Other Articles

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Second Careers for Orthopedic Surgeons
How should you plan for a change in focus later during your career? You may want to continue utilizing your research, managerial, or presentation skills. Find out what Drs. Ray Linovitz and Stephen Hochschuler have to say about how to stay involved in the field at any stage of one’s career.

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Some orthopedic surgeons dream of a time when their days are filled with weighted drivers and strategies of how to take the backswing out of their swing. Others may be tired of the increasing demands of a daily orthopedic practice but want to remain involved in the field. The ideal situation is to have a choice.

Says Dr. Ray Linovitz, an orthopedic spine surgeon, “Many surgeons have accumulated a vast wealth of knowledge over the years and instead of retiring, want to keep active in the field. These are people in their 60s who want to withdraw from the stresses of daily practice, yet remain involved in the cutting-edge technology that comes along every day. Spine in particular lends itself to that because it is a rapidly growing field with exciting new areas like tissue engineering. An orthopedic surgeon who has planned well could make himself or herself available to industry and do research on multiple fronts.”

But you can’t just leap into these waters at the age of 55. States Dr. Linovitz, “Surgeons are so consumed with work that they often don’t think about planning for a change in focus later in life. I encourage doctors to get involved in clinical research beginning at the age of 40. Yes, research always involves industry, and they are sometimes criticized for making a profit. But frankly, no other entity will run the studies. Early in your career you should start to identify ethical companies and cultivate relationships with them so you can become more involved with them as time goes on. This is a gradual process that should also involve developing relationships with people in a variety of departments, including engineering.”

Medicine is more complicated than it was 20 years ago. The next 20 years is anyone’s guess. Whatever happens, it can’t hurt to plan for the future. “There may be a physician who has been in practice for 30 years and who is disenchanted with the politics and increasing demands placed on them,” states Dr. Linovitz. “This person is sharp and experienced, however, and needs an outlet for his or her technical and/or managerial skills. Several ways to do this would be to get involved in a company at a board level, work on a project for artificial disc replacement, or help to set up training sites for studies. Many surgeons become very effective trainers and enjoy sharing their expertise in that way. You must be mindful of any potential conflicts of interest, however, and be familiar with federal, state, professional and industry guidelines and policies regarding corporate payments. Additionally, any relationship that a physician has with industry needs to be transparent to all authorities and patients."

Speaking of his own experience, Dr. Linovitz explains, “Even though I gave up my clinical practice, I found a very satisfying use for my 25 years of training. I direct the research and educational activities for a practice and interface with institutional review boards. Hospital review boards feel very comfortable having surgeons with 25 or 30 years of experience involved in these activities.”

Experienced surgeons can serve as partners and guides to those in industry. Notes Dr. Linovitz, “Let’s say a surgeon is a trainer who has been involved in a number of disc replacement trials. Someone from industry could approach this person and say, ‘We want to train surgeons on a new technology at these sites. The FDA is mandating this training so we need to get going.’ You could step in and develop a reasonable training program and also become a trainer. You can do this if you have built up your contacts through the years. If a 65-year-old surgeon tries to do this out of the blue without previous contact with industry, it’s difficult. It’s better if you pick up the phone at the age of 40, call a friend, and have that friend refer you to persons in industry. And again, industry can be a real friend to physicians. For one thing, industry people truly want and need doctors who understand the pathway through the FDA.”

Now about that exit strategy. “Most doctors never slow down enough to plan for retirement,” says Dr. Linovitz. “For many, planning consists of, ‘Well, I have my 401k so I’m alright.’ But people are retiring younger and younger and are truly interested in keeping active and having a career-oriented retirement. I have tried to serve as a mentor to my younger partners and recommend that they get involved in research studies. Let’s say you are in a busy total joint practice. You should call several companies and research organizations, let them know of your volume, and ask if you can involve your patients in a study. The key is to have a research coordinator in your office. For a minimal investment, you can develop a unit within your practice that can run a research protocol. I find that most younger surgeons are receptive to these ideas, as they see my current activities and want to follow in my footsteps later on. I think it is the responsibility of the senior surgeons in a group to look after those who are younger. As for the group, you shouldn’t create a practice and get rid of it. Too many people depend on it.”

Continues Dr. Linovitz, “There are numerous ways to approach this transition. If there are other practices in your area you could combine your efforts through a university or hospital. Meet with hospital representatives and say, ‘We want a research arm and you can cover neurology and surgery.’ A surgeon can approach his or her hospital administration and staff, suggesting that a research arm benefits not only orthopedics but also related subspecialties such as neurology, neurosurgery, rehabilitation, etc. Hospitals are having somewhat of an awakening and are realizing that they pressure industry and that they have to give something back. You can bargain with them, saying, ‘OK, we’ll provide the data collection software. In exchange we want to bring such-and-such product into the hospital.’”

Negotiation is one skill that will help prepare a surgeon for this new career stage. And then there is the podium. “Public speaking could be a significant part of one’s later career days. If you are 40 or 45 years old, start practicing now. Volunteer to give presentations so that you have a level of comfort that will only grow with time. I would also recommend that younger surgeons delve into the science and engineering of new technology so that they can confer with others and have in-depth, educated discussions. And be prepared to travel. If you are working with a company, the company will likely want you to go to the FDA or perhaps to Europe to oversee trials.”

This new career path can bring a surgeon deeper into the worlds of research and finance. Explains Dr. Linovitz, “There are non-FDA approved products that require product design and design of preclinical research [biomechanical, animal, human]. Ultimately this could mean working with the FDA, something that may be a full-time effort. Then there are post-market studies to consider, in which a product is approved but is being considered for other indications. In these cases you have the opportunity to train surgeons who are new to the technology. On the finance side, many startup companies are funded by venture capitalists (VCs). You may attend a meeting where the CEO says they need money to continue the development of a certain product. The next day you could receive a call from the VC who attended that meeting, and asks you to do due diligence on another company’s technology. That’s a great door that has opened…and it only happens because of someone’s involvement with industry.”

Those who desire and plan for a post-career career path shouldn’t find too many obstacles. Dr. Linovitz: “I was surprised to find such an extreme need for surgeon involvement in industry. Companies need the direction of medical professionals—otherwise they have a product but no medical or market need. Industry/physician collaboration has taken a big hit lately because of some illegal activities on the part of some individuals. Technology blossoms and patients are served, however, when industry and doctors work together in an above-board manner.”

Dr. Stephen Hochschuler, cofounder of the Texas Back Institute, has observed numerous surgeons approaching the traditional retirement age and has some definite opinions on the subject. “While some physicians can’t wait to retire, I think that most surgeons have their egos and identity attached to the profession,” states Dr. Hochschuler. “You don’t easily go from being king of the hill to retirement. Many who try get depressed and then begin seeking out interesting activities. They stick out retirement for about 18 months and then assume board positions or take on some other professional role. My advice is to just slow down somewhat and shift your focus. I personally never tired of medicine. I just rearranged my time so as to give myself some more variety. And when working with companies, I am able to bring a skill set that they would not otherwise have.”

And Dr. Hochschuler has no use for the term “active retirement.” Dr. Hochschuler: “With all of the experience that a surgeon has garnered, ‘active retirement’ sounds pretty negative. This is not retirement, but a second career. Seasoned physicians are simply reevaluating what they want to do next. Maybe you want to go the industry route or perhaps you’ll become a world champion sailor. The good news is that it’s largely up to you.”

Continues Dr. Hochschuler, “The key is that technology affords us the opportunity to stay involved forever and from wherever. Thanks to the Internet, PDAs with e-mail, and cell phones, we can work with companies anywhere in the world from any location.”

“Start strategizing for your career as a 60-year-old at the age of 40,” recommends Dr. Hochschuler. “Your goal should be to have a network that is broader than your practice. Take baby steps and before you know it you will have a stimulating and informed network of people in all corners of the field. With that, you can take your career anywhere you want it to go.”