident or fellow, you’re likely sorting through hundreds of job postings—all of them potentially lucrative positions that could take you virtually anywhere. Whether you do so on a full-time basis, as a part-time volunteer or moonlighter, taking the road less traveled can enrich your career. It can even help you stay in love with medicine.

A career in corrections

As a physician in the California Correctional Health Care System (CCHCs), Brandon Imp, M.D., MPH, might describe his job as an unexpected way to “have it all” as a physician. His work includes interesting, challenging cases; the opportunity to help a highly marginalized population; rewarding patient relationships; and excellent compensation. It even boasts undeniable work/ life balance.

“The prison system is a fantastic opportunity to continue the type of work we’re trained to do during medical school and residency,” Imp says. “We’re trained to give extremely high levels of clinically competent care, and we’re also trained to be socially aware of marginalized populations and to support people that might not otherwise have that support. It is ingrained in medical training these days.”

Imp says that most physician jobs, especially in primary care, serve patient populations that are largely not marginalized. “It’s the rare clinic that is actually focused on a marginalized population.” Where such jobs do exist, Imp adds, lower compensation and greater stress can make them unsustainable.

“The opposite is true for the prison system,” he says. “It’s [a job focused on] a marginalized population that has great work/life balance, great compensation, great medicine.”

Before pursuing a rotation with CCHCS during fellowship, Imp felt that his options to pursue his clinical interests might be limited by other factors.

“I always knew that I was going to work with HIV- infected people or people at risk for acquiring HIV. I definitely have a bleeding heart and felt responsible from my training to work with a marginalized population. However, I don’t want to work internationally, and I only speak English. My possibilities in the U.S. looked limited. Then this opportunity with the prison came up, and I thought, this is an incredible population that’s very marginalized in many different ways.”

“[In my rotation with the prison system], I got to work alongside the HIV team. I was so impressed by the program — how up-to-date they were on HIV medicine, and how fantastic the patients were. Just really, really impressed. [That experience] eventually led to a job that I applied for, and here I am.”

Imp says that primary care and psychiatry are the most in-demand specialties in his organization. His schedule includes two days a week delivering in-person primary care at San Quentin State Prison and three days a week treating patients with viral hepatitis and HIV in facilities throughout California via telemedicine. One of the CCHCS initiatives Imp finds highly rewarding focuses on hepatitis C.

“A few years ago, the state of California began an initiative to rid the prison population of this disease,” he says. Imp says that the effort has been bolstered by new drugs that cure the disease reliably, unlike earlier therapies that often failed and had harsh side effects that prompted many patients to abandon treatment.

Imp says that work/life balance is built into a prison physician’s fixed schedule. “We’re unionized. We’re really only allowed to work 40 hours a week.” Physicians who want to earn extra money have time to moonlight in other settings — though Imp also believes the compensation that the prison system offers is better than most primary care jobs. The benefits, which include two different retirement programs, are substantial, too.

Should he decide to return to a more conventional primary care role in the future, Imp adds, his experience handling complex patients would prepare him well. He says that many of his patients have had several problems to manage — in some cases, as many as 20.

Despite the advantages of working in the prison system, Imp adds that during his own residency and fellowship training it was rare to meet colleagues who were considering it — or even aware of the opportunities it presents for physicians. False assumptions about the job may be the main reason. For example, some people wrongly assume that because it’s a government job, the pay must trail other job options, though Imp has found the opposite is true. Others may worry about how safe it can be to treat incarcerated patients.

Imp says he understands that reaction and notes that working in a prison setting is probably not right for anyone triggered by trauma. He acknowledges that some higher-security environments might be more intimidating than where he works. But he emphasizes that he’s never felt unsafe. He credits that to the meticulous care the system takes in ensuring everyone’s security. “Everything is focused on safety,” he says.

“I love my job,” Imp says. “It’s a great opportunity to bring a little hope, do good medicine and make positive connections with people that really need connection— and a smile on their face once in a while.”

Following a passion to a dream job: Major league sports physician

Michael Baraga, M.D., is an orthopedic surgeon and sports medicine physician at the University of Miami Sports Medicine Institute, where he is head team physician for the Miami Marlins.

Growing up, Baraga played sports—and, like most kids, he couldn’t help fantasizing about going pro, however unrealistic a dream that might have been.

Then along came a sports injury that ultimately defined his path forward — a career that encompasses all his skills in science, team leadership, wellness and, of course, sports.

“It’s a very common story for a lot of orthopedic surgeons, especially in the sports realm: You have an injury, and that’s your first understanding that, hey, there’s somebody who treated me for that sports injury,” Baraga says. He describes the experience as a sort of awakening to an alternative entry point to a sports career. “I played high school sports and some in college and have been active my whole life. So I’ve always had this inkling. I realized I’m probably not going to play at the professional level, but medicine is a great way to get involved.”

Unlike so many other fields a physician might pursue, team physician roles in major league sports are relatively few, and there are more candidates hoping to take them on than required. So timing, skill set, and interpersonal connections are important factors that can help a physician (eventually) land such a role.

On the plus side, if you’re interested in athletics and pursue a sports medicine specialty, opportunities to practice the kind of medicine you love abound. Staying in the mix of sports — improving your expertise, doing work you enjoy, and experiencing a wide variety of settings — is exactly what could conjure the fortuitous connections that can lead to a pro-sports career.

David Chao, M.D., orthopedic surgeon, former team physician with the San Diego Chargers, and founder and lead physician analyst with Sports Injury Central, adds that even with plenty of luck and the best-laid plans, serving as team physician for a pro team may not be a realistic or sustainable goal for an entire career.

“You could be the best doctor in town, but there’s no [pro] team. Or you could be the best doctor in town and there’s a hospital-affiliated sponsorship contract to provide medical care for the team,” he says.

Even when there is a team in town and you’re lucky enough to secure a team physician position, the team could pick up and move. Sports team sales and relocations are common. The move of the Chargers from San Diego to Los Angeles is exactly what brought an end to Chao’s tenure with them.

But as long as you’re staying in the game, Chao says there are always possibilities to practice in a sports environment. By being flexible and ready to move in his earlier years as an orthopedic surgeon, Chao found work as a team physician for several NBA teams, the NHL, PGA, MLB— but all along the way, he covered high school games, too.

He says not being able to plan for a lengthy career with one team in one place — combined with his love of all sorts of sports and athletes— encouraged him to be adaptable. For example, he’s worked with the X Games and USA Rugby (“It’s a contact sport, and I knew I could help the guys”) and even WWE (“it’s scripted, but the injuries are real”).

Baraga adds that a common misconception is that team physicians do the job full-time. “But for the majority of us, we have our full practice and also take care of teams,” he says.

In Baraga’s case, he’s not just head team physician for the Marlins. He’s also the head orthopedic physician for both men’s and women’s University of Miami basketball and for women’s soccer—and sees private patients as well. With the possibility of post-season play for the pros and deep tournament runs for college teams, not to mention training camps, Baraga says scheduling “can be a bit of a balancing act. It helps to have a supportive family.”

Another aspect of being head physician for a pro sports organization that may not be immediately obvious: Baraga sees himself as leading a team whose job it is to keep all the players as healthy as possible.

“My most successful day is when I spend five hours at the ballpark and nobody needed me,” he says. “There’s a big portion that’s administrative. Sometimes I see my role as surgeon, sometimes as care coordinator—it’s my job to get [the player] to the best person to help address the problem.”

Chao points out that all the different roles he’s had have helped him continuously improve his craft. And staying at the peak of his practice and engaged in multiple ways prepares him to take on new opportunities — something he advises residents and fellows to think about.

Hundreds of Monday mornings studying game videos for over nearly two decades as a pro sports physician gave Chao a unique perspective and base of knowledge about how injuries are caused on the field. That, in turn, prepared him for an unexpected career opportunity. When his wife suggested he share his views in real time via Twitter (commenting, for example, on which injuries will sideline a player for the season and which are likely less serious than they appear), he quickly attracted a large following of avid sports fans. That opened the door to an entirely new career in media as the founder and lead physician analyst of Sports Injury Central.

Sports Injury Central is now a fast-growing business that has attracted high-profile investment. Chao’s analyses of pro sports injuries are viewed by fans all over the world, via a media platform that includes video, podcasts and social media.

No strings attached: the free-agent physician

Physician employment offers many well-known advantages, but isn’t always described as “flexible.” But by working as a locum tenens—a contracted, temporary form of employment—you can exchange some of the predictability of full-time employment for more control over your schedule, your calendar and your workload. You also gain the option to test out different employers, work settings and geographic locations.

Jamila Goldsmith, M.D., chair of the ACEP locum tenens section, physician coach and host of the Locums Lounge podcast, started doing locum tenens work straight out of residency. “I knew very early that I wanted to be an entrepreneur and have control over my time.”

Still, when the pandemic began, Goldsmith found full-time employment more appealing—at least at first. Then she had a child and quickly realized locums work would be a much better fit with the family life she envisioned.

“Transitioning to locums allows me to choose a schedule which accommodates my family and important events,” she says.

While full-time work offers the lure of permanence and predictability, it’s also true that there are no guarantees. Choosing to work independently may better prepare you to manage—and take advantage of—unexpected bumps in the road of full-time employment.

David Lee, M.D., a pain management physician and anesthesiologist in Chino, California, found this to be the case when the large anesthesiology group he’d joined right out of training disbanded, putting him unexpectedly out of a job. That’s when he took his first locums assignment, at the very same hospital he was already working at.

“I wasn’t ready to sign a long-term contract with the new group that had come to the hospital. So instead they offered me a locums contract, which I accepted. That’s really how I got introduced to the locums process as a whole.”

Lee says an opportunity to work with a group or hospital on a contract basis offers a chance to try a job on for size before making a more permanent commitment. The main attraction of locums for Lee, though, was the flexibility. Fellowship-trained in both anesthesiology and pain management, he hoped to build a pain management practice but knew that the flexibility to do that while employed as an anesthesiologist would be hard to come by.

“I knew that if I signed with an anesthesia group, it’s very typical for them to have at least a three-month out policy, meaning I’d have to give them three months’ notice before leaving the group.” He says that he understands why (“it takes groups a long time to find new providers and get them credentialed and confirm privileges for the hospital”). But for him to pursue his pain management practice, he’d need more control over his time.

For recent grads, locums work may offer another advantage: an opportunity to moonlight. Lee says that when he wanted to earn extra cash to pay down student debt, the same locums company he worked with on his main contract at the hospital lined up some weekend stints for him.

Goldsmith says that starting out as a locum tenens physician straight out of residency helped her learn to be more adaptable to different hospital environments and develop strategies she uses to prepare herself for every new assignment.

“I’ve realized that an emergency room is essentially the same regardless of the specific system in place,” she says. “Each facility wants things to run smoothly and for you to know everything important to thrive in their environment. But some have very detailed and time-intensive onboarding processes, while others expect locums to learn and get up to speed quickly.”

Goldsmith says that she deals with this uncertainty by proactively developing a list of questions that are important to her job before starting a new assignment. She adds that because she took on locums work right out of residency, she finds adapting to new environments less challenging.

Lee says, though, that at least in anesthesiology, working as a locums immediately out of residency might be overwhelming.

“I think that if you talk to most anesthesiologists, they would tell you that the first several years after residency, you’re still learning a lot. It’s very different to be in the controlled environment of residency, where you always have so much backup from your attendings and other co-residents, versus a locums environment where you’re completely on your own, and where the pace is much faster.”

He says that working as a locums has its own learning curve, including learning to spot certain pitfalls. While he says all of his assignments have been “great,” he’s heard from some colleagues that important details are sometimes left out of agency description of assignments — like, for example, a lack of senior colleagues to consult. Other hidden issues could include a less-than-desirable location or a culture of poor morale. He advises probing for specifics about any assignment you’re considering.

On the plus side, building a business around locum tenens work also provides the opportunity to learn how to maximize its benefits, Goldsmith says. For example, over time, locums physicians gain a clearer picture of their value in the market, enabling them to negotiate for higher pay.

More importantly, the lifestyle advantages of working as a locums can be priceless to your well-being, she adds.

“Flexibility in scheduling has allowed me to limit my exposures to stressors that contribute to burnout: fatigue, short turnarounds, limited vacation time, and the inability to participate in hobbies and interests. By setting boundaries and tailoring my schedule to my individual needs, I’m better able to manage my workload and avoid excessive stress.”

Adventures in giving back

Picture yourself planning a trip to an exotic location.

The trip will require a lengthy journey—part of which could be in a questionable-looking vehicle. You may need to pack much of your own medical equipment and know going in that the most valuable pieces might not make the trip home with you.

When you arrive, dozens of patients will be waiting for your help. You’ll diagnose and treat problems ranging from the mundane to the esoteric. If you’re lucky, you’ll have a few clinical tests to help you—but you may not be that lucky.

Oh, and you’ll be working 12, 14 hours or more every day.

This probably doesn’t sound like a restorative break from work— much less a relaxing one. But ask the doctors who journey far and wide every year to provide essential care to patients who would otherwise go without, and they’ll tell you they wouldn’t trade these trips for anything.

“We have a lot of students in the office, and I tell every single one of them to go on a mission trip. I don’t care if it’s with the church or Doctors Without Borders or whatever group. You have to do it because you learn so much about the care of other individuals that you absolutely will not learn in medical school or residency,” says Jack Forbush, D.O., a family medicine and neuromuscular medicine physician and owner of the Osteopathic Center for Family Medicine in Hampden, Maine. Forbush is also president of the Maine chapter of the American College of Osteopathic Family Physicians.

For the better part of the past decade (except for when prevented by COVID-19), Forbush has made an annual journey to a remote area of Paraguay, where he volunteers with the Andrea Ritz Clinics. There, he treats indigenous Guaraní patients who otherwise might not have access to any medical care. The problems he sees range from “typical chronic diseases — high blood pressure, diabetes, lung disease”—to tropical maladies most U.S. physicians will never encounter.

“You get to see a lot of cool stuff you only read about in books. I’m probably one of the few doctors in the state of Maine who has actually cared for patients with leprosy or leishmaniasis or malaria or dengue fever,” he says, adding that he says so “with humility—because it’s really quite amazing.”

Forbush, his fellow volunteers, and the small local team who keep the clinics running are almost always short on equipment and supplies. They must rely on their analytical skills, instincts and creativity to solve problems small and large.

“I’ve removed thyroid nodules off a young patient with a flashlight, a scalpel, a straight hemostat, a pickup, and about five ccs of lidocaine,” he says. “You kind of have to say, ‘How are we going to do this? Because it needs to get done.’ You really have to have that level of from-the-hip creativity.”

Once a year, Ami Shah Vira, M.D., an oculoplastic surgeon and owner of Texas Neuro Eye & Plastic Surgery, lets patients know her Austin, Texas, clinic will be closed for a couple of weeks and arranges emergency coverage. She sets a plan for childcare and scheduling for her two small children, coordinating with her husband and calling on her parents to help. She then travels to Riobamba, Ecuador, where she works long hours providing needed eye surgeries, in some cases for patients who’ve traveled from as far as Argentina.

Shah Vira volunteers with a group called PACH—Partners for Andean Community Health. pach helped establish Fibuspam, the community hospital in Riobamba, which has dramatically increased care access for the local population. There are still gaps in the availability of specialty care, though—including Shah Vira’s expertise.

When Shah Vira visits, she’s typically booked for surgeries from as early as 7 in the morning until 9, 10 or later at night. Yet despite the physical demands of the work, she always looks forward to her missions—and finds the experience restorative, not depleting.

“I think it just reignites your passion for medicine,” she says. “It’s kind of like what you thought you were getting into when you were a med student: a doctor and a patient, and you’re just helping them.”

The surgeries Shah Vira performs can be life-changing for patients— such as one she treated on her last trip, a young child who had recently dropped out of school.

“The family had pooled their resources and had her in school and were really proud. She was the first in her family to go. But she had a lazy eye, and the other students made fun of her. We were able to realign her eyes and get her back to school. I’m excited to go back next year and see her. I’m sure she’s just thriving now.”

Here in the U.S., Shah Vira says, such surgeries are relatively uncommon, because problems like strabismus or amblyopia are addressed in young children with simple interventions like eye patching. But there’s little awareness of why or when to do this in parts of the world that have less regular pediatric care. Unaddressed, something as common as a lazy eye can lead to loss of binocular vision, which can severely impact a child’s entire future.

Shah Vira says that during her most recent trip, “almost solely what I did was muscle surgery on children, realignments to give them that binocular vision back.”

Shah Vira encourages others to find the time for this type of volunteer work—for their own empowerment and well-being.

“It just drives you to do better here [in your home practice], to not get sucked into being jaded and burned out. I see a lot of people going down that road, and it’s understandable. But I think this [type of volunteer work] keeps you from doing that.”

Soaring through service

Natalie Nevins, D.O., professor of family medicine and associate dean of graduate medical education and program development and professor of family medicine and neuromusculoskeletal medicine at Touro University California, College of Osteopathic Medicine, and senior fellow, Center for Disaster Medicine, New York Medical College, couldn’t agree more with the idea that being of service is a powerful way to sustain your own career and mental health.

She notes that physicians come to the medical field “because they care about people, right? It’s the ultimate job of service. It’s a natural extension to do humanitarian work.”

Her own experience helping others has included a stint as a humanitarian-aid nonprofit CEO for more than a decade, but that was just one moment in her distinguished career in service. For the better part of several decades, Nevins has served via a channel she wishes physicians knew more about the military reserves.

“We don’t just care for the military. When hurricanes hit, it’s the reservists. It’s the National Guard. It’s those docs who step in and fill the gaps that exist.”

There are opportunities for physicians at any career stage with the Reserves, Nevins says. And the experience offers opportunities to gain invaluable experience in a wide range of niches. For example, Nevins has had a lifelong passion for aviation medicine, and for keeping military pilots healthy and ready to fly. Early on, she realized that her background as a D.O. gave her a special advantage when taking care of pilots.

“They have lots of musculoskeletal pain, but can’t take pain meds and still be on flight status. But I can treat them with osteopathic manipulation and get them back to work. I came back to the Army Reserves in 2014 specifically for that, then continued on and wound up being the Command Flight Surgeon for the Army Reserve Aviation Command, managing all the aviation medical requirements and MEDEVAC assets for the United States Army Reserve.”

Nevins has served in the military in one fashion or another for the better part of her medical career (both active duty in the Air Force and in the Reserves of both the Air Force and Army), starting during her internship. But she emphasizes that physicians who have an interest should check out the Reserves whether they’re still in training or already practicing.

Doing so offers many benefits, she says. Training is one. (If you’re interested in becoming a pilot, for example, this might even be possible through the Reserves.) Humanitarian and military missions alike provide opportunities to see the world, get out of your comfort zone and help others. And there are even financial benefits. For example, reservists can participate in retirement programs, and signing bonuses, annual bonuses and loan repayment programs may be available.

What’s more, by law, reservists can serve without giving up any vacation time. And your employer may make up any difference in salary between your Reserve duty pay and what you would have earned at work.

Nevins’ own work as a flight surgeon in the military reserves has opened numerous career opportunities for her, including civilian roles as an aeromedical examiner for the FAA and collaborator with NASA.

Of course, the best reason to consider the Reserves is to learn about military life — and to be part of an organization that protects us all, but few citizens actually experience it.

“Less than 2% of the U.S. population will ever serve in the military,” Nevins says. “If you feel that perhaps there’s something missing in your life, this is a great way to fill that gap and truly serve both your country and your community, and to gain what I think is a very needed perspective.”

The military is just one way to serve, Nevins adds. She encourages every physician to find one that fits. “There are many ways to give back, and it always gives you more than you gave.” •